Licensing Standards for DayCare Centers
- 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.
HEALTH CARE PLAN
- A. The above requirement shall be excepted when the Center employs a Registered
Nurse licensed in Delaware to provide health services.
- 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.
- 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.
- In case of after-school care, a copy of the health record from
the school in the Center's file is sufficient.
- 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.
HEALTH OBSERVATION ON ARRIVAL
- A Center shall report the immunization status of each child enrolled
in the Center to the Division of Public Health annually.
- 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.
- 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
- C. Two (2) or more episodes of acute vomiting within a period of twenty-four
- 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
- 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.
- 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
TABLE OF REPORTABLE COMMUNICABLE DISEASES
- 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.
| German Measles
|| Hepatitis A
| Hemophilus Influenzae Disease
| Measles (rubeola)
| Bacterial (spinal) Meningitis
| Pertussis (whooping cough)
- 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.
- 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
- 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;
- 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.
ADMINISTRATION OF MEDICATION
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- Unused medication shall be returned to the parent(s) when no longer
needed by a child.
- 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.
CHILD ACCIDENT AND INJURY
- 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.
- 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.
- 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.
FOOD AND NUTRITION
- 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.
- 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
- 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
- F. This policy shall be provided to all parent(s) at enrollment.
- 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.
- 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.
- 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
- 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
- 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:
| 2 hours - 4 hours
|| 1 snack
|| 4 hours - 6 hours
|| 1 meal and 1 snack
|| 7 hours - ll hours
|| 2 meals and 1 snack/or 2 snacks and 1 meal based on time of child's
|| 12 hours or more
|| 3 meals and 2 snacks
- 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,
- 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.
- When fruit juice is served, l00% unsweetened juice shall be used,
not a fruit drink.
- A Center shall ensure that children are encouraged but not forced
- 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.
- Powdered milk shall not be used as a substitute for fluid milk
for drinking purposes but may be used in cooking.
- Special, therapeutic diets shall be served by the Center only
upon written instructions by a licensed physician.
TODDLER AND OLDER CHILDREN
- Special foods provided by a parent shall be served to a child
upon parent(s) request.
- 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,
- 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.
- 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
- 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
- A. A Center shall, at a minimum, provide a snack(s) meeting nutritional
requirements, even if parents provide meals.
- A Center shall provide meals for infants according to the following
- 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
- 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
- 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.