If toilet facilities are provided on a site, then each such facility shall provide a changing table for infants/toddlers to the same standards that the ADA holds for wheelchair accessible toilet facilities. Just as a wheelchair-bound individual should receive equal access to a public toilet facility by providing adequate space, so shall a infant/toddler receive equal access to a public toilet facility by provide a safe, clean, and raised surface on which to be placed during a diaper-changing.
This should be considered a health hazard not only to the child, but to the facility. It is a health hazard to expose that child to an unclean bathroom floor and to expose patrons to possible contamination outside the restroom.