Health

6.1 Administering medicines

Policy statement

While it is not our policy to care for sick children, who should be at home until they are well enough to return to the setting, we will agree to administer medication as part of maintaining their health and well-being or when they are recovering from an illness.

In many cases, it is possible for children’s GPs to prescribe medicine that can be taken at home in the morning and evening. As far as possible, administering medicines will only be done where it would be detrimental to the child’s health if not given in the setting. If a child has not had a medication before, it is advised that the parent keeps the child at home for the first 48 hours to ensure there are no adverse effects, as well as to give time for the medication to take effect.

The key worker/buddy is responsible for the correct administration of medication to children for whom they are the key worker/buddy. This includes ensuring that parent consent forms have been completed, that medicines are stored correctly and that records are kept according to procedures. In the absence of the key worker/buddy, the duty manager is responsible for the overseeing of administering medication.

Procedures

  • Children taking prescribed medication must be well enough to attend the setting.
  • Only medication prescribed by a doctor (or other medically qualified person) is administered. It must be in-date and prescribed for the current condition (medicines containing aspirin will only be given if prescribed by a doctor). Children’s prescribed medicines are stored in their original containers, are clearly labelled and are inaccessible to the children.
  • Parents give prior written permission for the administration of medication. The staff receiving the medication must ask the parent to sign a consent form stating the following information. No medication may be given without these details being provided:

–          – the full name of child and date of birth;

–          – the name of medication and strength;

–          -who prescribed it;

–          – the dosage to be given in the setting;

–          – how the medication should be stored and its expiry date;

–          – any possible side effects that may be expected; and

–          – the signature of the parent, their printed name and the date.

Parents bringing medication into the setting should seek out their key worker or key buddy to complete a medication form.  The key worker/buddy is then responsible for making sure all staff for that session are aware that there is medication to be administered.  The Child’s initials and the time the medication needs to be given should be written onto the whiteboard on the main desk. The key worker/buddy remains responsible for administering the medication.

  • The administration of medicine is recorded accurately in our medication record book each time it is given and is signed by the key person/manager. Parents are shown the record at the end of the day and asked to sign the record book to acknowledge the administration of the medicine. The medication record book records the:

–          name of the child;

–          name and strength of the medication;

–          date and time of the dose;

–          dose given and method;

–          signature of the key person/manager; and

–          parent’s signature.

Storage of medicines

  • All medication is stored safely in a locked cupboard or refrigerated as required. Where the cupboard or refrigerator is not used solely for storing medicines, they are kept in a marked plastic box.
  • The child’s key person is responsible for ensuring medicine is handed back at the end of the day to the parent.
  • For some conditions, medication may be kept in the setting to be administered on a regular or as-and-when- required basis. Key persons check that any medication held in the setting, is in date and return any out-of-date medication back to the parent.

Children’s prescribed medication is stored in a green plastic box which is kept in the kitchen and locked into the cupboard as necessary.  Medication which requires refridgeration is kept in the covered compartment in the top of the fridge door.  No food is kept in this compartment.

All staff are made aware of this policy and this method of storage.

  • If the administration of prescribed medication requires medical knowledge, individual training is provided for the relevant member of staff by a health professional.
  • If rectal diazepam is given, another member of staff must be present and co-signs the record book.
  • No child may self-administer. Where children are capable of understanding when they need medication, for example with asthma, they should be encouraged to tell their key person what they need. However, this does not replace staff vigilance in knowing and responding when a child requires medication.

