Immunization Issue California

[Livin4grace]

I am newly licensed California provider. A few weeks ago when I was looking over my daycare children's records, using the template licensing provided me i noted one child had an empty space for his 4th HIB vaccine. He is 22 mos (Born in Dec '14) and has only had 3 doses, 2/12/15, 7/27/15 and 3/28/16. He appears to be WAY overdue. I asked the mom to get him in for the vaccination and she did not. I completely forgot he needed that shot until last night when the mom told me she had an appointment today to take her other child for shots, which triggered my memory. I asked mom to take son along on the Dr visit, so he got his 4th dose (our pediatrician does walk in immunizations).

Long story short, mom took him and claims the Dr says he is up to date and that the Dr has REFUSED to give him the shot. I was just now notified of this after hours on a Friday.

Not knowing quite how to handle this, I asked mom to find other care for Monday so I can reach out to licensing for clarification. She is furious and of course it is all my fault she is going to loose her job.

So I have a few questions:

A) Can more seasoned licensed small group providers tell me how you would have handled this situation? Yes, I'm shamelessly looking for validation, ideas, anything...

B) Do you use a particular program or system to manage who needs shots and when so you don't get cited for this when licensing visits? If so, what is it?

C) Do you have a written policy on how you handle immunizations so situations like this with parents don't occur? (and please share if you are willing)

Thanks in advance

[spedmommy4]

If the doctor truly did refuse to give the vaccination, she should have brought in proof. Only a doctors exemption clears you with licensing.

Though, in my experience, California does not visit and check up on providers all that often. If you are newly licensed, you probably could've safely given her a deadline by which to take care of it.

I give parents something like this. http://www.smmusd.org/CDS/pdf/IMM-230.pdf
I explain that licensing does audit my files to ensure that all children are up to date on immunizations and, if some are missing, my policy is that care will be terminated until immunizations are caught up. As a licensed childcare, I have to stay in compliance. It isn't a choice.

To keep up on when immunizations are due, I review files quarterly and send out a reminder to all parents.

[daycare]

I am in CA. I STAY ON TOP OF MINE BY CREATING an excel spreadsheet and I will know 30 days prior that a child needs immunizations.

DO NOT FALL BEHIND. I HEAR THEY ARE fining people left and right

First thing I would do is update your policies that reflect the following

Under the new immunization laws, There is a ZERO grace period for immunization updates. Your child MAY not attend care if their immunizations are not up to date. It is the responsibility of the parent to keep your child current on all vaccinations and return all required documents to the provider By the compliance date.

If for some reson your child is not able to receive immunizations at the time they are to be administered, a doctors note with new schedule of dates must be submitted in place of an update.

If your child is not current, all services will be suspend and full payment will be required. You will have 5 days to fix the issue, and if it's not resolved, you contract will be terminated immediately.


One thing you should know. In CA if the child is in attendance or not, if their records are not current you will still be fined. So let the child attend and give them 24-48 hours to get that doctors note.

Show the parent the new law and let them
Know it's out of your hands. You have no choice to enforce the LAW.

I have had some really hard times with this since the law changed. Parents don't seem to get how serious it is. CA is not treading lightly with this.

I hope this helps some.
Good luck.

[mommyneedsadayoff]

Why would the doctor refuse? If it is because he has already had it, a new immunization record should show this. Sounds like he is due for the booster, so I would ask mom for a doctor note stating the reason behind not giving it to him or for a new copy of his immunizations that shows he has had the shot.

[MarinaVanessa]

EVERYTHING that Daycare said.

If her son is up to date then she can provide you proof of updated immunizations. Maybe she did get him the shot and forgot to show you proof. Whatever the case is she needs to provide you with either a copy of the yellow immunization card that shows the updated shots or she can get a printout from her doctor's office.

For sure print out the new law. The way that the law is writte there is absolutely no wiggle room.

[Solandia]

not in Ca, but none of my kids have a 4th HiB, it was only a 3 shot series to begin with...we all go to the same clinic. Hib isn't even a required vax in my state anyway.

[Livin4grace]

not in Ca, but none of my kids have a 4th HiB, it was only a 3 shot series to begin with...we all go to the same clinic. Hib isn't even a required vax in my state anyway.

