Vocabulary List

• Foodborne: caused by food contaminated with pathogenic microorganisms or toxic substances
  
  
• Staph aureus: Gram-positive spherically shaped bacterium and frequently found in the upper respiratory tract and on the skin
  
  
• Deficiencies: a failing or shortcoming
  
  
• Regulations: a rule or directive made and maintained by an authority
  
  
• Hygiene: conditions or practices maintaining health and preventing disease, especially through cleanliness
  
  
• Campylobacter: a bacterium that sometimes causes food poisoning in humans
  
  
• Spoilage: the action of deteriorating food and perishable goods
  
  
• Aseptic: free from contamination caused by harmful bacteria, viruses, or other microorganisms
  
  
• Abnormal: moving away from what is normal or usual, typically in a way that is undesirable or worrying
  
  
• Nonabsorbent: not capable of soaking up liquids
  
  
• Residential: designed for people to live in
  
  
• CPR: short for cardiopulmonary resuscitation, an emergency life-saving procedure that is done when someone's breathing or heartbeat has stopped
  
  
• Infectious disease:  illnesses caused by germs (such as bacteria, viruses, and fungi) that enter the body, multiply, and can cause an illness. Some infectious diseases are contagious (or communicable), meaning they are capable of spreading from one person to another
  
  
• Accidents: an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury
  
  
• Childcare providers: someone who provides supervision and care for children's basic needs in childcare facilities. They perform a range of duties including preparing meals, creating lesson plans, and helping children with homework
  
  
• Supervision: the action of overseeing, controlling someone or something
  
  
• Poisonous: causing or capable of causing death or illness if taken into the body
  
  
• Blinds: a screen for a window, especially one on a roller or made of slats
  

Food Safety

Benjamin and Febe Garcia were planning on getting married Friday afternoon on the 29th of October. They had a lot of family and friends that were going to attend the event, so they contracted with a local restaurant to cater the family dinner. The dinner began shortly after the wedding was finished at around 3:00 p.m. At about 7:00 p.m., several of the guests started to complain about vomiting, abdominal pain, or diarrhea. By 9:00 p.m., 42 of the 117 guests had become sick.

Health department officials investigated the outbreak and determined that the illness was associated with eating a special chicken dish that was made especially for the dinner and that the most likely cause was a bacteria named Staph Aureus, which was later confirmed. The investigation revealed that to save time, the chicken dish was prepared the evening of the 28th. The raw chicken thighs were defrosted in the microwave. The defrosted chicken thighs were cooked in a five-gallon (20-liter) stock pot of boiling water. After cooling, the chicken was removed from the thigh bones by hand and placed back into the stock pot. To complete the dish, rice was added to the stock pot and cooked until all remaining water was absorbed. The pot was then placed in a walk-in refrigerator for the night. On the morning of October 29th, the inner temperature of the dish was still around 65 degrees Fahrenheit. It was transferred to a slow cooker for reheating for approximately one hour on a high setting before transportation and consumption. Because the chicken dish was not properly cooled, Staph Aureus was able to build up in the dish all night. The reheating in the morning was not sufficient to destroy the Staphylococcal toxins that were created.

As we see from this case study, holding foods at improper temperatures can cause people to get sick. Food safety inspections are an excellent way to prevent these kinds of outbreaks.

Access to safe and nutritious food is key to sustaining life and promoting good health. Safe food is not contaminated with potentially harmful bacteria, parasites, viruses, toxins, chemicals and/or radionuclides. However, food can become contaminated at any point of production and distribution. A large proportion of foodborne disease incidents are caused by foods improperly or unhygienically prepared or mishandled at home, in food service establishments, or in markets. Over 200 diseases are caused by eating food contaminated with bacteria, viruses, parasites, or chemical substances such as heavy metals (World Health Organization, 2022).

To ensure the public is served safe food, health departments carry out routine food safety inspections. This week, you will learn how to conduct a food safety inspection and what types of unsafe practices might be found during a food safety inspection.