Children who have long term medical conditions and who may require ongoing medication

  • A risk assessment is carried out for each child with long term medical conditions that require ongoing medication. This is the responsibility of the manager alongside the key person. Other medical or social care personnel may need to be involved in the risk assessment.
  • Parents will also contribute to a risk assessment. They should be shown around the setting, understand the routines and activities and point out anything which they think may be a risk factor for their child.
  • For some medical conditions, key staff will need to have training in a basic understanding of the condition, as well as how the medication is to be administered correctly. The training needs for staff form part of the risk assessment.
  • The risk assessment includes vigorous activities and any other activity that may give cause for concern regarding an individual child’s health needs.
  • The risk assessment includes arrangements for taking medicines on outings and advice is sought from the child’s GP if necessary where there are concerns.
  • A health care plan for the child is drawn up with the parent; outlining the key person’s role and what information must be shared with other staff who care for the child.
  • The health care plan should include the measures to be taken in an emergency.
  • The health care plan is reviewed every six months, or more frequently if necessary. This includes reviewing the medication, e.g. changes to the medication or the dosage, any side effects noted etc.
  • Parents receive a copy of the health care plan and each contributor, including the parent, signs it.

Managing medicines on trips and outings

  • If children are going on outings, staff accompanying the children must include the key person for the child with a risk assessment, or another member of staff who is fully informed about the child’s needs and/or medication.
  • Medication for a child is taken in a sealed plastic box clearly labelled with the child’s name and the name of the medication. Inside the box is a copy of the consent form and a card to record when it has been given, including all the details that need to be recorded in the medication record as stated above.
  • On returning to the setting the card is stapled to the medicine record book and the parent signs it.
  • If a child on medication has to be taken to hospital, the child’s medication is taken in a sealed plastic box clearly labelled with the child’s name and the name of the medication. Inside the box is a copy of the consent form signed by the parent.
  • As a precaution, children should not eat when travelling in vehicles.
  • This procedure is read alongside the outings procedure.

6.2 Managing children who are sick, infectious, or with allergies

(Including reporting notifiable diseases)

Policy statement

We provide care for healthy children through preventing cross infection of viruses and bacterial infections and promote health through identifying allergies and preventing contact with the allergenic substance.

Procedures for children who are sick or infectious

  • If children appear unwell during the day – have a temperature, sickness, diarrhoea or pains, particularly in the head or stomach – the manager calls the parents and asks them to collect the child, or send a known carer to collect the child on their behalf.
  • If a child has a temperature, they are kept cool, by removing top clothing and sponging their heads with cool water, but kept away from draughts.
  • In extreme cases of emergency, the child should be taken to the nearest hospital and the parent informed.
  • Parents are asked to take their child to the doctor before returning them to the setting; the setting can refuse admittance to children who have a temperature, sickness and diarrhoea or a contagious infection or disease.
  • Where children have been prescribed antibiotics, parents are asked to keep them at home for 48 hours before returning to the setting.
  • After vomiting or diarrhoea, parents are asked to keep children home for a minimum of 48 hours or longer until a formed stool is passed.
  • The setting has a list of excludable diseases and current exclusion times. The full list is obtainable from

www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947358374 and includes common childhood illnesses such as measles.

Reporting of ‘notifiable diseases’

  • If a child or adult is diagnosed as suffering from a notifiable disease under the Health Protection (Notification) Regulations 2010, the GP will report this to the Health Protection Agency.
  • When the setting becomes aware, or is formally informed of the notifiable disease, the manager informs Ofsted and acts on any advice given by the Health Protection Agency.

HIV/AIDS/Hepatitis procedure

  • HIV virus, like other viruses such as Hepatitis A, B and C, are spread through body fluids. Hygiene precautions for dealing with body fluids are the same for all children and adults.
  • Single-use vinyl gloves and aprons are worn when changing children’s nappies, pants and clothing that are soiled with blood, urine, faeces or vomit.
  • Protective rubber gloves are used for cleaning/sluicing clothing after changing.
  • Soiled clothing is rinsed and bagged for parents to collect.
  • Spills of blood, urine, faeces or vomit are cleared using mild disinfectant solution and mops; any cloths used are disposed of with the clinical waste.
  • Tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit are cleaned using a disinfectant.

Nits and head lice

  • Nits and head lice are not an excludable condition, although in exceptional cases a parent may be asked to keep the child away until the infestation has cleared.
  • On identifying cases of head lice, all parents are informed and asked to treat their child and all the family if they are found to have head lice.