California just did a major crackdown on immunizations and Hib is a requirement for children under 5.

You are correct about the required doses. And I stayed up last night researching this and found on the CDC website it says three shots are acceptable if the third was given after the first birthday. Apparently I was misled here. I have already been in touch with the parent and cleared things up.

Sadly, there has been a major breakdown in communication between us that we will need to be intentional about fixing, but things are ok for now. She also now understands why I suggest all parents make a plan for backup care, and promises to work on this.

Thank you for you willingness to point this discrepancy out.

[spedmommy4]

I am in CA. I STAY ON TOP OF MINE BY CREATING an excel spreadsheet and I will know 30 days prior that a child needs immunizations.

DO NOT FALL BEHIND. I HEAR THEY ARE fining people left and right

First thing I would do is update your policies that reflect the following

Under the new immunization laws, There is a ZERO grace period for immunization updates. Your child MAY not attend care if their immunizations are not up to date. It is the responsibility of the parent to keep your child current on all vaccinations and return all required documents to the provider By the compliance date.

If for some reson your child is not able to receive immunizations at the time they are to be administered, a doctors note with new schedule of dates must be submitted in place of an update.

If your child is not current, all services will be suspend and full payment will be required. You will have 5 days to fix the issue, and if it's not resolved, you contract will be terminated immediately.


One thing you should know. In CA if the child is in attendance or not, if their records are not current you will still be fined. So let the child attend and give them 24-48 hours to get that doctors note.

Show the parent the new law and let them
Know it's out of your hands. You have no choice to enforce the LAW.

I have had some really hard times with this since the law changed. Parents don't seem to get how serious it is. CA is not treading lightly with this.

I hope this helps some.
Good luck.

Interesting fact . . .

Licensing came out to speak about the new immunization requirements at one of our R&R meetings before I moved out of state. The licensing rep said that the state of California passed the law but didn't grant any additional funds for it.

In central California, where I lived, I would only see my analyst every three years for an unannounced inspection. Unless they fund the law, I think the providers can probably assume the records will be checked at the next unannounced. (At the regular interval)

In contrast- I'm in Oregon now. Our immunization childcare records are checked by independent state auditors. They mean business here.

[pandamom]

My two children Only have 3 of the hib. They attended a government daycare facility and go to public school here in California. Both places accepted the three shots. I did at one point try to get the fourth shot for them when they were 3, but Their military pediatrician said they didn't need it and would write a note if needed

[TheMisplacedMidwestMom]

As a mom, and legally unlicensed provider, I have a question about this whole topic. (Will be looking into expanding and licensing when we move to a bigger home)

With both of my children we did a "delayed" vaccination schedule, where some of the shots were just spread out over time. My kids are now 2 and 3, and following our delayed schedule are caught up on everything to the standard schedule. However, there were times before now where they could have been considered late.

Is there allowance for this, or is it strictly you have to follow the "standard" schedule? Could a note from the pediatrician allow a family to continue in care if they were doing a delayed schedule?
I understand that it varies by state, but am interested to know in general.

(not trying to start a discussion about good vs. bad of the delayed schedule, just wondering how it affects participation in care)

[Mom2Two]

Yeah I'm wondering the same thing. Do these states allow religious exemptions or such?

[daycare]

As a mom, and legally unlicensed provider, I have a question about this whole topic. (Will be looking into expanding and licensing when we move to a bigger home)

With both of my children we did a "delayed" vaccination schedule, where some of the shots were just spread out over time. My kids are now 2 and 3, and following our delayed schedule are caught up on everything to the standard schedule. However, there were times before now where they could have been considered late.

Is there allowance for this, or is it strictly you have to follow the "standard" schedule? Could a note from the pediatrician allow a family to continue in care if they were doing a delayed schedule?
I understand that it varies by state, but am interested to know in general.

(not trying to start a discussion about good vs. bad of the delayed schedule, just wondering how it affects participation in care)

In CA yes you can have a delayed schedule. You would just need a doc note with new schedule of dates and then will be required to make certain the child follows new plan and updates records accordingly.

I have a few children with ZERO immunizations in my program and they can stay until they age out. At that time they will either have to be home schooled or if they wish to enter a schooling of any kind outside their home they will be required to be fully vax prior to entering the school. This includes both public and private schools.

