North Carolina North Carolina

Licensing Standards for DayCare Centers


SECTION .0800 - HEALTH STANDARDS FOR CHILDREN

.0801 APPLICATION FOR ENROLLMENT

(a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, legal guardian, or full-time custodian.

(1) The completed, signed application shall be on file in the center on the first day the child attends and shall remain on file until the child is no longer attending.

(2) The completed application shall include emergency medical information as specified in Rule .0802(b) of this Section.

(3) The completed application shall give the child's full name and indicate the name the child is to be called. In addition, the application shall include the child's date of birth and any allergies, particular fears, or unique behavior characteristics that the child has.

(4) The application shall include the names of individuals to whom the center may release the child as authorized by the person who signs the application. (b) Each child's application shall be readily available and easily accessible to caregiving staff during the time the children are present.

History Note: Authority G.S. 110-91(9); 143B-168.3; Eff. January 1, 1986; Amended Eff. November 1, 1989.

.0802 EMERGENCY MEDICAL CARE

(a) Each child care center shall have a written plan which assures that emergency medical care is available or can be obtained for children. The plan shall be reviewed during staff orientation with new staff and with all staff at least twice each year. This plan shall give the procedures to be followed to assure that any child who becomes ill or is injured and requires medical attention while at the center, or while participating in any activity provided or sponsored by the center, receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan:

(1) The name, address, and telephone number of a physician, nurse, physician's assistant, nurse practitioner, community clinic, or local health department that is available to provide medical consultation;

(2) The name, address, and telephone number of the emergency room to be used when the parents or family physician cannot be reached or when transporting the ill or injured child to the person's preferred hospital could result in serious delay in obtaining medical attention;

(3) Designation of a means of transportation always available for use in the event of a medical emergency;

(4) The name of the person, and his or her alternate, at the center, responsible for determining which of the following is needed, carrying out that plan of action, and assuring that appropriate medical care is given:

(A) Simple first aid given at the center for an injury or illness needing only minimal attention;

(B) Advice from previously identified medical consultant in order to decide if care is to be given at the center or if the ill or injured child is to be transported to a designated medical resource; or

(C) Immediate transportation of the child to a designated medical resource for appropriate treatment;

(5) The person(s) at the center responsible for:

(A) Assuring that the signed authorization described in(c) of this Rule is taken with the ill or injured child to the medical facility;

(B) Accompanying the ill or injured child to the medical facility;

(C) Notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment;

(D) Notifying the medical facility about the ill or injured child being transported for treatment; and

(E) Obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center;

(6) A statement giving the location of the telephone located on the premises which is in good working condition and is always available for use in case of emergency. Telephone numbers for the fire department, law enforcement office, emergency medical service, and poison control center shall be posted near the telephone. A telephone located in an office in the center that is sometimes locked during the time the children are present cannot be designated for use in an emergency. (b) Emergency medical care information shall be on file for each individual child. That information shall include the name, address, and telephone number of the parent or other person to be contacted in case of an emergency, the responsible party's choice of health care provider, and preferred hospital; any chronic illness the individual has and any medication taken for that illness; and any other information that has a direct bearing on assuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance.

(c) Each child's parent, legal guardian, or full-time custodian shall sign a statement authorizing the center to obtain medical attention for the child in an emergency. That statement shall be on file on the first day the child attends the center. It shall be easily accessible to staff so that it can be taken with the child whenever emergency medical treatment is necessary.

(d) An incident report shall be completed each time a child receives medical treatment by a physician, nurse, physician's assistant, nurse practitioner, community clinic, or local health department, as a result of an incident occurring while the child is at the child care center. This incident report shall include, at a minimum: child's name, date and time of incident, part of body injured, type of injury, names of adult witnesses to incident, description of how and where incident occurred, piece of equipment involved(if any), treatment received and steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, and maintained in the child's file. A copy of the incident report shall be mailed to a representative of the Division within seven calendar days after treatment.

(e) An incident log shall be completed any time an incident report is completed. This log shall be cumulative and maintained in a separate file and shall be available for review by a representative of the Division. This log shall be completed on a form provided by the Division.

History Note: Authority G.S. 110-91(1),(9); 143B-168.3; Eff. January 1, 1986; Amended Eff. July 1, 1998; January 1, 1996; October 1, 1991; November 1, 1989.

.0803 ADMINISTERING MEDICATION

(a) No drug or medication shall be administered to any child without specific instructions from the child's parent, a physician, or other authorized health professional. No drug or medication shall be administered after its expiration date.

(1) Prescribed medicine shall be in its original container bearing the pharmacist's label which lists the child's name, date the prescription was filled, the physician's name, the name of the medicine or the prescription number, and directions for dosage, or be accompanied by written instructions for dosage, bearing the child's name, which are dated and signed by the prescribing physician or other health professional. Prescribed medicine shall be administered only to the person for whom it is prescribed.

