HomeMy WebLinkAboutHornet Soccer Camp 7/16/2018Commonwealth of Massachusetts
Town of Mansfield
Town of Mansfield 6 Park Row
Mansfield, MA 02048
Board of Health
License to Operate a Recreational Camp I
This is to certify that: KEVIN SMITH
20 PHEASANT LANE
ATTLEBORO
MA 02703
Is hereby granted a HORNET SOCCER CAMP
permit for:
at PLYMOUTH STREET SOCCER FIELDS, PLYMOUTH ST.
MANSFIELD
MA 02048
This permit is granted in conformity with 105 CMR 430.000, Minimum Standards for
Recreational Camps for Children, State Sanitary Code, Chapter IV, Department of Public
Health, and expires on closing date of each session unless sooner suspended or
Date(s) of Operation: MONDAY JULY 16, 2018 -FRIDAY JULY 20, 2018
MONDAY JULY 23, 2018 - FRIDAY JULY 27, 2018
Hours of Operation: 9:00 AM - 3:00 PM
Date Approved:
BOARD OF HEALTH
9blichaeCNcCCean, Chairman
DEPARTMENT OF PUBLIC HEALTH - COMMUNITY SANITATION PROGRAM
105 CMR 430.000: MINIMUM STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN
STATE SANITARY CODE, CHAPTER IV
NAME OF CAW:ADDRESS:
. I -
CAMP DIRECTOR:
Current Certificate(s) of Inspection from local
TYPE OF
..y , I
. � ...
INSPECTED BY:
"No" column = ✓ marked below indicates a violaflon of 430.000.
"Yes" column = ✓ marked below indicates compliance with provision of 430.000.
"N/A!'column = V marked below indicates that the provision of 430.000 is not applicable to this camp.
430 -Camp Inspection Form 3-27-18 Page I
Current Certificate(s) of Inspection from local
x
.451
building inspector for sleeping/assembly areas.
.215
Written compliance from local fire department.
.300(A)(2)
Private water supply:
(a)
DEP approval (>25 people,>60 days/yr)
y
Private water supply: (Q5 people OR <60days/yr)
.300(A)(2)
BOH approval, chemical & bacterial analyses, no more
(b)
than 45 days lr or too enin
CAMP'"P9T�iCIES-
W�iT�....
Procedures for Background Review of
.090(A)
Staff and Volunteers.
Staff— CORIand SORI
/
ire r" v-x�`�
.090(C)
Previous Work History (5yrs) — 3 Positive Reference Checks
Out-of-state/International Criminal Background Checks
Volunteer Staff— CORI and SORI
\ /
.090(D)
Previous Work/Volunteer History (5 yr,
Out-of-state/International Criminal Background Checks
ly\
All Background Info - Received, reviewed, & made
.090(F)
determination required pursuant to .090 (C&D).
c
.091
Staff/Volunteer Orientation: Orientation Plan &
need u� e �� a- mac. car
.159(B)(1)
Attendance Records, Training on Disaster/Emergency
.210
Plans, Health Care Policies, & Concussion Awareness
Abuse & Neglect Prevention Policies & Procedures
.093
Report procedures in accordance w/ M.G.L. c. 119, § 51A
11
Written notification to MDPH and BOH.
Discipline Policy: Appropriate Discipline Methods &
Prohibitions: (1) Corporal Punishment, including
spanking, is prohibited; (2) No camper shall be
.191
subjected to cruel or severe punishment, humiliation, or
verbal abuse; (3) No camper shall be denied food, water,
II
or shelter; (4) No child shall be punished for soiling,
wetting or not using the toilet
430 -Camp Inspection Form 3-27-18 Page I
CAMP PLANS - WRITTEN
.210(A)
Fire Evacuation Plan and Drills v kax�--- -�\.wo:.p.
