Licensing Standards for DayCare Centers

HEALTH CARE

HEALTH CONSULTANT

198. A Center shall have specific arrangements with a Division of Public Health Nurse, Division of Public Health County Health Officer, or a licensed physician who will agree to provide consultation on both routine and emergency health care for children.

A. The above requirement shall be excepted when the Center employs a Registered Nurse licensed in Delaware to provide health services.

199. A Center shall have a written plan for the routine and emergency health care of children including procedures to be followed in case of illness and plans for accessing emergency services. Each staff member shall receive a copy of this plan and shall be trained in its implementation during staff orientation. Parent(s) shall be given a copy of this plan at the time of enrollment. The plan shall be approved by the health consultant and shall include:

A. Procedures to be followed in case of illness or emergency, including method of transportation and notification of parents;

B. Procedures to be followed in case of illness or emergency, when parent(s) cannot be reached;

C. A plan for the management of communicable disease including:

i. The list of symptoms of illness for which a child will be excluded from the Center or separated from the group if symptoms occur after the child has been admitted for the day as specified in Requirement 205.

ii. The list of reportable communicable diseases for which a child will not be admitted to the Center without a written statement from a licensed physician as specified in Requirement 207.

iii. Assurance that each parent whose child may have been exposed to a reportable communicable disease shall receive written notice of the outbreak of such disease at the Center;

D. The Center's policy regarding the administration of medication.

200. Within one (l) month following admission, the caregiver shall have on file an age-appropriate health appraisal conducted within six (6) months prior to admission for each child enrolled. Health appraisals shall be certified by a licensed physician or nurse practitioner and shall be updated yearly or in accordance with the recommended schedule for routine health supervision of the American Academy of Pediatrics. The health appraisal shall include:

A. A health history;

B. A physician examination;

C. Growth and development;

D. Recommendations regarding required medication, restrictions or modifications of the child's activities, diet or care;

E. Medical information pertinent to treatment in case of emergency;

F. Documentation of the immunization status, with a listing of day, month and year of administration for each immunization, according to the recommendations of the American Academy of Pediatrics and the Immunization Practices Advisory Committee, as specified in the Appendix, Immunization Schedules.

i. The Center shall not permit a child to be admitted to the Center without written documentation from a licensed physician or nurse practitioner that the child has received at least one (1) dose of DPT or DT, one (1) dose of TOPV or IPV, the MMR vaccine and Hib conjugate vaccine, if required by the age of child.

ii. If a child has not received adequate immunizations as required for the child's age, the Center shall require a written plan for updating the immunizations within a reasonable time frame to be submitted to the Center within fourteen (14) days of the child's admission.

iii. If the additional required immunizations are not completed within the time frame specified in the written plan, the child shall be excluded from the Center until the immunizations have been obtained and written documentation of such has been submitted to the Center.

201. In case of after-school care, a copy of the health record from the school in the Center's file is sufficient.

202. A child whose parent(s) objects to immunizations on a religious basis will be exempt from the immunization requirement provided that the parent(s) submits to the Center a notarized statement to that effect.

203. A Center shall report the immunization status of each child enrolled in the Center to the Division of Public Health annually.

204. A Center shall ensure that each child is observed on arrival by a person capable of recognizing common signs of communicable disease, physical injury or other evidences of ill health.

205. A Center shall not permit a child who has symptoms of illness specified below to be admitted to the Center or remain at the Center unless written documentation from a licensed physician, or verbal with written follow-up, states the child has been diagnosed and poses no serious health risk to the child or to other children. The symptoms of illness for possible exclusion shall include, but not be limited to any of the following:

A. Severe pain or discomfort particularly in joints, abdomen, ears;

B. Acute diarrhea, characterized as two (2) times the child's usual frequency of bowel movements with a loose consistency within a period of twenty-four (24) hours;

C. Two (2) or more episodes of acute vomiting within a period of twenty-four (24) hours;

D. Severe coughing or sore throat;

E. Oral or axillary temperature of 101.5 degrees F. or over accompanied by behavior changes and/or other symptoms;

F. Yellow (jaundiced) skin or yellow eyes;

G. Red eyes with discharge;

H. Infected, untreated skin patches or lesions;

I. Difficult or rapid beathing;

J. Severe itching of body or scalp;

K. Skin rashes, excluding diaper rash, lasting more than one (1) day;

L. Swollen joints;

M. Visibly enlarged lymph nodes;

N. Stiff neck;

O. Blood or pus from ear, skin, urine, stool;

P. Unusual behavior for the child characterized by no playing, confusion, persistent, unconsolable crying;

Q. Loss of appetite characterized by refusing all solids; or

R. Symptoms which indicate any of the following diseases:

i. Chicken Pox

ii. Impetigo

iii. Lice

iv. Scabies

v. Strep Throat

206. The child may return to the Center when the symptoms are no longer present or a licensed physician indicates the child poses no serious health risk to the child or to other children.