Food Safety Inspection Protocol

Food safety inspections should be unannounced; however, the inspector should be respectful and work with companies, organizations, and people preparing food for public consumption. There are four parts of a successful food safety inspection:

1. Opening conference
2. Walkaround inspection
3. Closing conference
4. Report

Opening Conference

Upon arrival at a food establishment, an inspector should not just enter a food preparation area and start inspecting. The inspector should identify themselves and ask to speak to the person in charge. Once the inspector is with the person in charge, the opening conference may begin. First, the inspector should again share who they are, why they are there, and the presumed scope of the inspection. The scope may be the entire facility from door to door, or it may be just one specific process. Even if the inspection starts out as a limited inspection, if the inspector sees deficiencies, the scope can be expanded to account for them. Next, the inspector should ask to look at the facilities paperwork. The paperwork could include a license to prepare and sell food, employee training records, and the workers' food handlers permits if required in that jurisdiction. The inspector may use the opening conference to ask the supervisor any questions about the facility or employees.

Often, the opening conference depends on the size of the facility, the number of employees, and the initial scope of the inspection. Some opening conferences might take ten minutes, while other conferences might take a couple of hours.

Walkaround Inspection

In a limited scope inspection—used to address things such as a complaint about the cleanliness of a meat slicer—the inspector will just inspect that meat slicer and the inspection will be complete. In a full facility inspection, the inspector may start at one end of the facility and inspect everything in the facility. In addition to inspecting the facility, the inspector may conduct a variety of tests, which might include testing food temperatures, dishwasher temperatures, and the levels of sanitation solutions for cleaning rags and dishes. An inspector can also interview employees or food handlers to understand the work they are doing and to see if they know how to properly handle food. Finally, the inspector may spend time just observing the workers to see what protective equipment they are wearing, such as gloves, aprons, and hairnets. They will also watch to see how they handle food, dishes, and other food safety practices. The inspector should use an inspection form to document any unsafe actions or practices that are observed.

Closing Conference

After completing the walkaround inspection, the inspector should meet with the supervisor to discuss what was observed and what can be done to fix any deficiencies that were identified.

Written Report

After an inspector finishes the inspection, he or she should use the notes from the inspection to write an inspection report. The report should include the following:

• Introduction
• Narrative
• Methodology (if any testing was conducted)
• Results table (if testing was conducted)
• Results and recommendation table that lists any unsafe practices and how to resolve them

The final report should be sent to the supervisor of the food establishment.

Suggestions for Effective Walkaround Inspections

Inspections can be carried out in any way the inspector desires; however, here are some suggestions on how to conduct a walkaround inspection.

• Start at the front entrance of the facility or location where people are seated to eat their food.
• Observe the overall cleanliness of the eating area. A clean eating area may show a willingness to commit to cleaning procedures elsewhere in the facility while a dirty eating area may indicate a lack of commitment to food safety. Do not just look at the tops of the tables; also look underneath the tabletops and the floor below the tables.
• During the inspection, if you need to measure something such as food temperature or sanitizing solution, ask a worker to measure it for you so you can assess whether he or she knows how to perform the function. If they are unable to perform the function on their own, the worker probably has not been performing the function regularly.

Examples of Safe Food Handling Practices

Food safety regulations are jurisdiction dependent, which means every city, county, state, or province may have their own food safety regulations. Inspectors should learn and become familiar with the regulations in the area where they work. Below is a list of general food safety practices organized by specific categories. Although it is not a complete list of all safe food handling practices, the World Health Organization (WHO) has outlined the following practices.

Keep clean

• Wash hands before handling food, wash them often during food preparation, and after going to the toilet.
• Wash and sanitize all surfaces and equipment used for food preparation.
• Protect kitchen areas and food from insects, pests, and other animals.

Separate raw and cooked foods

• Separate raw meat, poultry, and seafood from other foods.
• Use separate equipment and utensils, such as knives and cutting boards, for handling raw foods.
• Store food in containers to avoid contact between raw and prepared foods.

Cook thoroughly

• Cook food thoroughly, especially meat, poultry, eggs, and seafood.
• Bring foods like soups and stews to boiling; make sure that juices are clear, not pink.
• Ideally, use a thermometer to ensure proper food temperatures.
• Reheat cooked food thoroughly.