Procedures for children with allergies

  • When parents start their children at the setting they are asked if their child suffers from any known allergies. This is recorded on the Registration Form.
  • If a child has an allergy, a risk assessment form is completed to detail the following:

–          The allergen (i.e. the substance, material or living creature the child is allergic to such as nuts, eggs, bee stings, cats etc).

–          The nature of the allergic reactions e.g. anaphylactic shock reaction, including rash, reddening of skin, swelling, breathing problems etc.

–          What to do in case of allergic reactions, any medication used and how it is to be used (e.g. Epipen).

–          Control measures – such as how the child can be prevented from contact with the allergen.

–          Review.

  • This form is kept in the child’s personal file and a copy is displayed where staff can see it.
  • Parents train staff in how to administer special medication in the event of an allergic reaction.
  • No nuts or nut products are used within the setting.
  • Parents are made aware so that no nut or nut products are accidentally brought in, for example in lunch boxes.

Insurance requirements for children with allergies and disabilities

  • The insurance will automatically include children with any disability or allergy, but certain procedures must be strictly adhered to as set out below. For children suffering life threatening conditions, or requiring invasive treatments; written confirmation from your insurance provider must be obtained to extend the insurance.

At all times the administration of medication must be compliant with the Safeguarding and Welfare Requirements of the Early Years Foundation Stage and follow procedures based on advice given in Managing Medicines in Schools and Early Years Settings (DfES 2005).

Oral medication

  • Oral medications must be prescribed by a GP or have manufacturer’s instructions clearly written on them.
  • The setting must be provided with clear written instructions on how to administer such medication.
  • All risk assessment procedures need to be adhered to for the correct storage and administration of the medication.
  • The setting must have the parents or guardians prior written consent. This consent must be kept on file.

Key person for special needs children – children requiring assistance with tubes to help them with everyday living e.g. breathing apparatus, to take nourishment, colostomy bags etc.

  • Prior written consent must be obtained from the child’s parent or guardian to give treatment and/or medication prescribed by the child’s GP.
  • The key person must have the relevant medical training/experience, which may include those who have received appropriate instructions from parents or guardians, or who have qualifications.
  • Nappy Changing policy
    Policy Statement:
    ● We expect to change a child’s nappy if it becomes necessary to do so.
    ● We do not discriminate against any child for any reason, and no child shall be
    excluded from our setting because they are still wearing nappies.
    ● We expect to support parents with the process of toilet training their child.
    ● We expect to maintain a comfortable safe environment for all the children in our
    care and will work closely with parents to achieve this.
    Procedure:
    ● Should a child require a nappy change it should be the child’s key worker or key
    buddy who undertakes this task.
    ● The key person makes sure they have all the equipment they require before starting
    the task. This would include the child’s bag,(as parents are expected to provide
    nappies), gloves, wipes, change mat, wipes for cleaning the change mat, disposal
    system.
    ● The nappy change will take place in the main room, behind a screen. This way the
    child’s privacy is protected and the member of staff can remain in ear shot of other
    staff members, therefore safeguarding themselves.
    ● Once the nappy change has taken place the change mat should be cleaned with
    disinfectant wipes, and the area made ready for the next user. All members of staff
    are responsible for making sure the changing box remains well stocked with wipes,
    gloves, etc.
    ● All staff are responsible for the safe and appropriate disposal of the soiled nappy
    and the gloves they have used.
    ● The nappy change should be recorded on the sheet which will be kept in the box.

6.3 Recording and reporting of accidents and incidents

(Including the procedure for reporting accidents and incidents to the HSE under RIDDOR requirements)

Policy statement

We follow the guidelines of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) for the reporting of accidents and incidents. Child protection matters or behavioural incidents between children are not regarded as incidents which need reporting under the guidelines of this policy and there are separate procedures for this.

Procedures

Our accident book:

  • is kept in a safe and secure place;
  • is accessible to staff, who all know how to complete it; and
  • is reviewed at least half termly to identify any potential or actual hazards.

