On June 9^th 2020, the Government of Ontario announced child care centres across Ontario would be able to reopen effective Friday June 12^th, 2020. This decision comes after the reopening of many business and establishments, leaving many parents in need of child care. This document is intended to support service providers with developing a plan to reopen their agencies in a safe and effective way.

The Government of Ontario has outlined that all child care service providers must have enhanced health and safety practices put into place prior to reopening. This document is intended to support in creating these practices. This document is modelled off of the YMCA NEO Child Care Procedures for COVID-19 Emergency Operation as well as their Reopening Procedures.

Guiding Procedures and Principles:

First and foremost, ensure all health and safety procedures are in place at all times, safety exceeds the programming.
Educate our staff on COVID-19 symptoms as well as preventative measures.
Regulate food distribution to include grab-and-go options, smaller groups, and more.
Mandate that those who are not feeling well to stay home to prevent the spread of germs.
Develop a routine and schedule as it helps children feel safe and comfortable.
Plan activities and experiences that support the interests and needs of the children with a program plan.
Room capacities have been lowered; therefore, you may be flexible with the number of activities provided at one time. For example:
- Some toys can be taken out of rotation and disinfected, as long as there is enough variety and toys for the children.
- Suspension of all sensory activities (water, sand, etc…).
- Set-up enough table activities for the children, not necessarily all tables will be required.
- Some play areas may be closed at times (morning or afternoon) for disinfecting.
- Ensure you are supporting play by being a caring, sensitive and fun co-learner
- Toys that are harder to clean will be removed from the play environment.

Children naturally play in close physical proximity. There is no requirement to separate children during play, rather we are implementing additional precautions like screening and enhanced disinfection to reduce the spread of illness.
When choosing small groups, focus on keeping the same children and staff together as much as possible to reduce the spread of illness.
Younger children will be in fenced areas or in strollers where Physical Distancing will apply.
Be yourself, have fun, know that you are doing something important and that you are helping our community.

Opening Checklist (Before Children Arrive)

All staff are screened.
Regular tasks associated with opening the rooms (eg. Flush for lead, check for fire extinguishers, etc)
Clean with detergent/soap and then disinfect using required dilution for outbreak (see label or Manufacturer Safety Data Sheet (MPDS) for more information on correct dilution):
- All high touch areas (e.g. door knobs/push bars, light switches, railings, sinks, toilets, soap/hand sanitizer dispensers, phones, computers, garbage cans, change tables, diaper genies, counter tops, table tops, chairs, mirrors) at least twice a day.

All shelves, equipment, and toys.

Put away all soft/plush toys, dress-up clothes, rugs, pillows, blankets, and furnishings that cannot be cleaned and sanitized easily.
Put away all group sensory activities (I.e. no group water or sand play). Only use individual sensory activities that are discarded after each child’s use.
Put a plan in place to close the outdoor sand box, if children cannot physically distance themselves from others (eg. Sand box is small)or other outdoor sensory activities (e.g. tarp, cones or tape).
Make sure to only have free running water when outside playing – so therefore no buckets or water tanks to play in – remove if water is still out.
Take out of cubbies all regular children’s personal belongings from cubbies and store in plastic bags, labelled with the child’s name until our regular children return to child care. Clean and disinfect all cubbies. Mark every second cubby (e.g. masking tape) so that there is a cubby left empty between each child’s personal belongings.
Discard any expired or opened/unlabelled food.
Take out of bins all regular children’s personal belongings from the diapering area and store in plastic bags, labelled with the child’s name until child returns to the center. Clean and disinfect storage baskets so they are available for the children.
Take inventory of personal protective equipment including disposable covers for ear probe thermometers, vinyl gloves, masks (only procedural or surgical grade and must be minimum Class 1 or ASTM Level 1) and goggles and gowns (from blood spill kit). Let your Supervisor/Manager know what you need.
Take inventory of cleaning and disinfecting supplies including detergent/soap, disinfectant, cleaning supplies like cloths, disposable disinfecting wipes, liquid hand soap and hand sanitizer. Inventory of all required supplies per classroom, kitchen and full centre will occur. Inform your Supervisor/Manager well in advance if you require more supplies (before your supplies are depleted).
Take inventory of paper products including napkins, dishes, cutlery, disposable serving utensils, tissue, and paper towels. Inform your Supervisor/Manager well in advance if you require more supplies (before your supplies are depleted).
Purchase back-up diapers, diaper wipes, and snacks/lunches for everyone in case families are not prepared for emergency situations.
Rooms that do not have walls that go all the way to the ceiling between rooms, should have walls 8 feet high.
There will be one room designated as the isolation room for anyone that becomes ill during operational hours. The room will have a door that can close. All PPE must be in a place that is known by all staff in the event this process is enacted (masks, gloves, cot, lined bucket, etc.).
Families or guardians will be informed on the procedure for drop-off and pick-up. This will allot for Physical Distancing. Note: There will only be one family member allowed in the screening area at one given time.
The screening area as a best practice will be outdoors (front entrance), weather permitting
Post relevant information on the front door including:
- All signs and instructions
- Hours of operation and contact information.
- COVID-19 screening/information.
- List of items permitted in child care (eg. nut products, toys, etc)
- Address of short-term shelter/evacuation site.
Update emergency contact list and ensure all staff know how to contact each other and all families.
Short-term and long-term evacuation site must be contacted and accessible prior to reopening.
Communication Methods – Intercoms, Personal Cell Phones, Walkie Talkies (ensure what needs to be charged is charged). The screener will need some form of communication to contact those people inside.
Screening prior to approval and each day thereafter.
Tour and/or training for all new persons approved to drop-off and pick-up will occur prior to their first day. Limit of 1 adult at drop-off and pick-up and consistent members and only those that are approved with the registration.