Keep food at safe temperatures

• Do not leave cooked food at room temperature for more than two hours.
• Refrigerate promptly all cooked and perishable food.
• Keep cooked food hot until served.
• Do not store food too long, even in the refrigerator.
• Do not thaw frozen food at room temperature.

Use safe water and raw materials

• Use safe water or treat it to make it safe.
• Select fresh and wholesome foods.
• Choose foods processed for safety, such as pasteurized milk.
• Wash fruits and vegetables, especially if eaten raw.
• Do not use food beyond its expiration date.

Practice good personal hygiene

• Wash and dry hands with a clean, dry towel after using a toilet, diapering a child, and touching animals.
• Change clothes and bathe regularly.
• Cover cuts, lesions, and wounds.
• Use a toilet or latrine to urinate or defecate.

Safe food handling practices taken from the Compendium of WHO and other UN guidance on health and environment.

Dairy Safety

Case Example

Eric and Melissa Lewandowski had been sick with nausea and vomiting for about 24 hours when they discovered that they also had bloody diarrhea. At that point, they decided to visit the local doctor. The doctor conducted a stool sample test, and they were diagnosed with a bacterial diseased named campylobacteriosis. Their illness was reported to the health departments that saw it was their 16th and 17th cases of campylobacteriosis they had received that week. Upon interviewing all the cases, the health depart discovered that all the cases had all bought raw milk from the same dairy within the past week. A health inspector was sent to that dairy. It was a small dairy with only 20 cows, but during the inspection, he identified one cow with a Campylobacter infection in her udder. The dairy’s operational permit was suspended until they could show that they had taken care of the situation.

As we see from this case study, milk, especially raw milk, can become contaminated, causing people to get sick. Dairy safety inspections are an excellent way to make sure that the milk is safe and to prevent these kinds of outbreaks.

Introduction

Dairy History and Pasteurization

The first evidence of dairy consumption dates back over six thousand years, and today dairy products are enjoyed all over the world (Curry, 2021). By 2018, about 843 million metric tons of cow milk were produced worldwide (FAO, b). Milk is a valuable nutritious food that has a short shelf-life and requires careful handling. Milk is highly perishable because it is an excellent medium for the growth of bacterial pathogens that can cause spoilage and diseases in consumers (FAO, a). Pasteurization of milk was adopted decades ago as a basic public health measure to kill dangerous bacteria and largely eliminate the risk of getting sick from it (FDA, 2022). When milk pasteurization began in the early 1900s, deaths and diarrheal illnesses in young children declined dramatically (CDC, 2022a).

The term pasteurization means the process of heating milk to the proper temperature for the correct amount of time. There are several types of pasteurization, including Vat pasteurization, High Temperature Short Time pasteurization (HTST), and ultra-pasteurization (UP). Vat pasteurization heats milk in a large tank to 155° F (69° C) for at least 30 minutes. HTST pasteurization raises milk temperatures to at least 161° F (72° C) for not less than 15 seconds, and ultra-pasteurization heats milk to 280° F (138° C) for two seconds. Another method, aseptic processing, which is also known as Ultra-High Temperature (UHT) pasteurization, involves heating the milk and filling it under aseptic conditions into hermetically sealed packaging (IDFA).

In many areas, however, raw milk is still consumed. Raw milk is milk that has not been pasteurized to kill harmful bacteria. Raw milk can carry harmful germs, such as Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella, and Salmonella. These germs can pose serious health risks to you and your family (CDC, 2022b). People who get sick from raw milk might have many days of diarrhea, stomach cramping, and vomiting. Some people might develop severe or even life-threatening diseases (CDC, 2022b).

Prevention of milk-caused illnesses begins at a dairy. There are many ways for the milk to get contaminated. Germs from the animal’s feces or germs from dirty milking equipment can get into the milk. The dairy animals could have udder infections or other diseases, such as bovine tuberculosis. Unsanitary conditions in the milk processing plant or dairy workers’ dirty clothing or boots can also lead to contamination (CDC, 2022b). Dairy inspections can be a great tool to encourage clean production facilities and assure safe milk products for the consumers.