Basically I believe it's called changing herds requires full vax

[Leigh]

As a mom, and legally unlicensed provider, I have a question about this whole topic. (Will be looking into expanding and licensing when we move to a bigger home)

With both of my children we did a "delayed" vaccination schedule, where some of the shots were just spread out over time. My kids are now 2 and 3, and following our delayed schedule are caught up on everything to the standard schedule. However, there were times before now where they could have been considered late.

Is there allowance for this, or is it strictly you have to follow the "standard" schedule? Could a note from the pediatrician allow a family to continue in care if they were doing a delayed schedule?
I understand that it varies by state, but am interested to know in general.

(not trying to start a discussion about good vs. bad of the delayed schedule, just wondering how it affects participation in care)

In my state, a child may attend without the required vaccinations if they have a doctor's statement about a delayed schedule and a written schedule of when vaccines will be administered.

[MarinaVanessa]

In CA yes you can have a delayed schedule. You would just need a doc note with new schedule of dates and then will be required to make certain the child follows new plan and updates records accordingly.

I have a few children with ZERO immunizations in my program and they can stay until they age out. At that time they will either have to be home schooled or if they wish to enter a schooling of any kind outside their home they will be required to be fully vax prior to entering the school. This includes both public and private schools.

Basically I believe it's called changing herds requires full vax

I'm only quoting Daycare here because she mentions delayed schedules here in CA ... from what I understand the ONLY way that a delayed schedule will be accepted is due to a medical condition and a note from a DR. Personal belief delayed schedules will no longer be accepted since they completely took the personal belief exemption out.

So in other words if a parent decides that she does not want her child to have all vaccines at the same time and prefers a delayed schedule and she gets a note from her pediatrician stating this then it won't count and the provider will still be in violation. But if a child is due for their immunizations and becomes ill, has had a reaction to multiple shots at once or has another medical condition that prevents her from getting all immunizations then the parent can get the pediatrician to write a note that states this and that has a plan to eventually get the child caught up. The delayed schedule has to have a date as to when the immunizations will be given plus have a medical reason justifying it.

BUT this is CA where a new law just went into effect over the summer that says that children that aren't up to date cannot attend licensed childcare (family child care or center based care) or public school. Another BUT is that it depends on how strict your analyst and region is being. Some might be more inclined to look the other way or just not even check while others might bring down the hammer.

Also it's true that we were getting inspected every 3 years just about due to finding but community care licensing (in my area at least, not sure if it's state-wide) has been visiting providers once a year it seems, sometimes more. I've had two visits in the last year and one last year and my analyst has always checked my immunization records even before this new law went into effect.

[daycare]

I'm only quoting Daycare here because she mentions delayed schedules here in CA ... from what I understand the ONLY way that a delayed schedule will be accepted is due to a medical condition and a note from a DR. Personal belief delayed schedules will no longer be accepted since they completely took the personal belief exemption out.

So in other words if a parent decides that she does not want her child to have all vaccines at the same time and prefers a delayed schedule and she gets a note from her pediatrician stating this then it won't count and the provider will still be in violation. But if a child is due for their immunizations and becomes ill, has had a reaction to multiple shots at once or has another medical condition that prevents her from getting all immunizations then the parent can get the pediatrician to write a note that states this and that has a plan to eventually get the child caught up. The delayed schedule has to have a date as to when the immunizations will be given plus have a medical reason justifying it.

BUT this is CA where a new law just went into effect over the summer that says that children that aren't up to date cannot attend licensed childcare (family child care or center based care) or public school. Another BUT is that it depends on how strict your analyst and region is being. Some might be more inclined to look the other way or just not even check while others might bring down the hammer.

Also it's true that we were getting inspected every 3 years just about due to finding but community care licensing (in my area at least, not sure if it's state-wide) has been visiting providers once a year it seems, sometimes more. I've had two visits in the last year and one last year and my analyst has always checked my immunization records even before this new law went into effect.

Because of QRIS I have had about 6 visits from different agencies this year. One for licensing.

During QRIS under health and safety all of my immunizations were inspected, they are asking me proof now for my employees records since the law passed in September that al of us have to show proof as well.

I have a headache from all of this.