Role of Supervisor or Designate

Provide all staff with a copy of these COVID-19 procedures and review/train staff so that they understand their responsibilities. Post a copy on the staff information board.
Supervisors will not be caring for ill children in isolation.
Ensure that staff know how to use PPE correctly, as per Public Health guidelines.
Reassure staff that masks/gloves are not recommended during regular activities – only when cleaning and disinfecting body fluids or caring for an ill child.
Be onsite during all hours of operation (or a designate).
Screening and registration. Record allergies/food restrictions, medication, and individualized plans (I.e. anaphylaxis, medical, special needs). Ensure there are emergency contacts in addition to immediate family.
Dispense all medication, with the exception of emergency medications.
Monitor symptoms of health of staff/children throughout the day.
Monitor throughout the day, that staff are implementing COVID-19 procedures.
Immediately report to the Public Health outbreak phone line, if a child, parent, or staff is suspected/confirmed positive for COVID-19. Follow all directions of Public Health.

Orient staff who are new to the centre. Take them on a tour, review the fire/emergency plan and all children’s emergency health information.
All media inquiries will go to the approved designated contact. This designate is the only person that will speak with the media or any other person with inquires, including the public/neighbours, etc.
Ensure all Policies are being followed. Staff who are unable to provide an updated PRC VSS will be required to sign a declaration allowing them to update their PRC VS within 6 months.
Review PPE procedures with staff weekly.

Role of Staff

Welcome children and help them choose a cubby to store their personal belongings and assist them to wash their hands before entering the classroom.
Add child to the attendance list.
For many children, it will be like starting on their first day of child care all over again. Be patient with children. Allow them time to re-familiarize themselves with their environments, educators and peers.
Provide play-based activities or experiences based on children’s ages and interests and keep parents updated.
Provide as many opportunities of programming as you are able to, keeping in mind current limitations or restrictions to:
- group sensory activities
- soft/plush toys, dress-up clothes, rugs, pillows, blankets, and furnishings
- singing – in closed spaces, areas that are not easy to clean (singing can be directed to an outdoor activity)
- neighborhood walks – social distancing must be respected
- sending art work home only after minimum 7 days of quarantine
Assist with cleaning and disinfecting.
During lunch breaks, observe Physical Distancing from all staff, and wash hands before starting work again.
Send all children’s personal belongings home at end of day to be cleaned and disinfected.
Children must not share soothers, bottles, sippy cups, facecloths, etc. Label these items with the child’s name to discourage accidental sharing.
Report any health or safety concerns to your Supervisor immediately.
Practice and respect confidentiality at all times.

Scheduling Staff

Supervisors or their designate are required to be on site during all hours of operation.
Maximum group size is a cohort of 10 (includes children and adults).
It is preferred that children of staff members remain in the same group as their parent .
It is preferred that siblings remain in the same group.

Ratios must be maintained in accordance with the CCEYA.
When possible, try to have additional staff to ensure proper ongoing cleaning and disinfection. Where possible, these staff will not be included in ratio.

The cook will have their Food Handler Certificate.
When possible there will be a supply/back-up staff available in the event that a staff is unable to report to work.

Staff included in ratios and all home child care providers are required to have valid certification in first aid training including infant and child CPR, unless exempt under the CCEYA
- *special note – the WSIB has indicated that all certifications that expire after March 1,2020 are automatically temporarily extended until September 20, 2020.
All staff and other persons who are interacting with children at the premises are required to obtain a VSC.
Service providers are not required to obtain a new VSC from staff or persons interacting with children where the fifth anniversary of the staff or person’s most recent VSC falls within the emergency period, until 60 days after the emergency period ends

COVID-19 Parent Information *Provided to Each Parent and/or Guardian

You and your child(ren) will be screened each day for COVID-19.
We encourage the same parent/guardian to drop-off/pick-up child. We request this be limited to 1 person at a time and consistent if possible (18 years of age or older).