Dairy Safety Inspection Protocol

Dairy safety inspections are conducted following the same protocol as food safety inspections.

Opening Conference

During the opening conference, an inspector should explain why they are there and the scope of the inspection. Next, the inspector should ask to look at the facility’s paperwork. The paperwork could include a permit, milk testing results, employee training records, and animal medication records. The inspector should ask how many cows there are, how much milk is produced daily, the type of pasteurization they use, if any, and whether the water comes from a well or a city system. If it is from a well, the inspector should also ask to look at the well testing results.

Walkaround Inspection

The inspector should start in the milking parlor, preferably while the cows are being milked, so the process can be observed. The milking parlor is where the cows are milked. Next the inspector should inspect the milk house, the place where milk is treated and stored. Additionally, the barn where the animals are located may be inspected with special focus on the condition and cleanliness of the animals.

Closing Conference

After completing the walkaround inspection, the inspector should meet with the supervisor to discuss what was observed and what can be done to fix any deficiencies that were identified.

Written Report

After an inspector finishes the inspection, he or she should use the notes from the inspection to write an inspection report. The report should include the following:

• An introduction
• Narrative
• Methodology (if any testing was conducted)
• A results table (if testing was conducted)
• A results and recommendation table that lists any unsafe practices and how to resolve them.

The final report should be sent to the supervisor of the dairy.

Examples of Dairy Safety Issues and Practices

Dairy safety regulations are jurisdiction dependent, which means every city, county, state, or province may have their own food safety regulations. Inspectors should learn and become familiar with the regulations in the area where they work. Below is a list of general dairy safety issues and practices organized by specific categories.

Milking Process

• Milking done in stable, barn, or parlor
• Brushing and cleaning of animals before milking
• Flanks, bellies, udders, and tails clean at time of milking
• Teats treated with sanitizer and dried prior to milking
• Cows that secrete abnormal milk are last or separated from the other cows
• Abnormal milk properly disposed of properly

Milking Barn

• Floors, gutters and feed troughs of concrete or impervious materials, and are in good repair
• Walls and ceilings smooth, painted, and in good repair
• Adequate light and ventilation
• Clean and free of litter, swine, fowls, or rodents

Milkhouse

• Floors, smooth concrete or impervious materials, in good repair, and adequate drains
• Walls have approved materials in good repair
• Adequate light and ventilation
• Doors and windows shut or screened
• Area and surfaces clean, free of trash, insects, rodents, animals, and fowl

Milk Protection

• Milk and equipment properly protected
• Sanitized milk surfaces not exposed to contaminants
• Improperly handled milk is immediately discarded
• Cleaners and sanitizers stored away from milk surfaces
• Milk cooled to 45 degrees F (7.2 C) within two hours of milking

Utensils and Equipment

• Smooth, impervious, nonabsorbent, safe materials, easily cleanable
• Instruments and utensils are in good repair
• Instruments and utensils clean and properly sanitized
• Separate sink and washing facilities
• Utensils properly stored when out of use

Personal Sanitation and Hygiene

• Toilet provided and conveniently located
• Properly designated hand washing facilities
• Hot water and soap available
• Wash and rinse vats not used for hand washing
• Workers and outer garments are clean

Drug Storage

• All drugs, antibiotics, and medications used and stored to preclude contaminating milk
• All drugs, antibiotics, and medications should be properly labeled
• Store lactating animal drugs in an area segregated from the non-lactating animal drugs
• Should not have prohibited drugs, antibiotics, or medications

Group Homes

Case Example

Elizabeth, the head supervisor at an assisted living group home, was called into a room by the nurse who was on duty. Upon entering the room, Elizabeth saw one of the residents improperly suspended in a special person lift. The nurse explained that she was trying to lift the resident from her wheelchair into her bed. The two workers attempted to straighten out the lift when the resident slipped out of the lift. The nurse tried to catch the resident as she fell but was unsuccessful, and they both ended up on the floor. Unfortunately, the resident suffered a broken leg, and the nurse strained her shoulder.