Reporting accidents and incidents

Ofsted is notified as soon as possible, but at least within 14 days, of any instances which involve:

  • food poisoning affecting two or more children looked after on our premises;
  • a serious accident or injury to, or serious illness of, a child in our care and the action we take in response; and
  • the death of a child in our care.

Local child protection agencies are informed of any serious accident or injury to a child, or the death of any child, while in our care and we act on any advice given by those agencies.

Any food poisoning affecting two or more children or adults on our premises is reported to the local Environmental Health Department.

We meet our legal requirements in respect of the safety of our employees and the public by complying with RIDDOR (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations). We report to the Health and Safety Executive:

  • any work-related accident leading to an injury to a child or adult, for which they are taken to hospital;
  • any work-related injury to a member of staff, which results in them being unable to work for seven consecutive days;
  • when a member of staff suffers from a reportable work-related disease or illness;
  • any death, of a child or adult, that occurs in connection with activities relating to our work; and
  • any dangerous occurrences. This may be an event that causes injury or fatalities or an event that does not cause an accident, but could have done; such as a gas leak.

Our incident book

  • We have ready access to telephone numbers for emergency services, including the local police.
  • We keep an incident book for recording major incidents, including those that that are reportable to the Health and Safety Executive as above.
  • These incidents include:

–          an intruder gaining unauthorised access to the premises;

–          a fire, flood, gas leak or electrical failure;

–          an attack on member of staff or parent on the premises or nearby;

–          any racist incident involving staff or family on the setting’s premises;

–          a notifiable disease or illness, or an outbreak of food poisoning affecting two or more children looked after on the premises;

–          the death of a child or adult, and

–          a terrorist attack, or threat of one.

  • In the incident book we record the date and time of the incident, nature of the event, who was affected, what was done about it or if it was reported to the police, and if so a crime number. Any follow up, or insurance claim made, is also recorded.
  • In the unlikely event of a terrorist attack, we follow the advice of the emergency services with regard to evacuation, medical aid and contacting children’s families. Our standard Fire Safety and Emergency Evacuation Policy will be followed and staff will take charge of their key children. The incident is recorded when the threat is averted.
  • In the unlikely event of an escape from Broadmoor Secure Hospital, we follow the advice from the emergency services and the Local Authority.  We follow our Lockdown procedure.
  • In the unlikely event of a child dying on the premises, the emergency services are called, and the advice of these services are followed.
  • The incident book is not for recording issues of concern involving a child. This is recorded in the child’s  own file.

6.5 Food and drink

Policy statement

Our provision regards snack and meal times as an important part of our day. Eating represents a social time for children and adults and helps children to learn about healthy eating. We promote healthy eating using resources and materials from various sources. At snack and meal times, we aim to provide nutritious food, and encourage parents to do the same, which meets the children’s individual dietary needs.

Procedures

We follow these procedures to promote healthy eating in our setting.