Bring all required diapers, wipes, creams, medications/Epi-Pen, approved food (if required for health reasons), change of clothes and clothes to play outdoors every day. Diapers and wipes can be left overnight.
Label all items with child’s name.
If someone in the household develops signs of COVID-19 (cough, fever, difficulty breathing) stay home and contact health care provider and the centre immediately.
Do not bring any food, especially any peanut or nut products into the centre. Special approval by the Supervisor must be provided to bring food from home into the centre.
Parents will not be permitted to enter the child care facility (limited to the screening area only).
Explain importance of the emergency pick-up person.
Providers will ensure freshly laundered blankets/sleep toys are done each day at the child care centre.

Personal Protective Equipment (PPE)
The below procedures are for staff that are required by Public Health to wear (PPE). Training will be provided on the below instructions.

https://www.publichealthontario.ca/-/media/documents/poster-ipac-pss-removing-ppe.pdf?la=en

The Supervisor will review how and when to use PPE with all staff prior to working and on a regular basis to ensure staff understand how to put on and take off their PPE.

DAILY OPERATIONS

Screening Process During the Initial Orientation

*The screener will have PPE as recommended by local Public Health

Questions – please visit website for most current list of sample questions to ask: http://health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_patient_screening_guidance.pdf

First welcome and greet all families and children. We want to make sure the process is as natural as possible for the children (our new norm).
Let them know you are going to ask them some screening questions, and then take their temperature and record all the information.
Ask parent to practice Physical Distancing and to use hand sanitizer provided.
Take temperature of child and parent/guardian and record all information. Temperature must be lower than 37.8.

If the participant answers “NO” to all questions, they have passed the screening process and can enter into program.
If the participant answers, “YES” to any of the questions or refuses to complete the form, they cannot enter program. *Some discretion can be used during allergy season (runny nose, watery eyes with no presenting symptoms of illness or being unwell). Consult with Public Health if unsure.
Explain “Unfortunately, because you answered ‘yes’ to one or more of the Ministry of Health screening questions, we are unable to let you enter our program today. If you have not already done so, please reach out to local Public Health (contact numbers are listed at the end).
Families will be trained on the daily routine for arrivals and departures and informed that entering the facility is not permitted. Physical Distancing between families and children should occur whenever possible during drop-off and pick up times, therefore, families will be required to remain in their vehicle until the parent before them leaves the screening area.
Parents and guardians will have access to the vestibule screening area only, as all inside areas in the child care centre are off limits to families to help reduce the risk.

Screening Process (Replaces Daily Health Checks)
Families will be trained on the required ‘drive-up’ process for drop-off and screening to ensure Physical Distancing (PD). The screener will have on approved personal protective equipment (PPE) as recommended by local Public Health (face mask, shield, gloves, gown- if carrying a child in).

Staff, children and parents/guardians will be required to take their temperature before arriving at the child care centre. If unwell, they are not to arrive at the child care centre and call the Supervisor immediately. If a parent/guardian is sick, the child cannot attend and the Health Unit shall be notified immediately.

Screening questions can be done in person, over the phone or using an online document to complete prior to arrival.

The Supervisor or designate is responsible for all screening of staff, families, and children every day.

Screening will be conducted outdoors (weather permitting) or in the vestibule area with open doors.
Stagger arrival/departure times of parents. Parents will be required to remain in their vehicle until the next parent has left the screening area.
Screener to wear mask, eye protection and gloves.
Parents will not be permitted to enter into the child care centre (only screening area)
Visitors will not be permitted in the centre except essential workers (eg. Maintenance) but proper PPE needs to be worn, and they will be screened.
Any child or staff with the symptoms below will be excluded and both the Agency and the parent are to call local Public Health and follow all their directions (Supervisors to follow Serious Occurrence Procedure):
- Severe difficulty breathing (struggling for each breath, can only speak in single words)
- Severe chest pain (constant tightness or crushing sensation)
- Feeling confused (for example, unsure of where you are)
- Losing consciousness
- Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)
- Chills
- Cough that’s new or worsening (continuous, more than usual)
- Barking cough, making a squeaky or whistling noise when breathing (croup)
- Shortness of breath (out of breath, unable to breathe deeply)
- Sore throat
- Difficulty swallowing
- Hoarse voice (more rough or harsh than normal)
- Runny noses (stuffy or congested nose)
- Lost sense of taste or smell
- Headache
- Digestive issues (nausea/vomiting, diarrhea, stomach pain)
- Fatigue (lack of energy, extreme tiredness)
- Falling down more than usual
- For young children and infants: conjunctivitis, sluggishness or lack of appetite

In consultation with Public Health, the screening staff is able to use their discretion (on both staff and children) where the individual presents with known symptoms (i.e. allergies, migraines, etc.) or are easily tied to unrelated events (tired in morning from late night, allergies, prone to migraines, etc.). The individual will be carefully assessed throughout that day. Consult with Public Health if unsure.

After screening is completed, the parent/guardian will leave their child with a program staff member and must ensure that any forms, information, or medication is complete and given to them. At no time can the parent enter the child care centre (only in screening area).