Many accidents can occur in an assisted living facility or group homes. Improper lifting is one of the biggest hazards that lead to accidents in group homes. Inspections are a great way to ensure that group homes are kept safe and that workers are properly trained.

Introduction

A group home is a residential living facility that provides specialized care, treatment, and stability for a group of people with similar characteristics. Often, they need additional support such as medication assistance, personal hygiene care, or special therapies. Examples of different kinds of group homes include group homes for the elderly such as assisted living or nursing home facilities, group homes for disabled, developmentally delayed, troubled youth, low-income homes, foster care facilities, substance abuse homes, and other facilities that have special populations in need. Each type of facility will have its own specific regulations; nevertheless, this chapter will look at some of the general hazards and policies associated with group homes.

Health departments regularly inspect all types of group homes to make sure that both the workers and the residents are safe and protected.

Group Home Inspection Protocol

Group home inspections are conducted following the same protocol as food safety and dairy inspections.

Opening Conference

During the opening conference, an inspector should explain why they are there and the scope of the inspection. Next, the inspector should ask to look at the facilities paperwork. The paperwork could include a permit, employee and resident training records, fire drill records, and emergency evacuation plan. The inspector should ask about the number of beds, the current number of residents in the facility and whether the water comes from a well or a city system. If it is from a well, the inspector should also ask to look at the well testing results.

Walkaround Inspection

The inspector should walk through the facility looking at its overall cleanliness while focusing on the food preparation and laundry areas. The inspector should ask to see where the medications are stored and may inspect the medication reports and files. The walkaround should not be limited to just inside the facility but should include the outdoor areas, especially where residents are active.

Closing Conference

After completing the walkaround inspection, the inspector should meet with the supervisor to discuss what was observed and what can be done to fix any deficiencies that were identified.

Written Report

After an inspector finishes the inspection, he or she should use the notes from the inspection to write an inspection report. The report should include the following:

• Introduction
• Narrative
• Methodology (if any testing was conducted)
• Results table (if testing was conducted)
• Results and recommendation table that lists any unsafe practices and how to resolve them

The final report should be sent to the supervisor of the group home.

Examples of Group Home Issues and Practices

Group home regulations are jurisdiction dependent, which means every city, county, state, or province may have their own safety regulations. Inspectors should learn and become familiar with the regulations in the area where they work. Below is a list of general group home issues and practices organized by specific categories.

Training

• Employees should be trained in first aid and CPR.
• Employees should be trained on proper lifting techniques.
• Employees should be trained on emergency evacuation.
• Residents should be trained on rules of the facility.
• Residents should be trained on the emergency evacuation plan.

Emergency Safety

• Emergency numbers, such as police, paramedics, and the fire department, should be posted.
• Functioning smoke detectors in each sleeping room and each level of the facility.
• Exit routes should be clearly marked and not obstructed.
• Fire extinguishers available and maintained.
• Emergency evacuation plans should be tailored to the resident's needs.
• Fire drills should be regularly conducted.

Food Safety

• All recommendations from Chapter 8 on food safety still apply.
• Proper food storage.
• Proper food temperatures.
• Sanitized surfaces.
• Proper dishwashing facilities.
• Hand washing facilities for food preparation workers.

Housekeeping

• Main rooms should be clean and clear of clutter.
• Adequate trash containers that are covered and taken out regularly.
• Storage of cleaning items should not be in an electrical or mechanical room.
• Proper maintenance to both the interior and exterior of the facility.

Laundry Facilities

• The facility must have sufficient linen for the proper care and comfort of residents.
• Adequate facilities must be provided for the proper and sanitary
• washing and drying of linen and other washable goods.
• The laundry should be situated in an area separate and apart from where food is stored, prepared, or served.
• The laundry area must be well-lighted, ventilated, adequate in size for the facility.

Sanitation and Hygiene

• Staff are not allowed in the facility when sick.
• Staff provided personal protective equipment when working with sick residents.
• Sufficient showers, toilets, and hand washing facilities.
• Standard precautions should be used to prevent transmission of infectious disease.

