5.3 Health and Safety Standards for CCDF Providers

Lead Agencies must have health and safety standards for providers serving children receiving CCDF assistance relating to the required health and safety topics as appropriate to the provider setting and age of the children served. This requirement is applicable to all child care programs receiving CCDF funds regardless of licensing status (i.e., licensed or license-exempt). The only exception to this requirement is for relative providers, as defined by CCDF. Lead Agencies have the option of exempting certain relatives from any or all CCDF health and safety requirements. Exemptions for relative providers’ standards requirements will be addressed in question 5.8.1. Describe the following health and safety standards for programs serving children receiving CCDF assistance on the following topics (note that monitoring and enforcement will be addressed in subsection 5.5): 5.3.1 Prevention and control of infectious diseases (including immunizations) health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention and control of infectious diseases for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: For child care centers, At least one staff member who has successfully completed within the last three years a department approved first aid course shall be present at all times the child care program is in operation. Instruction shall include communicable disease prevention; hygiene; diapering techniques; signs and symptoms of illness; temperature taking; and education in specific communicable disease. Staff members shall be knowledgeable about signs and symptoms of childhood illness and shall be responsible for the initial observation of each child upon arrival and continued observation throughout the day for such signs and symptoms. Any child showing suspicious signs or symptoms of short-term contagious illness shall be placed in a designated isolation area with continual visual supervision by staff. The parent(s) or other authorized adult shall be called immediately to remove the child from the child day care center or group day care home. Hands of staff and children shall be washed before and after each diaper change, and diapering areas shall be washed and disinfected after each use. Both staff and children shall was their hands before eating or handling food. When cots are shared, they shall be washed and disinfected, and linens changed between children. Toys used for infants shall be kept separate, washed and disinfected at least daily. Toys for toddlers shall be washed and disinfected at least weekly. Facilities using potty chairs shall ensure they are cleaned and disinfected after each use. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family child care providers must maintain current certification in first aid. The provider, staff and children shall wash their hands with soap and water before eating or handling food and after toileting. Diapering surfaces shall be nonporous and disinfected after each use. Waste materials shall be disposed of in a sanitary manner out of the reach of children. A family child care provider may choose to care for a mildly ill child if the child attends the family child care home on a regular basis and does not have a fever exceeding 101 degrees Fahrenheit, more than one undiagnosed episode of diarrhea or vomiting, or an undiagnosed skin rash. No child shall be accepted for sick care. The provider must use standard precautions and sanitary practices to prevent the spread of infection. The provider must also give parents information about the presence of any contagious illness affecting children, staff or household members. iii. All CCDF-eligible licensed in-home care. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Licensed exempt child care centers must ensure toys used for infants shall be kept separate, washed and sanitized at least daily. Toys for toddlers, including floor and riding toys, shall be washed and sanitized at least weekly and as needed. Diapering areas shall be washed and disinfected after each use, and the hands of the staff and the children shall be washed after each diaper change. Diapering and hand washing policies and procedures shall be posted in each diapering area and followed. Disposable diapers shall be discarded in a covered receptacle immediately after diapering. Staff shall complete at least one percent of the total annual hours worked of professional development and shall include at least one health and safety topic as defined in 45 CFR § 98.44(b)(1) which may include the prevention and control of infectious diseases. Physical Plant and Program Policies Procedures in case of illness (1) Staff members shall be knowledgeable about signs and symptoms of childhood illness and shall be responsible for the initial observation of each child upon arrival and continued observation throughout the day for such signs and symptoms. (2) Any child showing suspicious signs or symptoms of short-term contagious illness shall be placed in a designated isolation area with continual visual supervision by staff. The parent(s) or other authorized adult shall be called immediately to remove the child from the program. (3) Standard precautions and sanitary practices are used to prevent the spread of infection. Proper Hygiene Children and staff shall wash their hands with soap and water before eating or handling food and after toileting. