Licensing Standards for DayCare Centers

Section 418.9
Health

(a) The provider must prepare on forms furnished by the department a health care plan that includes policies and procedures for obtaining professional assistance in emergencies, conducting a daily evaluation of each child for any indication of illness, injury or abuse, and making advance arrangements for the care of any child who has or develops symptoms of illness or is injured. Such arrangements must include notifying the parent and maintaining a record of each child's illnesses, injuries and signs of abuse.

(b) Each employee and volunteer must submit a statement from a physician, physician's assistant or nurse practitioner prior to beginning employment at the day care center giving satisfactory evidence that he or she is physically and mentally fit to provide child day care and free from communicable disease. Such statement must state that the employee's or volunteer's health is satisfactory to provide child day care and must include the results of a tuberculin test on each such person performed within the 12 months preceding the date of employment. Where readily available, a Mantoux tuberculin test is required. Such statement must also be submitted by each employee and volunteer every other year thereafter.

(c) No child may be accepted for child day care in a child day care center unless:

(1) The provider has been furnished with:

(i) evidence that the child has received a health examination within 90 days prior to admission by a physician, physicians assistant or nurse practitioner who has completed the health examination form supplied by the department; or

(ii) a written statement signed by a physician, physician's assistant or nurse practitioner stating that the child is receiving health care, including appropriate health examinations in accordance with the American Academy of Pediatrics schedule of such care and examinations; or

(iii) a copy of the child's school medical record;

(2) a written statement signed by a physician, physician's assistant or nurse practitioner has been furnished to the provider assuring that the child is free from contagious or communicable disease and is able to participate in child day care;

(3) the provider has been furnished with;

(i) a certificate of immunization prepared by a physician or other authorized person who administered the immunization which specifies the products administered, the dates of administration and the physician-verified history of measles, mumps and other diseases; or

(ii) the official New York State immunization record card completed by the administering physician or health care facility; or

(iii) a certificate from a physician, physician's assistant or nurse practitioner stating that one or more of the required immunizations may be detrimental to the child's health, and specifying which immunization may be detrimental; or

(iv) a copy of the school record documenting immunization; and

(4) the immunization certificate or record card shows that the child has received age-appropriate prophylaxis. This must include immunization against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella and Haemophilus influenza type b (Hib) except where there is a medical contra-indication and a physician, physician's assistant or nurse practitioner has completed and signed the medical exemption section of the department's physical examination of day care child form; and

(5) the day care center determines that each infant and toddler is immunized appropriate to his or her age. An infant not yet immunized because of age may be admitted provided the infant's parent agrees in writing that the infant will subsequently be immunized according to the current schedule for immunizations required by the New York State Health Department.

(1) obtain written consent at the time of admission from the parent, which authorizes the provider to obtain emergency health care for the child;

(2) arrange for the transportation of children in need of emergency health care and for the supervision of the children remaining in the day care center; and

(3) in the event of an accident or illness requiring immediate health care, secure such care and notify the parent.

(f) Children must not be given any medication, prescription or any other remedy or treatment, nor can special medical procedures be carried out, except:

(1) upon written order of a physician stating that the day care provider may administer such medication, prescription, remedy, treatment or procedure and specifying the circumstances, if any, under which the medication, prescription, remedy, treatment or procedure must not be administered accompanied by written instructions from the parent; or

(2) as provided in subdivision (i) of this section.

(h) Prescription medication must be in the original container and labeled with the child's complete name, the medication name, recommended dosage, time intervals for administration, method of administration, expiration date and prescriber's name and license number. Such medications must be stored according to the instructions on the label, kept beyond the reach of children and returned to the parent when no longer needed.

(i) Over-the-counter medication may be given on an infrequent, non-routine basis under written instructions from the parent, provided such instructions are consistent with the directions on the manufacturer's label. If a child develops symptoms, which indicate a need for over-the-counter medication while in care at the center, such medication may be given under oral instructions from the parent for that day only. The provider must document that oral approval was given by the parent. Topical ointments may be applied as needed for protection against the sun or diaper rash under written parental instructions.

(j) Over-the-counter medication must be in the original container with the manufacturer's label and directions for administration. Such medication must be labeled with the child's complete name, stored according to the instructions on the label, kept beyond the reach of children and returned to the parent when no longer needed.

(k) Nothing in this section shall be deemed to require any provider to give any medication, prescription or other remedy or treatment.

(l) Universal blood precautions must be observed as follows:

(1) Disposable gloves must be immediately available and worn whenever there is a possibility for contact with blood, including but not limited to:

(i) changing diapers where there is blood in the stool;

(ii) touching blood-contaminated body fluids;

(iii) treating cuts that bleed;

(iv) wiping surfaces stained with blood; and

(v) any other situations where there is potential or actual contact with blood.

(2) Disposable gloves must be discarded after each use.

(3) If blood is touched accidentally, the exposed skin must be thoroughly cleansed with soap and running water.

(4) Clothes contaminated with blood may be washed in the regular manner.

(5) Surfaces that have been blood stained must be wiped with a germicidal solution.

(6) In an emergency, a child's well-being must take priority. A bleeding child must not be denied care because gloves are not immediately available.

(n) Consumption of or being under the influence of alcohol or controlled substances by staff of the day care center is prohibited. Smoking in indoor areas and in vehicles while children are being transported is prohibited.

(o) No staff member may be on duty while such staff member has any communicable disease.

(p) Staff health practices must be implemented and instructions given that will help staff to minimize infections and enable them to observe symptoms of illness in the children who require medical care.

(q) A daily health check of each child must be carried out by a person who is competent to recognize symptoms of illness, communicable disease and child abuse or maltreatment.

(r) a registered professional nurse must visit and instruct staff on the care of infants and toddlers in accordance with this section.

(s) The provider must establish a program to meet the individual needs of any child(ren) accepted for child day care who may require an unusual amount of care or attention because of a mental or physical condition or handicap.

Revisions (10/02/96 subd. (m) repealed, new subd. (m) added.)

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