  • Before a child starts to attend the setting, we ask their parents about their dietary needs and preferences, including any allergies. (See the Managing Children who are Sick, Infectious or with Allergies Policy.)
  • We record information about each child’s dietary needs in the Registration Form and parents sign the form to signify that it is correct.
  • We regularly consult with parents to ensure that our records of their children’s dietary needs – including any allergies – are up-to-date. Parents sign the up-dated record to signify that it is correct.
  • We display current information about individual children’s dietary needs so that all staff and volunteers are fully informed about them.
  • We implement systems to ensure that children receive only food and drink that is consistent with their dietary needs and preferences, as well as their parents’ wishes.
  • We display the menus of snacks for parents to view.
  • We provide nutritious food for all snacks, avoiding large quantities of saturated fat, sugar and salt and artificial additives, preservatives and colourings.
  • We include foods from the diet of each of the children’s cultural backgrounds, providing children with familiar foods and introducing them to new ones.
  • We take care not to provide food containing nuts or nut products and are especially vigilant where we have a child who has a known allergy to nuts.
  • Through discussion with parents and research reading by staff, we obtain information about the dietary rules of the religious groups to which children and their parents belong, and of vegetarians and vegans, as well as about food allergies. We take account of this information in the provision of food and drinks.
  • We require staff to show sensitivity in providing for children’s diets and allergies. Staff do not use a child’s diet or allergy as a label for the child, or make a child feel singled out because of her/his diet or allergy.
  • We organise meal and snack times so that they are social occasions in which children and staff participate.
  • We use meal and snack times to help children to develop independence through making choices, serving food and drink and feeding themselves.
  • We provide children with utensils that are appropriate for their ages and stages of development and that take account of the eating practices in their cultures.
  • We have fresh drinking water constantly available for the children. We inform the children about how to obtain the water and that they can ask for water at any time during the day.
  • For those children attending Lunch Club we inform parents who provide food for their children about the storage facilities available in the setting.
  • For those children attending Lunch Club we give parents who provide food for their children information about suitable containers for food.
  • In order to protect children with food allergies, we discourage children from sharing and swapping their food with one another.
  • We provide semi-skimmed milk for all children.  Substitutes to milk are provided for those children with allergies.

Packed lunches

For those who attend Lunch Club, children are required to bring packed lunches. We:

  • Encourage parents to make sure that the lunch box contains an ice pack to keep food cool;
  • inform parents of our policy on healthy eating;
  • encourage parents to provide sandwiches with a healthy filling or an alternative savoury product such as pasta, fruit, and milk based deserts, such as yoghurt or crème fraîche. We discourage sweet drinks and ask parents to provide a drink bottle with water.
  • discourage packed lunch contents that consist largely of crisps, processed foods, sweet drinks and sweet products such as cakes or biscuits. We reserve the right to return this food to the parent as a last resort;
  • ensure staff sit with children to eat their lunch so that the mealtime is a social occasion.

6.6 Food hygiene

(Including the procedure for reporting food poisoning)

Policy statement

We provide and/or serve food for children on the following basis:

  • Snacks.
  • Packed lunches.

We maintain the highest possible food hygiene standards with regard to the purchase, storage, preparation and serving of food.

We are registered as a food provider with the local authority Environmental Health Department.

Procedures

  • All staff involved in the preparation and handling of food receive training in food hygiene.
  • The person responsible for food preparation and serving carries out daily opening and closing checks on the kitchen to ensure standards are met consistently.
  • We use reliable suppliers for the food we purchase.
  • Food is stored at correct temperatures and is checked to ensure it is in-date and not subject to contamination by pests, rodents or mould.
  • Packed lunches are stored in a cool place; un-refrigerated food is served to children within 4 hours of preparation at home.
  • Parents are encouraged to supply ice packs in lunch boxes.
  • Food preparation areas are cleaned before use as well as after use.
  • There are separate facilities for hand-washing and for washing up.
  • All surfaces are clean and non-porous.
  • All utensils, crockery etc are clean and stored appropriately.
  • Waste food is disposed of daily.
  • Cleaning materials and other dangerous materials are stored out of children’s reach.
  • Children do not have unsupervised access to the kitchen.
  • When children take part in cooking activities, they:

–          are supervised at all times;

–          understand the importance of hand washing and simple hygiene rules;

–          are kept away from hot surfaces and hot water; and

–          do not have unsupervised access to electrical equipment, such as blenders etc.

Reporting of food poisoning

  • Food poisoning can occur for a number of reasons; not all cases of sickness or diarrhoea are as a result of food poisoning and not all cases of sickness or diarrhoea are reportable.
  • Where children and/or adults have been diagnosed by a GP or hospital doctor to be suffering from food poisoning and where it seems possible that the source of the outbreak is within the setting, the manager will contact the Environmental Health Department to report the outbreak and will comply with any investigation.
  • Any confirmed cases of food poisoning affecting two or more children looked after on the premises are notified to Ofsted as soon as reasonably practicable, and always within 14 days of the incident.