.210(B)
Disaster/EmergencyPlan a CN.oaQ ., o,,�_!�
.210(C)
Lost Camper Plan / Lost Swimmer Plan
.210(D)
Traffic Control Plan
SPECIAL CONTINGENCYPLANS- DAY CAMP
.211(A)
Camper doesn't show up for day.
.211(B)
Cam er doesn't show up at point of pick up.
.211(C)
Child not registered anives.
Promotional Literature/General'Re uirement
Copy of Policy (Parents/Guardians): Care of
y �Q� `"
.159(B)(2)
Mildly Ill Campers, Administration of Meds &
Emergency Health Care Provision,`�`�
.157(0)
Meningococcal Disease & Immunization info
provided to parents/guardians annually.
.190(B)
Camper released only to Parents/Guardians or
Designated Individual with written authorization.
Regulatory Compliance & Licensing Statement:
.190(0)
"This camp must comply with regulations of the MDPH & be
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CT/�� �-� > C"
licensed by the LBOH."
.190(D)
Inform parents of right to review background
\ y
(at time of
check, health care, discipline policies and grievance
application)
procedures upon request.
190(E)
Protocol in place to handle unrecognized persons at
camp.
`
FIELD TRIPS
.212(A)
Written itinerary provided to parents/guardians
before de arhrre.
212(B)
Source of emergency care identified; minimum 1
health care supervisor accompanying hip.
Health records easily accessible for all
.212(0)
campers/staff, medications stored securely and
accessible only by HCS. First aid kit present.
212(D)
Written contingency plans brought on all field trips:
\
(natural disasters, lost camper/swimmer, injuries and illnesses)
TRANSPORTATION
Vehicle must comply with M.G.L. c. 90 §§ 7B & 713:
<14 passengers & driver is camp coach, director, etc.
.250
camp vehicles may be used
>14 passengers, vehicle must be school bus
All vehicles RMV compliant w/ annual safety ins
.253
Proper automobile insurance.
.251(0)
Seatbelts must be worn.
1 staff person required when transporting:
Campers to the pick-up/drop-off site; or
.251(D)(E)
8+ campers under 5 yrs. of age; or
2+ campers with physical handicaps.
.251(1)
Camper under 7 yrs. are not transported longer than
1 hour non-stop.
Camp vehicle drivers: 18 yrs.+, 2yrs, driving
.252
experience, current license for Type of vehicle.
\�
First Aid certified if no other trained staff aboard.
430 -Camp Inspection Form 3-27-18 Page 2
430 -Camp Inspection Form 3-27-18 Page 3
Camp Director:
.102(A)
Residential: 25 yrs.+, successful completion of Camp
Administration Course or 2+ seasons experience.
.102(B)
Day: 21 yrs.+, successful completion of Camp
Administration Course or,2+ seasons experience.
Primitive, Travel, Trip: 25 yrs .+ and proof of
.102(C)
experience.
Designated Substitute:
102(D)
Substitute must meet above criteria.
Counselors/Junior
Counselors:
Day Camp, Non -Sport:
•-
.100(0)(2)
Counselor = 16 yrs.+ Junior Counselor =15 yrs.+
.100(A)
4+ weeks experience & attend orientation and training
Residential, Primitive, Sport, Travel, Trip, Medical:
.100(0)(1)
Counselors =18 yrs.+ or graduated fiom high school
.100(A)
Junior Counselors =16 yrs.+
4+ weeks ex erience & attend orientation and training
.100(C)(3)
All counselors 3 yrs. older than campers.
Required Counselor Ratios:
Residential / Day / Sports Camps:
�,���-� , a 7)
.101(A)
1 counselor per 10 campers 7 yrs. or above
1 counselor per 5 campers under 7 yrs.
Primitive/Outpost, Travel, Trip Camps:
.101(B)
1 counselor per 10 campers - 1 counselor at least 21 yrs.
.159(C)
2 counselor minimum with 1 counselor having First Aid
Certificate or its equivalent
Camps:
'10"")
Staffin plan to supervise campers w/ disabilities
Staffing p p
.103
timing regular and specialized high risk activities.
