Private Organization Accreditation

Germaine Lawrence is a residential treatment center for girls ages 12-18 with complex behavioral, psychological and learning challenges.   Girls live at our programs while receiving special education, individual, family and group therapy; psychiatric and primary medical care; and a wide variety of therapeutic activities and interventions.


Audrey Coleman, RN-MSN

Volunteer Roles: Military Reviewer; Peer Reviewer; Team Leader

My first experience with COA was in 1999 with what was a NC Area Program. I started as a peer reviewer in 2005, doing two to four site visits a year. I am also a team leader and have recently been approved to be a military reviewer.
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Children and youth who participate in After School and Youth Development programs gain the personal, social, emotional, and educational assets needed to support healthy development, increase well-being, and facilitate a successful transition through childhood, adolescence, and into adulthood.

CYD-AYD 13: Safety

The program ensures the safety of children, youth, and personnel on its premises.

Note: Additional practices key to ensuring safety are addressed in other standards.  For example, CYD-AYD 16 addresses the importance of providing adequate supervision, and CYD-HR 2 highlights the importance of conducting appropriate background checks.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Procedures for maintaining safety in the indoor and outdoor space (CYD-AYD 13.01, 13.02, 13.10)
    • Emergency response plan and preparedness procedures (CYD-AYD 13.03, 13.04, 13.11, 13.12)
    • Maintenance procedures (CYD-AYD 13.05)
    • Medication management procedures or protocols (CYD-AYD 13.06, 13.07, 13.08)
    • Procedures for vehicle use (CYD-AYD 13.09)
    • Motor vehicle insurance coverage expectations (CYD-AYD 13.09)
    • Emergency preparedness training materials
    • Documentation that emergency preparedness training has been provided (e.g., in training files or personnel records)
    • Record of fire drills held
    • Maintenance inspection reports
    • Medication logs
    • Documentation that medication management training has been provided (e.g., in training files or personnel records)
    • Accident, injury, and illness reports
    • CPR and first aid certifications
    • Computer usage policies and procedures (CYD-AYD 13.13)
    • Training curricula and/or information on computer usage provided to children, youth, and personnel
    • Copies of licenses, driving records, and insurance documentation
    • Interview:
      1. Program Administrator
      2. Site Director
      3. Program Personnel
      4. Children, youth, and families
    • Review files of children and youth
    • Observe facility

  • FP
    CYD-AYD 13.01

    There are no observable safety hazards in the indoor space, and materials used for indoor play are safe.

    Interpretation: Equipment, toys, and materials should meet safety requirements set forth by the Consumer Product Safety Commission (CPSC), and the program should be aware of any recalls that affect its products.  The CPSC provides web-based access to a list of product recalls.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • Electrical cords, heating pipes, and sharp-edged objects are covered and secured;
    • All stairs and climbing structures have railings;
    • The floor is free of dangerous clutter and spills;
    • The area is free of glass and other unsafe litter;
    • Windows are secured and window guards are installed where necessary;
    • Floor coverings are secured (i.e., there are no loose rugs);
    • There are no walk-in freezers or refrigerators that do not open from the inside;
    • Water temperatures are appropriate, not harmful;
    • There are no unscreened areas or unmarked glass doors;
    • Entrances and exits are unobstructed and well-lit;
    • Children and youth do not have unsupervised access to poisons or cleaning agents such as bleach;
    • Toxic substances are kept in a locked cabinet, out of the reach of children and youth;
    • Electrical appliances and other objects (e.g., hair dryers, space heaters, radios, toys) are used safely;
    • Cleaning supplies and other hazardous materials are stored properly;
    • Dividers, shelves, and cubbies are secured so that they cannot tip over; and
    • Tables are stored in a safe manner so they will not fall on anyone.

  • FP
    CYD-AYD 13.02

    There are no observable safety hazards in the outdoor space, and equipment for active play is safe.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • The outdoor space is protected from traffic by fences or by other means;
    • Program entrance and exit areas are sheltered from traffic;
    • Fencing is provided when needed to ensure safety;
    • Large equipment is bolted down;
    • Equipment is free of rust, splinters, and loose nails or screws;
    • Swings are placed out of the way of passing children and youth;
    • All playground equipment is on a resilient surface (e.g., fine loose sand, wood chips, wood mulch about nine inches deep, or rubber mats);
    • In summer, there is shady outdoor space and access to water;
    • Sidewalks are free of ice, snow, and slippery mud; and
    • There is a supply of extra coats, gloves, and boots for winter.