207. A Center shall not permit a child with a reportable communicable disease, as specified in the table below, to be admitted to or remain at the Center, unless:

A. Written documentation from the child's licensed physician states the child has been evaluated and presents no risk to the child or to others; or

B. The Center has reported the illness to the County Health Officer of the Division of Public Health and has been advised he child presents no health risk to others.

C. If there is conflict in the opinions of the physician and the ounty Health Officer regarding the exclusion of a child, the Center shall follow the instructions of the County Health fficer.

RESPIRATORY	GASTRO-INTESTINAL
Diptheria	Giardiasis
German Measles	Hepatitis A
Hemophilus Influenzae Disease	Salmonellosis
Measles (rubeola)	Shigellosis
Bacterial (spinal) Meningitis
Mumps
Pertussis (whooping cough)
Rubella
Tuberculosis

208. The Center shall report any reportable communicable disease to the County Health Officer of the Division of Public Health in accordance with Division of Public Health procedures.

209. When a child has been diagnosed as having a reportable vaccine-preventable communicable disease, all children who have not been immunized against the disease shall be excluded from the Center in accordance with Division of Public Health procedures.

210. If a child who has already been admitted to a Center manifests any of the illnesses or symptoms specified in Requirements 205 and 207 above, the Center shall remove the child from the group of well children to a separate area as specified in Requirement 128 until:

A. The child can be picked up by the parent(s) or suitably cared for elsewhere; or

B. A licensed physician indicates verbally or in writing that the illness/symptoms pose(s) no serious health risk to the child or to other children.

211. While a child is cared for in the separate room/area, a Center shall ensure that the child is supervised and the child's individual needs for rest, comfort, food, drink and appropriate activity are met.

212. Only staff members authorized in accordance with State Law, or physicians, nurses or other qualified medical health personnel shall administer medication to children in a Center.

213. Medication shall not be administered to a child by a staff member unless the Center has received written permission from the child's parent(s) for each medication to be administered.

214. All prescription medication shall be in its original container, properly labeled and authorized by the child's health care provider.

A. Medication shall only be given to the child whose name appears on the prescription.

215. All non-prescription medication shall be in its original container, properly labeled with directions for its administration and shall be labeled with the child's name.

A. Any deviations from the label instructions shall be in writing from the child's health care provider.

216. All medication in the Center shall be stored so as to be secure and inacessible to children.

A. Medication requiring refrigeration shall be kept in closed containers separate from food.

217. Unused medication shall be returned to the parent(s) when no longer needed by a child.

218. The Center shall keep a record of the administration of medication to children including medication dosage, time administered, by whom administered and any adverse effects observed.

219. When a child is receiving medication, staff members shall note in the records of that child and shall advise the parent(s) of the occurrence of any health problems, such as diarrhea, vomiting, continuous hunger, refusal to eat, nosebleeds, skin rash or high temperature.

220. When an accident or injury occurs to a child during the hours of care, a Center shall take the necessary emergency action to protect the child from further harm and shall notify the child's parent(s).

A. The Center shall maintain an injury report for each incident in the child's file and shall report to the Department an accident or injury which results in death or hospitalization as required in Requirement 60. An injury report shall include name of child, date, description of injury, how it occurred and first aid or medical care required.

221. The Center shall ensure that a staff member or volunteer does not provide personal care to or have direct contact with children when that staff member or volunteer is known to have a communicable or other reportable disease which is readily contagious to others during normal working activities, whether the person has symptoms or is a carrier of such disease.

A. A staff member or volunteer shall not be involved in food preparation or serving, if so indicated by the symptoms or illness. The County Health Officer shall be notified of the reportable communicable disease and consulted to determine the most appropriate action, including exclusion.

GENERAL

222. A Center shall have a written policy concerning food service including:

A. A description of all food services provided;

B. Times of snacks and meals;

C. If appropriate, nutritional information and guidelines concerning the content of meals to be provided by parents;

D. If appropriate, procedures to prevent spoilage of food brought from home;

E. If appropriate, a procedure to be followed by the Center if food brought from home fails to meet nutritional requirements as specified by Requirements 235-237;

F. This policy shall be provided to all parent(s) at enrollment.

223. A Center shall ensure that staff responsible for food service has knowledge of nutrition, sanitary food preparation and clean-up.