Staff Personal Belongings & Routines

Bring only what is necessary into centre.
Each staff is designated a space to store personal items that is separate from other staff. Each staff member is responsible for cleaning and disinfecting their area at the end of each shift.
Staff room/washroom – each staff member is responsible for cleaning and disinfecting after each use.
Office – each staff member is responsible for cleaning and disinfecting after each use including – desk, phone, computer, chair arms, door handles, and light switches.
Staff are to practice physical distancing whenever and wherever possible with one-another.
As a best practice, we recommended staff to wash their hands and their clothes when they arrive home.

Storing PPE When Not In Use

PPE should be stored in a way that it is protected from contamination (sealed bag or container).
Reusable masks should be taken off carefully and stored in a paper bag with the staff member’s name on it
Gloves should be disposed of.
Goggles and face shields can be disinfected and stored away from contamination.
Gowns can be hung in a place where they ae not touched or additionally contaminated. They can also be discarded after each use.

Cleaning & Disinfecting

Cleaning – removing all visible dirt from the surface of an object. Use detergent/soap and water and do not forget to rinse off detergent/soap residue.
Disinfecting – reduces germs on a surface and is done after cleaning. Ensure you understand the correct concentration of disinfectant to use during outbreaks, that disinfectant is not expired (discard mix everyday), and that you are leaving disinfectant to remain on surfaces for the correct contact time (I.e. don’t wipe disinfectant off immediately). If using Virox, follow the strict guidelines for use (spray on towel or cloth, let sit for the required time and rinse). Children should be away from tables or other surfaces when they are being disinfected. You are able to use other cleaners as approved by your local health inspector.
Virox can be used but it is preferred that it is not sprayed on any toys. Toys can be washed in the dishwasher.
Use of Personal Protective Equipment (PPE) – gloves, goggles, masks, gowns – read the label of the approved disinfectant or look up the manufacturer’s instructions on the internet to determine which PPE is required. Typically, PPE is only required if cleaning up body fluids (saliva, urine, stool, vomit, mucus, blood). Always wash your hands after removing gloves.
When possible, do cleaning and disinfecting when children are not present.

Before re-opening the child care centre for emergency child care.
Before eating, clean and disinfect tables.
After children leave a room, clean and disinfect all high touch areas and shared toys/equipment.
After all children have left for the day, before you close, clean and disinfect all cubbies.
After a child puts a toy in their mouth, sneezes or coughs on toys, take the toy out of rotation and clean and disinfect.
Washrooms, including sink faucets, toilet flusher, and soap dispensers should be cleaned and disinfected frequently throughout the day, and also after every washroom routine.

Enhance cleaning every night in all areas, on all touched surfaces.
Increase the use of anti-bacterial hand sanitizers and disposable gloves.
Increase cleaning and disinfecting for all electronic devices, such as site phones and iPads after each use, as well as staff cell phones and personal items (water bottle, thermos, etc.)
Instruct employees to wash/scrub their hands, and children’s hands, a minimum of hourly, which has been proven by the Centre for Disease Control to be the most preventative measures.

Cleaning & Disinfecting Body Fluids

Treat all body fluids (e.g., saliva, urine, stool, vomit, mucus, blood), as potentially infectious.
Take photo(s) and/or be able to describe in detail any body fluids that could be potential symptoms of COVID-19 for Health Unit.
Wear single use non-latex gloves when there may be contact with another person’s body fluids such as when cleaning cuts or scrapes, cleaning up blood, vomit and/or stool from surfaces or contaminated linens, and changing diapers.
In addition to gloves, staff should wear a mask when cleaning up vomit or bodily fluids from a contaminated surface.
An apron, gown or separate set of clothes may be used if direct contact with body fluids is likely to occur.

How to Clean and Disinfect Body Fluids

Put on gloves and mask.
Clean up body fluids using a disposable absorbent cloth (e.g., paper towel).
Clean the area with detergent/soap and water, then rinse off detergent/soap.
Disinfect the area using the manufacturer recommended concentration and contact time.
Discard contaminated paper towels, gloves, etc. in a plastic bag. Tie closed and place with regular trash.
Contaminated clothing can be wrapped tied closed in a plastic bag and sent home for cleaning. Normal detergent and laundry cycles are effective.
Wash hands after removing gloves.

Use of Thermometers

Best practice is the use of digital infrared forehead thermometers. However, if this is not possible the use of a digital with disposable covers or a disinfecting process for each use will be used. Public Health has approved this process.
If using the digital thermometer (where it is touching the person), the thermometer must be disinfectant after each use.

Approved Physical Distancing for Child Care Programs
Once the person has been screened and passed the process; physical distancing of 2 metres in the actual child care centre/classrooms will not be required. However, activities will be setup to allot for additional space between all children wherever possible.