    Note: See the Interpretation to CYD-AYD 13.01 regarding compliance with CPSC requirements.

  • FP
    CYD-AYD 13.03

    The program develops an emergency response plan that addresses:

    1. training personnel on how to respond in case of emergency;
    2. training children and youth on how to respond in case of emergency;
    3. maintaining emergency numbers, including police, fire, ambulance, and poison control, both on- and off-site;
    4. coordinating with emergency responders, and accessing emergency transportation both on- and off-site;
    5. coordinating and communicating with the families of children and youth;
    6. coordinating with appropriate local, state, and federal governmental authorities;
    7. evacuating persons with mobility challenges and other special needs;
    8. accounting for the whereabouts of children, youth, and personnel; and
    9. maintaining a readily accessible telephone for incoming and outgoing calls, both on- and off-site.

    Interpretation: Emergency situations include, but are not limited to: accidents; serious illnesses; fires; medical emergencies; water emergencies; natural disasters such as earthquakes, tornadoes, or snowstorms; emergencies associated with outdoor activities; hostage situations; bomb threats; unlawful intrusions; physical assaults; and situations involving harm or violence or the threat of harm or violence.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • Emergency procedures for exiting during a fire are posted;
    • Fire extinguishers are visible and accessible;
    • Personnel know how to use fire extinguishers;
    • Personnel, children, youth, and families know what to do in emergency situations;
    • Personnel are prepared to respond when strangers attempt to intrude or disrupt the program;
    • Written emergency numbers (e.g., for police, fire, ambulance, poison control) are posted near the phone;
    • Emergency information about children and youth is taken on field trips; and
    • Families are contacted immediately in case of emergency.

    Note: As noted in CYD-AYD 3.03, CYD-AM 8.02, and CYD-HR 8.01, it is also important to maintain emergency contact information for children, youth, and personnel.

  • FP
    CYD-AYD 13.04

    The program:

    1. conducts fire drills according to legal requirements, and at least monthly; and
    2. documents fire drills when they are held.

  • FP
    CYD-AYD 13.05

    Indoor and outdoor facilities and equipment are properly maintained through:

    1. regular inspections;
    2. preventive maintenance by a qualified professional;
    3. a monthly review of the heating, fire extinguishers, fire safety, lighting, and other systems;
    4. a review of vehicle safety inspections; and
    5. quick responses to emergency maintenance issues and potentially hazardous conditions.

    Interpretation: The monthly review can be a facility walk-through with a check list to verify that systems are functional, fire extinguishers are charged, etc.  Some or all of the above activities may be conducted by another party, such as a school district or a landlord, if the program is a tenant or shares space with another facility (such as a school).  In such instances, the program must be able to demonstrate that it monitors and documents the completion of elements (a) through (e) to provide a safe environment.

    “Emergency maintenance issues” include overflowing toilets, flooded basements, defective heating systems, and other situations that can damage property, interfere with program operation, or pose a threat to children, youth, and personnel.  “Hazardous conditions” include, but are not limited to, the examples listed in CYD-AYD 13.01 and 13.02.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • Guidelines note responsibilities for cleaning, maintenance, and routine costs (e.g., utilities, insurance, and repairs);
    • Personnel know whom to call for repairs on heating, plumbing, or telephone systems;
    • Personnel are routinely responsible for making sure the sidewalks are free of ice, snow, and slippery mud;
    • Personnel routinely test to be sure that large equipment is anchored and in good repair (e.g., free of rust, splinters, or loose nails and screws);
    • Personnel check and document that smoke detectors and fire extinguishers are functioning at least every three months;
    • Personnel are alert to safety hazards (e.g., litter or glass, equipment that has become unbolted or rusted);
    • Personnel take action to correct safety hazards;
    • Someone is routinely responsible to check that entrances and exits are unobstructed and well-lit; and
    • Someone makes sure that surfaces are washed and sanitized.

  • FP
    CYD-AYD 13.06

    Personnel directly involved in medication control and administration receive training and demonstrate competence in medication control and administration, and knowledge of applicable legal requirements.

    NA The program does not administer or store medication.

  • FP
    CYD-AYD 13.07

    Protocols and controls governing the proper administration and storage of medication include:

    1. locked, supervised storage with access limited to authorized personnel;
    2. use of child resistant packaging and labeling with the name of the child or youth, medication name, dosage, and prescribing physician name;  
    3. appropriate disposal of out-of-date or unused medication, or medication prescribed to former persons served;
    4. a record of who received medications, what medications were administered, and when and by whom medications were administered; and
    5. protocols for the administration of over-the-counter medications.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • Personnel follow protocols when administering medication;
    • Medication logs are maintained;
    • Children, youth, and unauthorized personnel do not have access to medication;
    • There are no out-of-date medications; and
    • Labels clearly indicate which child or youth a medication is for.