\I
.020
Lifeguard certification, 21 yrs +, 6 weeks previous
.103(A)
experience in similar supervisory position.
1/
At least 16 years old with [American Red Cross
Lifeguard Training Cert/Royal Bronze Medallion/Boy
.020
Scouts Lifeguard Cer"CA Lifeguard Cert]* AND
.103(A)
CPR AND First Aid Certificate*
*Or their a uivalent
Ml)/DO NP PA (with documented pediatric training)
9 a
.159(A)
*Check for Health Care Consultant Agreement*
License #:
Develop written orders to be followed by HCS,
.159(A)(6)
including responsibilities for medication
administration
e{`
.160(C)
Develop a written list of all medication
nU)
administered at camp
HCC Provided & Documented Trainings:
V('
.160
HCS required trainings, signs of hypo/hyperglycemia,
-
(E)(G)(H)
diabetic plan management, and administering epi -pen
with evidence of competency
430 -Camp Inspection Form 3-27-18 Page 3
tv�i o« �c �G��
HBa1tC► Care Sllp6x1�.90X' �5�+
(lillCaifi s"mustlraveafleasflHCSons0eGt'al,`(.tnnes
u
.020
MD PA NP RN LPN or...
.159(C)(E)
V18 rs.+, First Aid & CPR certified
159(B)
Camp Health Care Policy
.160
ALL Medications stored -in Original Containers
\c � S
(A)(])
(A)(])
and meds properly disposed of with dis osal log.
160(B)
Meds stored in secured manner (ACA standards)
Medication refrigerator temp 36°F - 46°F
\
Written Medication Administration Policy:
160
Medication administered by HCC authorized staff only;
\c `C
(C)(D)
oral/topical medication administration training; and
epi -pen and insulin use.
.163
Sunscreen policy with parent/guardian sign off.
155
Medical Log:
`U
Readily available and signed by authorized staff person
.154
Injury Report completed for a fatality or serious
\V\ w`
injury. Copy sent to MDPH and BOH.
(�
Day / Residential Camps - infirmary provided
161(A)
Residential Camps - Easily recognizable and
accessible during the day and night.
.453
Lighting provided in infirmary.
Residential Camp - Area for isolation of ill child
.161(B)
with ability to provide negative pressure.
First Aid Kit: meet ANSI Z308.1-2015 standards
.161(C)
Minimum: 1 Class B kit and 1 Class A kit
.140 &
Medical/Biological waste managed in accordance
/
F
1600
with 105 CMR 480.000.
maw=
OEM=
Health Record for each Camper & Staff:
.150
StaWCamper < 18 yrs: Emergency Contact Info,
.160(D)
Written Parental Permission for Meds, Emergency Care,
190(A)
and Self -Administration of epi -pan or insulin
Camper > 18yrs: Emergency Contact Info
Residential, Travel, Trip, Sports–Medical History &
.151(A)(B)
physical within past 18 months
Day – Medical history signed off by Parent/Guardian
1
Campers and Staff under 18vrs:
Number of records checked:
/—
.152
Campers and Staff over 18 -yrs:
Number of records checked:
.152
p
.153
Exemption Documentation
430 -Camp Inspection Form 3-27-18 Page 4
430 -Camp Inspection Form 3-27-18 Page 5
r
Activities and physical environment meet the needs
.190(A)
of campers; do not pose hazard to healtb/safety.
Swimming Pool: in compliance with
.430
105 CMR 435.000- Permit Posted
Compliant w/ VGB Act & Pool Fence Requirements
Bathing Beach: in compliance with 105 CMR
.432
445.000 - weekly water sampling, water clarity,
andritig buoy present
.204(0)
All camps in compliance with 105 CMR 432.000
Christian'sM.G.L.
c. 111 § 127A/2
,204(C)
.204(0)
Swim test to classify swimmers by ability at pools
.430(B)
and beaches (Christian's Law).