Staff will practice social distancing inside the centre (i.e. lunch rooms, breaks, hallways, offices).
Staff will prevent groups (cohorts) to interact at any time or during transitions.
Avoid gathering in groups in one area (cubbies, outside).
Avoid holding hands, except in safety situations; ensuring proper hand hygiene is practiced.
Avoid sharing of toys and materials between children, where possible, without disrupting play.
Families will remain outside of the child care centre. They will not be permitted to enter the child care centre.
Reduced child care centre operating capacity.
Children will remain in their assigned classroom; they will not transfer to another groups or classroom.
Set-up activities to provide larger distance between each child.
Place cots 2 meters apart where possible (minimum 1 meter – head-to-toe) when 2 meters is not possible.

Deliveries or Visitors

No one other than the approved (registered) staff and children will be permitted to enter the child care centre, with the exception of approved support workers, see below.

All deliveries will be left at the door, sign-offs will be waived.
If you are purchasing items, please ensure the company is aware of our process and no-one will be allotted to enter the child care facility.
In an emergency situation, at minimum, the screening process occurs before anyone can enter the centre (Public Health, other agency administrators, etc.).
Support Workers must be approved (by local Public Health, and DNSSAB) and must be exclusively working with one child care location and not be supporting other programs in the community. They are required to follow and sign off on the program’s Screening Procedures, COVID-19 Procedure and COVID-19 Assumption of Risk. In addition, they must follow Child Care & Child Protection Policies and requirements and the sections outlined in CCEYA for third party support staff.

Special Needs Resourcing Staff and Enhanced Staff (provided by agency to support group)

SNR Staff and enhanced staff who are on site and not counted as part of ratios are not included in the maximum capacity rules (eg. Not part of the maximum cohort size of 10- including children and staff)

SNR Staff and Enhanced staff supporting more than on cohort will be required to wear appropriate PPE which includes facial mask and eye protection and practice social distancing as much as possible.
Hand washing must occur upon entering/leaving each classroom.

School Board Staff

Janitors/teachers/contract workers do not need to be screened by the child care when they are entering schools as long as they use a separate entrance as they have procedures in place from their school board, and they do not have direct contact with children or child care staff.
If one of these criteria is not possible, people will have to be screened at the child care entrance by a child care worker.

Hand Hygiene and Washing

Hand washing is the best way to prevent the spread of illness for staff and children. Ensure an adequate supply of liquid soap and paper towels or a hot air hand dryer is in every washroom.
Wash hands using liquid soap and running water for 30 seconds. Can use a timer to help with this.
Staff are responsible for supervising children to ensure they are hand washing correctly.
If soap and water are not available, hands can be cleaned with an alcohol-based hand sanitizer that contains at least 70% alcohol ensuring all surfaces of the hands are covered and rubbed together until they feel dry. If there is no access to water and soap and the children are using the hand sanitizer, they must be supervised until the hand sanitizer has fully dried.

When staff must hand wash

When children must wash hands

After arriving to work & before leaving.
After removing gloves.
Before & after handling food, including eating.
After coughing, sneezing, or blowing your nose or helping a child.
After using the toilet or helping each child to use the toilet.
After each child’s diaper change.
Before and after administering medication.
Before and after cleaning/bandaging cuts, scrapes, wounds.
After cleaning & disinfecting.
When hands are dirty.
After playing outside.
After handling animals or their waste.

After arriving at the centre & before leaving.
Before & after eating.
After coughing, sneezing, or blowing nose.
After using toilet.
After diaper change.
After playing outside.
When hands are dirty.
After handling animals**

**No animals are allowed during an outbreak. Please place animals somewhere safe away from children and food preparation.

Hand Sanitizer

Limit the use of hand sanitizer to adults only (soap and water is the best method).
Using soap and water is the best method of cleaning hands. Use hand sanitizer when soap and water are not available.
If hands are dirty, they must be washed with soap and water before using hand sanitizer.
Minimum concentration of alcohol in hand sanitizer is 70%, the maximum is 90%.
Use enough hand sanitizer to wet hands for 15-20 seconds.
If you permit children to use hand sanitizer, ensure they are supervised, and that they do not touch their eyes, nose or mouth until it dries.
Infants should not use hand sanitizer as it is not good for children (or anyone) to ingest. Best practice is for the staff member to put on the hand sanitizer and hold the child’s hands by the wrists until it dries.

Cough and Sneeze Etiquette (Respiratory Etiquette)

Cover mouth and nose when you cough or sneeze with a tissue (use enough tissue so that fingers do not touch mucus).
Immediately dispose of tissue in a bin lined with a garbage bag and with lid.
Wash hands with soap and water.
Keep hands away from face.

Diapering and Toileting

Provide a bin for each child to store their diapers, creams, etc.
Clean and disinfect bins.
Purchase back-up diapers in case a family is not prepared.
Discard gloves and wash hands after diapering each child.
Assist child to wash hands after toileting and each diaper change.
Clean and disinfect diaper change table after each child.
Increase frequency of cleaning and disinfecting toilets, sinks, and after each toileting routine.
Provide a bin with a lid, lined with a garbage bag and take the garbage outside of the classroom when full.