(2) Over-the-counter medicines, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical teething medication, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be in its original container and shall be administered as authorized in writing by the child's parent, not to exceed amounts and frequency of dosage specified in the printed instructions accompanying the medicine. The parent's authorization shall give the child's name, the specific name of the over-the-counter medicine, dosage instructions, the parent's signature, and the date signed. Over-the-counter medicine may also be administered in accordance with written instructions from a physician or other authorized health professional.

(3) When any questions arise concerning whether medication provided by the parent should be administered, that medication shall not be administered without signed, written dosage instructions from a licensed physician or authorized health professional.

(4) A written statement from a parent may give blanket permission for up to six months to authorize administration of medication for asthma and allergic reactions. A written statement from a parent may give blanket permission for up to one year to authorize administration of sunscreen and over-the-counter diapering creams. The written statement shall describe the specific conditions under which these medications and creams are to be administered and detailed instructions on how they are to be administered.

(5) A written statement from a parent may give blanket permission to administer a one-time, weight appropriate dose of acetaminophen in cases where the child has a fever and the parent cannot be reached. (b) Any medication remaining after the course of treatment is completed shall be returned to the child's parents.

(c) Any time medication other than sunscreen or diapering creams is administered by center personnel to children receiving care, the child's name, the date, time, amount and type of medication given, and the name and signature of the person administering the medication shall be recorded. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for at least six months after the medication is administered.

History Note: Authority G.S. 110-91(1),(9); 143B-168.3; Eff. January 1, 1986; Amended Eff. July 1, 1998; January 1, 1996.

.0804 INFECTIOUS AND CONTAGIOUS DISEASES

(a) Centers may provide care for a mildly ill child who has a Fahrenheit temperature of less than 100 degrees axillary, 101 degrees orally, or 102 degrees rectally and who remains capable of participating in routine group activities; provided the child does not:

(1) have the sudden onset of diarrhea characterized by an increased number of bowel movements compared to the child's normal pattern and with increased stool water; or

(2) have two or more episodes of vomiting within a 12 hour period; or

(3) have a red eye with white or yellow eye discharge until 24 hours after treatment; or

(4) have scabies or lice; or

(5) have known chicken pox or a rash suggestive of chicken pox; or

(6) have tuberculosis, until a health professional states that the child is not infectious; or

(7) have strep throat, until 24 hours after treatment has started; or

(8) have pertussis, until five days after appropriate antibiotic treatment; or

(9) have hepatitis A virus infection, until one week after onset of illness or jaundice; or

(10) have impetigo, until 24 hours after treatment; or

(11) have a physician's or other health professional's written order that the child be separated from other children. (b) Centers which choose to provide care for mildly ill children shall:

(1) follow all procedures to prevent the spread of communicable diseases described in 15A NCAC 18A .2800, "Sanitation of Child Day Care Facilities", as adopted by the Health Services Commission;

(2) separate from the other children any child who becomes ill while in care or who is suspected of having a communicable disease or condition other than as described in Paragraph(a) of this Rule until the child leaves the center;

(3) notify all parents at enrollment that the center will be providing care for mildly ill children;

(4) immediately notify the parent of any child who becomes ill while in care or who is suspected of being ill with a communicable condition other than as described in Paragraph(a) of this Rule that the child is ill and may not remain in care;

(5) immediately notify the parent of any sick child in care if the child's condition worsens while the child is in care. History Note: Authority G.S. 110-91(1),(2); 143B-168.3; Eff. January 1, 1986; Amended Eff. July 1, 1998; November 1, 1991; November 1, 1989.

.0805 SANITARY FOOD SERVICE

(a) All food shall be served in a manner to minimize the possibility of contamination. In no instance shall any food be served directly on a table top, countertop, etc.

(b) No more than one child shall be fed with the same utensil, drink from the same cup or glass, or be fed from the same individual portion of food.

(1) Each child shall be served individual portions of food on a plate or in another appropriate container.

(2) Beverages shall be served to children in individual cups or glasses. Any child who is bottle-fed must be fed from the child's own bottle only.

(3) Each child shall be fed with an individual spoon or other safe utensil.

(4) Snack foods may be placed on an individual napkin or paper towel to be served to a child. History Note: Authority G.S. 110-91(1); 143B-168.3; Eff. January 1, 1986; Amended Eff. November 1, 1989.

.0806 TOILETING, CLOTHING AND LINENS

(a) Diapers will be changed whenever they become soiled or wet and not on a shift basis.

(b) There must be clean clothes available so that when the clothes worn by a child becomes wet or soiled the child has clean clothes to put on. The change of clothing may be provided by the center or by the child's parents.

(c) A supply of clean linen must be on hand so that linens can be changed whenever they become soiled or wet.

(d) Staff shall not force children to use the toilet and staff shall consider the developmental readiness of each individual child during toilet training.

History Note: Authority G.S. 110-91(1); 143B-168.3; Eff. January 1, 1986; Amended Eff. July 1, 1998; November 1, 1989.


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