Medications

• Copies of all physician or authorized provider orders, including prescribed medications and treatments, should be maintained.
• Medications and treatments should be properly labeled.
• All medications should be kept in a locked area such as a locked box or room.
• Toxic chemicals and cleaning agents must not be stored with medications.

Discontinued or outdated medications should be removed and disposed of in a manner that ensures it cannot be retrieved.

• The facility should track all controlled substances entering the facility.

Environmental Issues

• All chemicals should be properly labeled.
• They should have a pest control program that prevents insects, rodents, and other pests from entering or infesting the facility.
• The facility must have an adequate water supply that is safe and of a sanitary quality.
• If a water source comes from a well, the water quality should be tested on a regular basis, quarterly at a minimum.
• All human waste and sewage should be sent to a treatment facility.

Child Care Facilities

Case Example

A popular local childcare center, with a very good reputation, had a total of 23 children between the ages of 2–4 years old. The children were grouped in four classrooms. The classes were assigned different times to visit the outdoor play area. On one Friday, the childcare facility decided to have a water day and brought two 5-foot-wide (1.5 meter wide) child pools. The children loved the activity. After the four classes had finished their activities, the director of the facility made sure the child pools were emptied out to avoid any accidents. After the pools were emptied, there was no place to store them, so they placed them upside down in a corner of the property. Sometime during the month, the pools got flipped over. On Sunday, August 29, there was a surprise rain shower in the city and one of the pools filled about two inches (four centimeters) of water. On Monday, two classes decided to visit the outdoor playground at the same time, which was against the rules of the childcare facility. Instead of watching the children from the two classes, the two teachers started talking to each other. Two-year-old Jennifer wandered away from the playground; she was found 10 minutes later in the pool not breathing.

Many accidents can occur at childcare facilities. Regular inspections for hazardous situations are a way to prevent tragic accidents from happening.

Introduction

Just like group homes, there are many different types of childcare facilities and each type has their own regulations, which are jurisdiction dependent. Three of the main types of childcare facilities are family childcare, family group childcare, and childcare centers. Family childcare is conducted in the home of the provider and includes at least one of their own children. Generally, this type has one provider and only a few children. Another advantage is that it can have several siblings of different ages together.

Family group childcare is also done at a personal residence but has multiple people on staff and is allowed to care for more children. Often there are rooms in the house dedicated for the use of childcare.

Childcare centers are in their own building or found in the wing of a commercial structure. Childcare centers often have a classroom-like environment, and there are multiple care providers and many more children who are grouped with others of the same age.

It doesn’t matter which type of facility it is, it should still be licensed and inspected by the health department.

Childcare Facility Inspection Protocol

Childcare facility inspections are conducted following the same protocol as food safety and group home inspections.

Opening Conference

During the opening conference, an inspector should explain why they are there and the scope of the inspection. Next, the inspector should ask to look at the facilities paperwork. The paperwork could include a permit, employee training records, child immunization records, emergency contacts, fire drill records, and emergency evacuation plan. The inspector should make sure there is enough staff for the number of children present to make sure there is adequate supervision for the children. The inspector should find out whether the water comes from a well or a city system. If it is from a well, the inspector should also ask to look at the well testing results.

Walkaround Inspection

The inspector should walk through the facility looking at the overall cleanliness of the facility while focusing on the food preparation, activity, rest, and bathroom areas. The walkaround should not be limited to just inside the facility but should include the outdoor areas, especially the playground areas.

Closing Conference

After completing the walkaround inspection, the inspector should meet with the supervisor to discuss what was observed and what can be done to fix any deficiencies that were identified.

Written Report

After an inspector finishes the inspection, he or she should use the notes from the inspection to write an inspection report. The report should include the following:

• Introduction
• Narrative
• Methodology (if any testing was conducted)
• Results table (if testing was conducted)
• Results and recommendation table that lists any unsafe practices and how to resolve them

The final report should be sent to the supervisor of the childcare facility.

Examples of Childcare Facility Issues and Practices

Childcare facility regulations are jurisdiction dependent, which means every city, county, state, or province may have their own safety regulations. Inspectors should learn and become familiar with the regulations in the area where they work. Below is a list of general childcare facility issues and practices organized by specific categories.