Rest/Sleep

In new situations it may be difficult for children to fall asleep. Prepare to give reassurance and offer alternate activities if a child does not want to lie down.
Place cots 2 meters apart where possible (minimum 1 meter – head-to-toe) when 2 meters is not possible.
Wash sheets/blankets every day with regular detergent on the regular laundry cycle.
Disinfect cots prior to stacking.
Do not stack sheets/blankets with cots.
Ensure children only take out plush toys/blankets at sleep time and do not share with anyone (labelled Ziploc bag is a best practice if possible and refrain from bringing the stuffed toy back and forth from home).

Medication

Supervisors or RECE designate will be responsible for administering medication with the exception of emergency medication (I.e. Epi-Pen’s, puffers).
Follow the regular procedure for medication.
Ensure all medications are sent home at the end of each day.

Anaphylaxis

Ensure families and staff are aware of our policy regarding peanuts/nuts.
Follow the regular procedure for anaphylaxis.
Ensure all medications are sent home at the end of the day, if not a duplication.
Families will be asked to not bring lunch/snacks into the child care centre as per regular procedure. If there are special circumstances where food must be brought into the centre (special diet or allergies, etc.), the Supervisor must approve this plan and our regular policy will take effect (label and proper storage).
If a nut product or a known allergen that is extreme (I.e. child reacts to airborne/smells allergen), either provide the child with an alternative food from the pantry or move the child to another room to eat.

Food Handling

Designate one staff with a current Food Handler Certificate to be responsible for handling snacks/lunch and doing lunch checks. This person must not be the same person who is assigned to do cleaning and disinfecting, or the person assigned to look after ill children.

The best practice is to have the cook pre-plate and cover/wrap all meals just before serving. If staff are serving food, they must take extra precautions in plating away from the children and no child can self-serve. Unused food must be discarded in that classroom after use. There will be no family style serving where children self-serve. If there are special meals, the plate must be labelled with the child’s name.
Supervise the children at all times so they are not sharing food.
Food must be covered or wrapped when not serving.
Provide a bin with a lid that is lined with a garbage bag to discard food. Take outside each day (outdoor garbage bins).
Children must not prepare or handle food, therefore no cooking activities.
Bag lunches from home are allowed (if agency has a ministry approved Bag Lunch Policy)
- Clean hands before and after
- Ensure child’s name is on lunch bag
- Sanitize tables where lunch bags were on
- Sanitize cubbie where lunch was stored
- Where required, bag lunches should include freezer packs to ensure that food is maintained at a safe temperature and nutritional value is maintained.

MONITORING HEALTH OF STAFF, CHILDREN & PARENTS/GUARDIANS

Tracking Symptoms of Ill Health

The Supervisor is responsible for monitoring all staffs’ symptoms of ill health during the day.

Staff are responsible for monitoring children throughout the day for symptoms of ill health.
If staff observe children with symptoms of ill health, they must report their observation to the Supervisor immediately and it will be noted in the logbook.
Use the tracking system approved by Public Health.
Staff should be tracking all symptoms noticed, including non COVID-19 symptoms.

Isolating an Ill Child and/or Staff

If a child is observed to have symptoms related to COVID-19 or any other communicable illness, the child must be isolated from the group, under the supervision of 1 staff member.
Siblings are not to be put into isolation at this time, unless both are showing symptoms.
At minimum the child and staff should wear a mask (if tolerated, except if under 2, do not use) while calling Public Health.
The Supervisor will call the parent or guardian for immediate pick up (within 30 mins if possible depending on circumstances) pickup and Public Health for further directions.
The Supervisor will also advise the parent to contact their health care provider or Telehealth and the supervisor will also call local Public Health. Contact numbers provided at the end of this document..
If a staff member is observed to have symptoms related to COVID-19 or any other communicable illness, the staff is to go home, self-isolate and contact local Public Health for instructions. The Supervisor will also place the call to local Public Health.
If a staff or child in the cohort presents with COVID-19 symptoms, the NBPSDHU would declare an outbreak.
Staff should (if possible) keep as much distance as possible (2 meters if possible) from the ill child while maintaining appropriate supervision.
After the child is picked-up, a deep cleaning and disinfecting must occur (bedding, cot, equipment and full isolation room).
The remaining children from the ill child’s classroom will be removed from the classroom until the classroom is deep cleaned. The first location is to go outside, a secondary location if the outdoors is not an option is to be identified by the Supervisor and communicated to all staff
All other classrooms will be directed to stay in their classrooms.
The areas where the child was playing/toys must be cleaned and disinfected.
The Agency will contact local Public Health regarding any required next steps. Contact numbers provided at the end of this document.
Tissues should be provided to the child for proper respiratory etiquette, with proper disposal of the tissues and proper hand hygiene.

