Family Home Monitoring Checklist - DOC

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					                                           Family Home Child Care
                                            Monitoring Checklist
Facility Name                                                        Capacity      Provider ID #   Monitoring Date

Street Address                                 City                        State    Zip Code       10 digit telephone number
Licensor Name                                       Office                                         10 digit telephone number

Codes: NA - Not applicable D – Discussed O – Observed C – Compliance N – Noncompliance E - Exception granted
           1.    License visibly posted. (WAC 170-296-0540(1))
           2.    Evacuation plans and procedures including written record of monthly fire drills and smoke detector checks
                 are posted. (WAC 170-296-0540(2))
           3.    Emergency numbers posted. (WAC 170-296-0540(3))
           4.    Any civil penalties imposed are posted. (WAC 170-296-0540 (4))
           5.Notification which advises parent of children in care of the providers requirement to have copies of any
             current checklist or compliance agreement available for review is posted.(WAC 170-296-0540 (5)
Record Keeping
         6. Child records are complete based on sampling of files (see page 2). (WAC 170-296-0510)
         7. Attendance records maintained in licensed space (WAC 170-296-0520(3))
         8. Documentation of a cleared background check for all employees, volunteers and household members having
             unsupervised or regular access to the children in care. (WAC 170-296-1452, 1453)
          9. Provider in compliance with insurance requirements. (RCW 43.215.535)
Medication and First Aid/CPR
         10. Provider and staff/volunteers that are counted in staff/child ratios have current first aid/CPR training.
              (WAC 170-296-0230)
         11. Medications and toxic materials stored in accordance with WAC 170-296-0810, 0820.
         12. Required first Aid supplies are available. (WAC 170-296-0830)
General Safety and Sanitation
         13. Areas that include licensed child care space are safe, clean, sanitary, free of hazards, and in good repair.
               (WAC 170-296-0720 (1),
         14. The licensed child care space is prohibited from the use of window blind cords that form a loop or pose risk
               of strangulation (RCW 43.215.360)
         15. Smoke detectors (single station type) operational (manually tested). (WAC 170-296-0580, 0650)

          16. Provider routinely washes hands, cleans and sanitizes surfaces and equipment. (WAC 170-296-0700, 0990,
              1040, 1090)
              The diapers and diaper changing areas meet WAC requirements. (WAC 170-296-1090)
          17. Outdoor play area(s) meets WAC requirements. (WAC 170-296-1220) FH Monitoring Checklist                                                                                             1
Rev. 10/09
           18. Provider and staff must report suspected child abuse, neglect or exploitation immediately to your local
               Children’s Administration intake staff and your licensor (WAC 170-296-1340 (1) (a))
           19. Provider/child ratios and capacity meet licensing requirements. (WAC 170-296-1350)
           20. You or your primary staff person must be within site or hearing of the children in care, both inside and
               outside. (WAC 170-296-1360 (2))
           21. Provider/staff interact, guide and discipline children in accordance with WAC 170-296-1280and 1390.

Program, Activities, and Routines
         22. Daily routines provide children with an opportunity to strengthen large and small muscle groups.(WAC
              170-296-1370 (1) (d))

           23.   Learning and play materials (WAC 170-296-1370)
                    Sufficient quantity    Developmentally appropriate       Accessible      culturally relevant

           24. The daily schedule must provide and promote the needs and interests of children being served (WAC 170-
               296-1370) :

Licensee Signature                           Date           Licensor Signature                                     Date

Comments and Observations: FH Monitoring Checklist                                                                                          2
Rev. 10/09
                                                                          Facility Name                                   Monitoring Date
Family Home Monitoring Checklist

Children’s Files (Randomly Review Five (5) files)
      Child Information        Enrollment           Health Care      Health    Immunizations   Medical     Medication      Medication      People
     WAC170-296-0510           Application        Provider/Dentist   History                   Consent    Authorization    Dispensed    authorized to
                                                                                                                                        pick up child

Child # 1

Child # 2

Child # 3

Child # 4

Child # 5
Staff Qualifications (Randomly Review Five (5) Staff Files) and/or Review Family Home Provider/Staff/Volunteer File      * If applicable only
    Staff, Volunteer or Household
                                     Employment Age Criminal             TB     Blood Born   CPR       First        Program        STARS Training*
            Member Names                                     History
                                     Application*                        Test    Pathogen   Card*      Aid *      Orientation      20 Hrs     10 Hrs
         WAC 170-296-1410                                     Check              Training*                                                   Annually FH Monitoring Checklist                                                                                                                        3
Rev. 10/09

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