Proper supervision at swimming venue:
.103
1 lifeguard per 25 campers
.204(D)
1 counselor per 10 campers
Plan to check swimmers - "buddy system"
50+ kids in/near water Aquatics Director must be present
Swimming areas clean and safe, no swimming at
.204
undesignated sites or at night without lighting.
.204(F)
Piers, floats, and platforms in good repair.
r
watercraft: equipped with USCG approved
2040
*204(
flotation devices and worn b all campers and staff
engaging in watercraft activities.(paddte boards included)
White water, hazardous salt/fresh water activities:
.204(l)
Campers certified with ARC Level 4+ Certificate
or equivalent.
White water, hazardous salt/fresh water activities:
.103(B)
Minimum 2 counselors in separate watercrafts
1 counselor per 10 campers (counselor must have lifeguard or
small craft safety and basic water rescue cert, orequivalent )
CRAFTS:
.205
Equipment in good repair, safety precautions taken.
.206
Equipment properly maintained, fields/surfaces
(A)(B)
free of holes/accident hazards.
Playground equipment securely anchored with no
1\
.206(C)
concrete under/around it, and pliable swing seats.
.................................. .
ARCHERY:
amen/Certs:
.202(A)
Equipment in good condition, stored locked.
Range away from other activity areas, clearly
.202(B)
marked danger area with 25 yards clearance behind
each target. Common firing & ready line in place.
Personal weapons allowed with camp operator's
.203
written permission.
.103(E)
1 counselor per 10 campers at range at all times.
430 -Camp Inspection Form 3-27-18 Page 5
430 -Camp Inspection Form 3-27-18 Page 6
Names/Certs:
Firearms in good condition, stored in locked
.201(A)
cabinet. Ammunition locked in separate cabinet.
.201(B)
Shooting range away from other activity areas.
Only non -large capacity, single shot rifles
.201(C)
permitted.
.201(D)
Firing line in place, no crossing without instructor's
.201(E)
permission.
Direct Supervisor: NRA instructor's certification
.103(D)
and maintain compliance with applicable M.G.L.'s
1 counselor er 10 campers
c.
1tUEB�1C12iD �- �
aures/Certs.
.103(1)
Excursions: 1 Certified Instructor per 10 campers
.208(A)
Minimum 2 counselors present during excursions
'
In accordance with M.G.L. c. 128, § 2A
.208(A)
Riders must wear hard hat at all times.
.208(B)
Licensed stable in use.
G�AT�I.EI�C:'�
GO„III24�� A1�i17i C`I°iIlYII#ING WAT�LS`.. ;_:
Operator:
Licensed and maintained in accordance with
.103(G)(1)
520 CMR 5.00 — Amusement Devices
1'
.103(G)(2)
Annual inspection with written report
.103(G)(3)
1 counselor per 10 campers at all times
CABINS & STRUCTURES
.457
Day Camp provides shelter for on-going camp
\'
activities with certificate of inspection.
x
Residential - Smoke and carbon monoxide
.216
detectors provided.
.456
Adequate egresses free from obstruction (780 CMR).
.453
Lighting provided for stairways.
All structural and interior elements maintained in
.454
good repair and in a safe and sanitary condition.
SLEEPING AREAS - RESIDENTIAL
CAMPS
Provide adequate space:
Single bed: 40fl /person;
v
.458
Bunk bed: 35ft /person ;
f
501f/person requiring special equipment
Provide separate bed/cot per person with:
.470
6 ft. between individuals heads; and
\
31. between single beds & 4'/2 1. between bunks
I
Campers and staff with limited mobility housed on
.459
ground level; egresses leading to grade or ramp
provided.
Screens & screen doors provided. All doors
.452
equipped with a self-closing device.
All structural and interior elements maintained in
454
good repair and in a safe and sanitary condition.
TENTS
Clearly labeled as fire resistant. No open flame in
217
or near tent.