Staff and Children

• There should always be at least one adult over 18.
• There should always be at least one worker trained in CPR and first aid.
• There should be proper child to staff ratios.
• There should be policies in place for sick staff.
• There should be policies in place for sick children.
• There should be a system in place to track child immunizations.

Emergency Safety

• Emergency numbers such as police, paramedics, fire department should be posted.
• Parent contact information should be available.
• Functioning smoke detectors in each room and each level of the facility.
• Exit routes should be clearly marked and not obstructed.
• Fire extinguishers available and maintained.
• There should be an emergency evacuation plan.
• Fire drills should be regularly conducted.

Food Safety

• All recommendations from chapter 8 on food safety still apply.
• Proper food storage.
• Proper food temperatures.
• Sanitized surfaces.
• Proper dishwashing facilities.
• Hand washing facilities for food preparation workers.
• Serve pasteurized milk and juice only.
• No home canned foods.

Diaper and Toilet Facilities

• The diaper changing area cannot be in the kitchen or on counters or tables used for food preparation or dining.
• A smooth non-absorbent diaper changing surface is required.
• Dirty diapers and soiled clothing must be stored to prevent access by children.
• The employee is to sanitize the diaper changing surface after each diaper change.
• The employee is to wash their hands between each diaper change.
• Restroom(s) must be cleaned daily.
• Toilet training seats/potties are to be kept clean and should be sanitized after each use.

Play and Rest Areas

• Sleeping cots, blankets, and mats are kept clean and sanitized regularly.
• Toys, tables, and chairs should be washable and sanitized frequently.
• Equipment, materials, and furnishings should be sturdy and free of sharp points and/or corners, splinters, protruding nails and bolts, hazardous small parts or lead-based paint or poisonous materials.
• Play equipment must be safe, in good condition, and anchored. The area should be easily supervised.
• Pools, hot tubs, and other bodies of water must be inaccessible to children.
• Maintain areas free from hazards, such as window wells, garden tools, lawn mowers, gas grills, and animal waste.

Environmental Issues

• Garbage needs to be stored where it is inaccessible to children and cannot attract vermin.
• They should have a pest control program that prevents insects, rodents, and other pests from entering or infesting the facility.
• The facility must have an adequate water supply that is safe and of a sanitary quality.
• If a water source comes from a well, the water quality should be tested on a regular basis.
• Plumbing must be in good condition.

Other Safety Issues

• Electric cords, outlets, and lamps must be in good condition.
• Keep electric outlets covered.
• Cords for blinds must be out of reach.
• Prevent stairway access to children three years of age and younger.
• Railings for balconies and stairs must meet the building code requirements.
• Choking hazards such as balloons and objects less than one inch (2.5 centimeters) in diameter may not be accessible to children three years of age or less.
• Firearms must be in a locked container and ammunition stored in a separate locked container.

• Use of alcohol or smoking is prohibited when children are present.

References

CDC. (2022a). Raw Milk. Retrieved Jan 6, 2023, from https://books.byui.edu/-rNuV

CDC. (2022b). Raw Milk Questions and Answers Print. Retrieved Jan 6, 2023, from https://books.byui.edu/-KpTN

Curry, A. (2021). Humans were drinking milk before they could digest it. Retrieved Jan 6, 2023, from https://books.byui.edu/-PkvE

FAO. (a). Gateway to dairy production and products-Milk processing. Retrieved Jan 6, 2023, from https://books.byui.edu/-WqJ

FAO. (b). Gateway to dairy production and products-Milk production. Retrieved Jan 6, 2023, from https://books.byui.edu/-bxWc

FDA. (2022). Food Safety and Raw Milk. Retrieved Jan 6, 2023, from https://books.byui.edu/-vku

IDFA. Pasteurization. Retrieved Jan 6, 2023, from https://books.byui.edu/-UTTg

World Health Organization. (2022). Compendium of WHO and other UN guidance on health and environment. ( No. WHO/HEP/ECH/EHD/22.01). Geneva: https://books.byui.edu/-YrjX