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Health and Safety in the CACFP

Nutrition Services Division Management Bulletin
Purpose: Policy, Action Required, Beneficial Information
To: Child and Adult Care Food Program Day Care Home Sponsors and Center Sponsors Number: USDA-CACFP-14-2013
Attention: Child and Adult Care Food Program Sponsors Date: December 2013
Subject: Health and Safety in the Child and Adult Care Food Program
Reference: Title 7, Code of Federal Regulations , sections 226.6(c)(5)(i), 226.16(l)(2)(vi), 226.16(l)(4)(i)–(iv), and 226.16(d)(4)(viii); U.S. Department of Agriculture Policy Memoranda CACFP 13-2013

This Management Bulletin (MB) provides updated guidance from the U.S. Department of Agriculture (USDA) regarding appropriate action when Child and Adult Care Food Program (CACFP) monitors observe or suspect serious health or safety conditions in a day care home (DCH) or child care center. It offers information to help CACFP agencies detect and immediately report problems that may pose serious threats to children in care. It also instructs monitors to immediately report the situation to appropriate authorities and remain on the premises until those authorities arrive.

Background Information

The primary responsibility of CACFP DCHs and centers is to protect the health and safety of those in their care. CACFP regulations require sponsoring organizations to notify appropriate state or local licensing, health, or law enforcement authorities when they observe or suspect conditions that pose an imminent threat to CACFP participants or the public.

CACFP monitors must exercise good judgment when making a determination of an imminent threat, since not every licensing violation is an urgent issue. The American Academy of Pediatrics, along with other public health organizations, publishes a resource that provides specific guidance on managing, reporting, and documenting incidents that pose an imminent threat. The publication is titled Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs ( Caring for our Children ).

Sponsors can access information about this valuable resource on the Natural Resource Center for Health and Safety in Child Care and Early Education Web site at . This document recommends that child care facilities have a written plan for reporting and managing incidents that they consider to be threatening to the health, safety, or welfare of children, staff, or volunteers. Further, it recommends that child care facilities have procedures for training staff on the management, documentation, and reporting of such incidents.

When the monitor observes health and safety violations where an imminent threat is present, it is critical that the monitor respond appropriately and quickly to protect the safety of participants and the public. The USDA stresses that the health and safety of participants must always be the first and foremost consideration, and that CACFP monitors must respond in a fair and consistent manner.

Responding to Health and Safety Threats at Child and Adult Care Food Program Sites

When a monitor identifies an imminent threat at a CACFP site, the monitor must take the following actions:

  • Call the proper authorities immediately
  • Stay at the site until the appropriate authorities arrive and follow their instructions

The monitor must report the threat as soon as a threat is identified. Please note this is new guidance from the USDA. Monitors must now remain to report the situation while on site and stay until the authorities arrive.

Identifying Health and Safety Threats

CACFP agencies must train their monitors to recognize conditions that pose a threat to the health or safety of participants. Caring for our Children identifies the following situations as examples of imminent threats that should be reported immediately to the authorities:

  • Lost or missing child
  • Suspected maltreatment of a child
  • Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members while on the site of a child care facility
  • Injuries to children requiring medical or dental care
  • Illness or injuries requiring hospitalization or emergency treatment
  • Mental health emergencies, such as threats from impaired family members who have easy access to a secured building
  • Health and safety emergencies involving parents or guardians and visitors to the child care facility
  • Death of a child or staff member, including a death that occurred outside of child care hours which was a result of serious illness or injury at the child care facility
  • The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility

Other examples of situations that could pose an imminent threat to children’s safety include leaving a child unattended, the existence of child play areas with easy access to busy streets, or aggressive animals in the children’s areas of care.

Action Steps When Health and Safety Threats Occur in Day Care Homes

CACFP regulations provide DCH sponsors the authority to act when they suspect that children are not safe in a DCH, or when the DCH is engaging in activities that threaten public health or safety (Title 7, Code of Federal Regulations [7 CFR ] Sections 226.6[c][5][i] and 226.16[d][5][viii]). USDA guidance requires CACFP monitors to take the following actions:

  • Initiate a suspension

When the DCH is suspended, their participation, including all program payments, remains suspended until the CDE completes an administrative review. If the CDE overturns the suspension following the administrative review, the DCH may continue to participate in the CACFP and may claim reimbursement for eligible meals that were served and documented during the suspension period.

  • Declare the home seriously deficient and initiate the serious deficiency process (7 CFR 226.16[l][4])

The monitor must take this action regardless of whether the licensing authorities still have investigations or formal procedures pending or underway. Applying the serious deficiency process further minimizes risk to the CACFP and reinforces the sponsor’s authority to determine whether a facility meets the requirements for participation in the CACFP.

  • Follow protocols to immediately stop payments to the DCH
  • Notify the DCH immediately in writing that its CACFP participation is suspended, that it is being declared seriously deficient, and that the sponsor proposes to terminate the DCH’s Agreement for cause
  • Provide a copy of the above DCH notification to the California Department of Education (CDE)

Providing a copy of the DCH notification to the CDE will alert the Department to the problem, allowing the CDE to monitor the situation, and provide technical assistance as needed.

Action Steps for Monitors When Health and Safety Threats Occur in Centers

The above instructions and action steps apply to detecting and reporting incidents of imminent threats that may occur in any CACFP setting, including independent child care centers, adult day care centers, at-risk afterschool centers, and emergency shelters.

When addressing health and safety issues in sponsored centers, CACFP sponsors should use the process they have developed for notifying centers of suspensions, serious deficiencies, and the withholding of payments.

In the case of independent centers, a CDE monitor who identifies health and safety threats must take immediate action and follow the requirements for suspension of the independent center’s participation (7 CFR Section 226.6[c][5][i]). Monitors must also initiate the process for declaring the center seriously deficient and for withholding payments to the center.


The CACFP Unit will develop written standards by June 2014 to help monitors identify and measure the severity of a health or safety threat, along with procedures for monitors to follow once a threat is detected. The CACFP Unit will announce these standards in an MB, and will include them in annual mandatory training in Program Year 2014–15.


If you have any questions regarding this MB, please contact your CACFP specialist. You may contact Kayla Christensen, Community Nutrition Programs Administration Unit Office Technician, by phone at 916-324-6153 or by e-mail at , to be directed to your CACFP Analyst.

Questions:  Nutrition Services Division | 800-952-5609

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