4
430 -Camp Inspection Form 3-27-18 Page 6
::MEMO=
TOILETS/HANDWASH SINKS/SIOW1JR5
ENNEEMENOM
.360
Proper sewage disposal.
.301
Plumbing maintained in good working order.
Adequate # of toilets:
All Camps: Min. 2 toilets/privy seats for each gender
Day Camp: >60 of one gender, provide 1 more toilet
370
for each additional 30 persons of that gender.
Residential: >20 of one gender, provide 1 more
toilet for each additional 10 persons of that gender.
Toilets less than 200 feet from sleeping rooms.
Toilet paper provided.
X
372
Windows/ openings screened. Screen doors self-
elf-closin
.
closing.
Adequate # of sinks in compliance w/ 248 CMR:
.373
Day Camp: 1 sink per every 30 people
Residential Camp: 1 sink per every 10 people
Adequate # of showers (no duckboards):
.374
Residential Camp: 1 shower/tub per 20 people
378-.380
Campers with special needs provided sanitary
facilities meeting their needs.
.453
Lighting provided.
y
Adequate ventilation provided for all bathhouses,
.375
dressing rooms, shower rooms, and toilets for
indoor/outdoor pools.
Hot Water in sufficient quantity and pressure:
.376
Handwash Sink: 110°F - 130°F
Shower/Bathtub: 100°F - 112°F
.374(B)
Sanitary facilities maintained in clean condition.
y
�� + �� cu wV'O
.377
Shower room floors washed daily.
LAUNDRY
.162
Residential Camp: Laundry facilities provided.
.472
Bedding and towels laundered; no common towels.
GROUlyDS
.300
Potable water provided.
.300(B)
Adequate and centralized drinking water facilities.
.304
No common drinking cups.
.350/.355
Proper storage and disposal of solid waste.
y
Residential/Day Camps: Immediate access to reliable
209
phone with posted dialing instructions &
(or have readily accessible) telephone numbers for
HCC, police, emergency medical services, fire dept.
.213
Emergency Communication System
r O\R ✓\
Site location does not cause undue traffic hazards
.450
and is accessible at all times.
430 -Camp Inspection Form 3-27-I8 Page 7
MENEM-
'GROUNDS
.165
Tobacco use prohibited at camp.
X
.166
Alcohol and marijuana use prohibited during camp
K
operating homy.
207
Proper storage and operation of power equipment
u
Power tools stored in locked place.
.214
Flammable and hazardous materials labeled and
stored in locked unoccupied building.
.400
Rodent and insect control.
x
.401
Weed and noxious plant control.
FOOD SERVICE
Food service in compliance with 105 CMR
590.000, Minimum Standards for Food
SIG
.320
Establishments. Prominently displayed food permit
from BOH.
320(B)
USDA Summer Food Service Program—written
documentation of compliance with 105 CMR 590.
Nutritious meals that include a variety of foods
.330
served. Menus posted.
Residential, Travel, Trip camps — Provide at least
.331
3 nutritious meals per day. Foods must meet
recommended dietary guidelines.
Day camps — If serving 1 or 2 meals per day food
.332
must meet recommended dietary guidelines.
Adequately trained staff and equipment to ensure
.334
campers with disabilities are eating nutritious
meals. Meals not denied or forced.
Proper methods for storing meals brought from
.335
home. Meals provided to campers who arrive
without a bag lunch.
Screening provided for food preparation and food
.452
service areas. Screen doors must be self-closing.
.453
Lighting provided in kitchen and dining area.
.471
Sleeping prohibited in food areas.
MAINTENANCE OF RECORDS
Operator maintains all records relating to campers,
.145
staff, and volunteers for a minimum of 3 years.
Date and Time of Re -Inspection (if applicable):
430 -Camp Inspection Form 3-27-18 Page 8
430 -Camp Inspection Form 3-27-18 Page 9
430 -Camp Inspection Porm 3-27-18 Page 10