Managing a Situation when a child or adult Presents with COVID-19 Symptoms OR Is Presumed or Confirmed to have COVID-19

The information below has been sourced from the CDC and Public Health Ontario recommendations. All of these situations require you to notify local Public Health and take their direction on how best to proceed, as these instructions could change day-by-day depending on Public Health direction.

However, the following procedures were approved at the time this procedure was released. The Agency will update any procedures as requested by local Public Health. All presumed or confirmed cases must be reported to Public Health and is a reportable Serious Occurrence with the Ministry of Education and the municipality. Contact numbers are provided at the end of this document.

If a child staff, or family member develop COVID-19 or symptoms during the screening process (see screening symptoms), they will be excluded from entering the child care centre and immediately be asked to contact Public Health for further instructions. The Agency will also inform local Public Health and follow their instructions.
If a staff member is informed that a child or any of that child’s household members/contacts are known to have symptoms or a presumed or confirmed case of COVID-19, they will be excluded from entering the child care center and immediately be asked to contact Public Health for further instructions. The Agency will also inform local Public Health and follow their instructions.
If a child develops symptoms of COVID-19 while at the child care centre, staff will immediately separate the child to the isolation room and the parent/guardian will be called to pick up the child. If possible, the staff waiting with the child should stay 2 meters away and wear appropriate PPE (mask, gloves, and face shield). The Agency will call and inform Public Health and follow their directions.
If a staff member develops symptoms of COVID-19 while working at the child care center, the staff will be relieved so they can leave immediately and will be asked to contact Public Health. The Agency will inform Public Health and follow their directions.

A tracking system must be in place where all registered families and staff information is readily available to share with Public Health. Other people that could have been within the child care centre ‘bubble’ during this period will also be included in the tracking, therefore please ensure tracking sheet is completed daily and up-to-date at all times.

Agencies having to report to the Public Health any illnesses will want to inform the Public Health if the child/family were involved in Emergency Child Care at a different agency or program for contact tracing.

Children or Staff who have been exposed to a confirmed case of COVID-19 should be excluded from the child care centre until cleared to return by local Public Health.

Special Notes:

In the event of a presumed or confirmed case, that specific cohort will be required to go home and isolate. (e.g. for 14 days, or possibly longer if advised by local health officials.) The Agency will follow the direction provided by local Public Health.

If it is deemed a staff tests positive for COVID-19 due to a work-related exposure, the Agency Management/Administration will be notified immediately. The Agency will follow all guidelines as outlined in the Occupational Health & Safety Act.

Staff, children or their parents/guardians should not attend or work at another child care or emergency care facility where they could potentially expose others. It is also a best practice to not rotate staff from centre to centre.

In the event of a program closure, the duration of the closure will be dependent on staffing levels, outbreak levels in the community and severity of illness in infected individual. All directions will be taken by local Public Health.

The Agency will contact the Following Persons if there is a Presumed OR Confirmed Case of COVID-19

The following individuals will also be contacted
- Child Care Agency: Administration, Management and Board Members
- DNSSAB
- Follow the regular Serious Occurrence (SO) reporting requirements (including submitting a SO report in CCLS and posting the SO notification form)
- The staff must also complete an incident report (with parent signature), update communication book and ill health form in the respective classroom
- Parents of children enrolled at the child care centre will only be notified as directed by local Public Health

Testing for COVID-19

New employees returning to work do not need to be tested unless the child care is an agency requirement.
Children and staff changing sites do not need to be tested.
Symptomatic staff and children should be referred for testing.

Testing of asymptomatic persons should only be performed as directed by local Public Health or Ministry of Education as part of outbreak management

- Those who test negative for COVID-19 must be excluded until 24 hours after symptoms resolution.
Those who test positive for COVID-19 must be excluded from the child care centre for 14 days after the onset of symptoms and until clearance has been received from local Public Health.

Children or staff who have been in contact with a suspected COVID-19 case should be tested and monitored for symptoms and cohorted (i.e. grouped together) until laboratory tests, if any, have been completed or until directed by Public Health.
Staff members awaiting test results, i.e., random testing who are asymptomatic, may continue to work unless there is reason to believe they would be considered a case (e.g. potential exposure to an ill or positive case or household contact). Staff should be monitored for symptoms while waiting for test results. If they become symptomatic, they should be excluded from work.

All children or staff that are being tested is a reportable Serious Occurrence with the Ministry of Education. Notification in writing (email) must be given to the local Public Health, the Municipality and the Ministry of Education’s District Manager and Licensing Advisor. Please see contact information below.

In the event of a positive result, the staff or child cannot return to the child care centre and the Agency management/administration, Board members, local Public Health, Ministry of Education, and Municipality must be notified. If a staff tests positive, the entire Agency must be notified immediately and the program will follow the requirements as per the occupational Health & Safety Act.

