Adults are aware of the symptoms of common illnesses, alert to changes in children's behavior that may signal illness or allergies. Diaper changing areas are easily and routinely sanitized after each change. Because of limited or no sick leave, staff come to work even when they are ill. Children are left unattended. Toddlers' clothing is too confining, uncomfortable, or difficult to manage.
Adults are inconsistent or too casual about hand washing.
Staff do not notice or they ignore changes in children's behavior or do not know children well enough to detect changes in normal patterns of behavior. Several children are changed on the same surface.