A. Staff responsibilities for food service activities shall not reduce staff/child ratios nor be allowed to interfere in other ways with the Center's program or supervision of children.

224. A Center shall have an annual menu analysis by the Division of Public Health, Office of Nutrition. Consultation and technical assistance shall be used as needed to correct any problem(s) identified by this analysis and/or during licensing or complaint investigations.

225. A Center shall ensure that menus are planned in advance, are dated and are posted in a prominent place. Menus noting actual food served shall be retained by the Center for thirty (30) days. Any changes made in actual food served on a particular date are to be documented on the menu for that date.

226. Meals and snacks shall be provided by a Center except when one of the following circumstances occur:

A. A written statement has been signed by a parent and kept on file indicating that the parent has chosen to provide food for the child;

B. The Center makes it known to all parents at the time of application for enrollment that meals are to be provided by parents; or

C. The Center has a field trip or a specific activity requiring special meal arrangements.

227. Nutritional and appropriately-timed meals and snacks meeting nutritional requirements, shall be served in accordance with the following schedule which indicates number of hours child is present at the Center:

     A.	2 hours - 4 hours	1 snack
     B.	4 hours - 6 hours	1 meal and 1 snack
     C.	7 hours - ll hours	2 meals and 1 snack/or 2 snacks and 1 meal based on time of child's arrival
     D.	12 hours or more	3 meals and 2 snacks

228. A Center shall ensure that food servings provided by the Center are portions suitable in accordance with the Recommended Dietary Allowance (RDA) to the size and age of the children in care, as specified in Appendix, Nutrition Standards.

A. The Center shall have supplemental foods from all four basic food groups to serve children if meals provided by parents fail to meet nutritional requirements as specified in Requirements 235-237.

229. When fruit juice is served, l00% unsweetened juice shall be used, not a fruit drink.

230. A Center shall ensure that children are encouraged but not forced to eat.

231. A Center shall provide for the introduction of a variety of food textures and finger foods in the training of self-feeding and nutrition education.

232. Powdered milk shall not be used as a substitute for fluid milk for drinking purposes but may be used in cooking.

233. Special, therapeutic diets shall be served by the Center only upon written instructions by a licensed physician.

234. Special foods provided by a parent shall be served to a child upon parent(s) request.

235. A Center shall ensure that a breakfast served to children of toddler age or older shall have at least one (1) item from the dairy products, fruits and vegetables and grain food groups of the following four (4) food groups:

A. Dairy products: milk, milk products, cheese;

B. Protein: meat, fish, poultry, eggs, cheese, peanut butter; dried beans, peas, nuts;

C. Fruits and vegetables: include a variety of vegetables and fruits;

D. Grain: Whole grain and enriched products such as breads, cereals, pastas, crackers and rice.

236. A Center shall ensure that a lunch or dinner served to children of toddler age or older shall have one (l) item from each of the above food groups.

237. A Center shall ensure that a snack served to children of toddler age and older shall have at least one (1) item from two (2) of the above food groups.

A. A Center shall, at a minimum, provide a snack(s) meeting nutritional requirements, even if parents provide meals.

238. A Center shall provide meals for infants according to the following guidelines:

A. A written statement specifying food including specific formula or type of milk, and providing a feeding schedule shall be obtained from the parents for each child on a monthly basis;

B. Introduction to all new foods shall be made in consultation with parent(s);

C. Bottles and nipples maintained by the Center shall be sanitized before use;

D. Each child's bottle shall be individually labeled with the child's name and refrigerated immediately after preparation by the Center or upon arrival if prepared by parent;

E. Unused portions of formula shall be discarded after each feeding;

F. Every effort shall be made to accommodate the needs of the child who is being breast-fed;

G. Baby food for each child shall be served from a dish unless the whole contents of the jar will be served;

H. The Center shall encourage the use of a cup by toddlers;

I. A child too young to use a feeding chair or other age-appropriate seating apparatus shall be held when fed;

J. A child who is unable to hold his/her bottle shall be held for bottle feeding;

K. No infant shall be placed in his crib with a bottle for feeding and at no time shall a bottle be propped for a child;

L. A daily written record of each child's food/formula intake shall be maintained and provided to the parent(s) upon request. Any feeding problems experienced by a child shall be discussed with his/her parent(s) before the child's daily departure from the Center.

Home               About Us               Login               Sign-Up               Products            Contact Us