Guidelines for After the Testing

Individuals (children/staff) may return to the child care centre once receiving a notice from the Health Unit that their test results are negative. The Agency must be provided with documentation from the Health Unit to validate. The two options are:
- The individual can contact the Health Unit and pick up test results in person; or
- The individual can login to the online portal (covid19results.ehealthontario.ca) and print/email a screen shot to the Supervisor. This
Due to the delay in this process, individuals can provide in writing, they have received negative test results and will provide documentation within 3 days.
If validation is not provided within the outlined time frame, children/staff will not be able to attend the child care centre.

RESOURCES/ SIGNAGE/CONTACTS

Important Resources

Ontario.ca/COVID-19
Contacting your Public Health Unit
What we know so far – PHO
Government of Canada COVID-19 Outbreak update

Important Signs to Be Posted in Centre

Proper Hand Washing /Hand Hygiene
Cover your Cough
COVID-19 Tips
Proper PPE
Isolation Room in Use

Contact Agencies/People

Agency

Contact Number

Telehealth Ontario

1-866-797-7000

Local Public Health-Regular Hrs

Local Public Health-After Hrs

(4:30 pm-8:30 am & Weekends)

705-474-1400

705-474-1400 Dial “0” and request to speak to the nurse on call

Municipality – DNSSAB:

Lynn Demore-Pitre

705-474-2151 ext. 3155

Regional Manager, North (A), Early Years & Child Care Division, Ministry of Education:

Colleen Watts

416-303-8925

Licensing Advisor:

Lily Boucher

705-495-1708

Important: This document is a living document and will be updated as required by local Public Health.

QUESTIONS & ANSWERS FOR CHILD CARE REOPENING

1. It is our understanding that inspections from the local public health unit are not required prior to opening each site. Is this correct understanding?

At this time, health inspections for each site are not required as part of reopening child care centres.

2. Under staffing (p. 7) it indicates that supply/replacement staff should be assigned to specific cohorts. Would it be acceptable for the same staff to be assigned to more than one room when it comes to cleaning/ breaks/lunches/ supporting at the end of day? In this case, programs could ensure that there is consistency with staff supporting the program while providing flexibility in meeting the ratios throughout the day. The Ministry has confirmed that there is flexibility; however, we are requesting guidance to take into consideration when trying to complete a staffing plan.

Mixing staff within cohorts should not occur. This means that staff must be assigned to each cohort. If support is required by a staff that is not part of the “regular cohort”, that staff will need to wear appropriate PPE which includes facial mask and eye protection. Hand washing must occur upon entering/leaving classroom.

3. Under staffing (p. 7) it indicates that supervisors and or designate should limit their movement between rooms, when absolutely necessary. Can the supervisor/designate support each classroom as required as they play an important role in support staff throughout the day?

The supervisors/designate will need to limit movement between each room. When needed, the supervisor/designate will need to wear appropriate PPE which includes facial mask and eye protection. Hand washing must occur upon entering/leaving classroom. Supervisors/designate must also try to practice social distancing whenever possible.

4. If we know children/families/staff have allergies and they present with a running nose & watery eyes, are they still permitted to attend the child care centre?

Recognize that seasonal allergies will be common, service providers must ensure to monitor symptoms daily. If an individual’s symptoms change or worsen, that individual will need to be removed from the program.

5. The guidelines state that the maximum capacity rules do not apply to Special Needs Resourcing staff on site (i.e. if they are not counted as part of ratios they are not included in the maximum capacity rules). Would this apply to enhanced staff that remain in the program and support with the group of children either half a day or all day?

Enhanced staff are permitted in the program and do not count as part of the cohort numbers as they are not to be counted as part of ratios. Enhanced staff supporting more than one cohort appropriate PPE which includes facial mask and eye protection. Hand washing must occur upon entering/leaving classroom.

6. The guidelines state that the maximum cohort size for each classroom in a child care centre will consist of no more than 10 individuals, space permitting. This includes both staff and children. A cohort is currently defined as a group of children and staff members assigned to them, who stay together throughout the duration of the program for a minimum of 7 days. We understand that the principle is to keep the same group of children/staff.

Are programs permitted to enrol children who share a space within those 7 days?
For example, Tigger will attend Monday, Tuesday and Friday while Pooh attend Wednesday and Thursday and/or Tigger and Pooh share alternate weeks (due to custody arrangements)

In both scenarios, the ratio will not be exceeded and the grouping of children/staff remains the same. Would this be acceptable?

Maximum group size is a cohort of 10 (includes children and adults). Children who are part time cannot share a space with another child

7. Avoid indoor singing activities (page 18) Can we still do singing if we make sure to do so in a social distance manner? For example, in the gym as opposed to sitting in small circle in the classroom.

Educators are permitted to sing with children as long as it has been during an outdoor group activity.

8. Page 19 refers to finding alternate outdoor arrangements if outside space is challenging. Can we go for community walks around the neighbourhood as long as we do our best to select routes that are not as busy as some other streets? Also, can our infant program go for walks? If yes, spacing in strollers? We have two 3 seat strollers and a turtle bus with six seats for older infants. Our room is licensed for 10 but would only have a max of 7 infants since we will have three staff.