    Note: As referenced in CYD-AYD 3.03 and CYD-AM 8.02, the program should also obtain written permission forms from parents or legal guardians, and maintain copies in the files of children and youth.

    NA The program does not administer or store medication.

  • FP
    CYD-AYD 13.08

    When adverse effects of medication are observed, personnel discuss such concerns with the child’s or youth’s parent or legal guardian.

    NA The program does not administer or store medication.

  • FP
    CYD-AYD 13.09

    A program that permits or requires the use of program- or privately-owned vehicles to transport clients requires:
    1. the use of age-appropriate passenger restraint systems;
    2. adequate passenger supervision, as mandated by statute or regulation;
    3. proper maintenance of agency-owned vehicles;
    4. current registration and inspection of vehicles;
    5. annual validation of licenses and driving records; and
    6. motor vehicle insurance.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:
    • All drivers of vehicles used for transporting clients are adequately trained and licensed;
    • The program checks to be sure all drivers have good driving records; and
    • All cars, vans, buses, or taxis used for program purposes are licensed, inspected, and maintained.
    Interpretation: A program can receive a rating of 2 on ASE 6.03 if one or two elements of the standard are not fully implemented, e.g., copies of licenses and driving records are not available or out of date for no more than 20% of personnel; or registration and vehicle inspection records are out of date for no more than 20% of privately-owned vehicles. However, if any one element of the standard needs significant improvement, the program will receive a rating of 3. 
    Interpretation: Regarding element (a), United States federal law requires school buses weighing under 10,000 pounds to have lap-shoulder (three-point) passenger restraint systems in place. States have the authority to implement more stringent seat belt regulations, especially for school buses weighing over 10,000 pounds. Programs should refer to state and local regulations to determine if retrofitting is necessary. 

    Interpretation: Children weighing less than 50 pounds should be secured in a child safety restraint system (car or booster seat) which meets federal motor vehicle safety standards (See FMVSS No. 213). Please also refer to state and local regulations for more stringent weight requirements, and specific age and seat requirements. 
    Interpretation: This standard applies to vehicles owned by the program as well as those owned by its personnel or volunteers.

    Job-related tasks include running errands, attending home visits, traveling between sites, attending meetings, etc. When transporting children and youth is prohibited, element b will not apply. When state inspection is not available (d), the program should establish alternate procedures for verifying proper maintenance of both privately- and program-owned vehicles.

    Interpretation: When the program has a contract with an outside transportation provider, it must include relevant safety expectations in the contract.

    NA The program does not permit or require transporting clients in program- or privately-owned vehicles.

  • FP
    CYD-AYD 13.10

    The program assesses its security needs and takes any appropriate measures needed to protect the safety of all persons who are in its facilities or on its grounds.

    Examples: Examples of ways to demonstrate implementation of this standard include, but are not limited to:

    • Staff monitor program entrances;
    • Locks or buzzers are installed on doors;
    • People must check in with a receptionist when they arrive at the program; and
    • A staff member is posted at the entrance to the program site.

  • FP
    CYD-AYD 13.11

    The program is prepared to treat injuries and respond to accidents and medical emergencies by:

    1. maintaining poison control information and first aid supplies and manuals; and
    2. consulting with a health professional, as necessary, to develop procedures for such situations.

    Note: As noted in CYD-AYD 3.03, CYD-AM 8.02, and CYD-HR 8.01 7.01, it is also important to maintain emergency contact information for children, youth, and personnel.

  • FP
    CYD-AYD 13.12

    The program ensures that there is at least one person certified in basic first aid and age-appropriate CPR on duty and available at any time the program is in operation.

    Interpretation: Certification courses with an online component are acceptable as long as they include a hands-on, in-person skills evaluation by an instructor.  Although not required by COA, programs may also wish to have staff practice their skills between certifications (e.g., by engaging in hands-on practice with a manikin), especially if certifications are good for more than one year.

  • FP
    CYD-AYD 13.13

    When computer access is offered to participants:

    1. children, youth, and staff are trained on internet safety and the program’s internet usage policies and procedures; and
    2. the program has appropriate internet safety measures in place to prevent access to specific sites or inappropriate content.

    NA The program does not offer computer access.

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