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: licensed center: At least one staff member who has successfully completed within the last three years a department approved first aid course shall be present at all times the child care program is in operation. Instruction shall include communicable disease prevention; hygiene; signs and symptoms of illness; temperature taking; and education in specific communicable disease. Staff members shall be knowledgeable about signs and symptoms of childhood illness and shall be responsible for the initial observation of each child upon arrival and continued observation throughout the day for such signs and symptoms. Any child showing suspicious signs or symptoms of short- term contagious illness shall be placed in a designated isolation area with continual visual supervision by staff. The parent(s) or other authorized adult shall be called immediately to remove the child from the child day care center or group day care home. Both staff and children shall was their hands before eating or handling food. When cots are shared, they shall be washed and disinfected, and linens changed between children. License-exempt programs: Staff members shall be knowledgeable about signs and symptoms of childhood illness and shall be responsible for the initial observation of each child upon arrival and continued observation throughout the day for such signs and symptoms. Any child showing suspicious signs or symptoms of short-term contagious illness shall be placed in a designated isolation area with continual visual supervision by staff. The parent(s) or other authorized adult shall be called immediately to remove the child from the child day care center or group day care home. The building and equipment shall be maintained sanitary and free of health and safety hazards. Potentially hazardous substances and materials in the child care program shall be handled in a safe manner and stored in a separate locked area. Staff shall complete at least one percent of the total annual hours worked of professional development and shall include at least one health and safety topic as defined in 45 CFR § 98.44(b)(1) which may include the prevention and control of infectious diseases. Physical Plant and Program Policies Procedures in case of illness (1) Staff members shall be knowledgeable about signs and symptoms of childhood illness and shall be responsible for the initial observation of each child upon arrival and continued observation throughout the day for such signs and symptoms. (2) Any child showing suspicious signs or symptoms of short-term contagious illness shall be placed in a designated isolation area with continual visual supervision by staff. The parent(s) or other authorized adult shall be called immediately to remove the child from the program. (3) Standard precautions and sanitary practices are used to prevent the spread of infection. Proper Hygiene Children and staff shall wash their hands with soap and water before eating or handling food and after toileting. b. Provide the standards, appropriate to the provider setting and age of children, that address that children attending child care programs under CCDF are age-appropriately immunized, according to the latest recommendation for childhood immunizations of the respective State public health agency, for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The operator shall admit no child to a child care center or group child care home unless such child’s parent(s) furnishes documentation of age-appropriate immunization, immunization-in-progress or exemption from immunization. A record of such determinations under this subdivision shall be maintained on file at the child care center or group child care home for a period of two years after such child is no longer receiving child care services at such child care center or group child care home. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(b)(2)(A)(i) Providers shall have a complete and current general health record on file which includes the following information (i) a statement about the child's general health and the presence of any known medical or emotional illness or disorder that would currently pose a risk to other children in care or which would currently affect the child's functional ability to participate safely in a child care setting; (ii) Allergies; (iii) Disabilities; (iv) Ongoing medication; and (v) An immunization record that includes the month, day, and year of each immunization required for admission as specified in subdivision (1) of subsection ( [) of this section, and such documentation as is required to confirm age appropriate immunization, immunization in progress or exemption to immunization as defined in subdivision (3) of subsection ([J of this section. The immunization record and said documentation of immunizations shall be submitted to the Office upon request. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The operator shall maintain in the child care program a written statement signed by the operator or the operator’s designee attesting to the fact that no child will be admitted to child care program unless such child's parent(s) furnishes documentation of age-appropriate immunization, immunization-in- progress or exemption from immunization against the diseases for which vaccination is recommended in the current schedule for active immunization adopted by the commissioner of public health in accordance with section 19a-7f of the Connecticut General Statutes. No child shall be permitted to continue to attend a child care program for more than thirty days unless such child continues to meet said requirements. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Center - The operator shall admit no child to a child care center or group child care home unless such child’s parent(s) furnishes documentation of age-appropriate immunization, immunization-in-progress or exemption from immunization. A record of such determinations under this subdivision shall be maintained on file at the child care center or group child care home for a period of two years after such child is no longer receiving child care services at such child care center or group child care home. License-exempt: The operator shall maintain in the child care program a written statement signed by the operator or the operator’s designee attesting to the fact that no child will be admitted to child care program unless such child's parent(s) furnishes documentation of age-appropriate immunization, immunization-in- progress or exemption from immunization against the diseases for which vaccination is recommended in the current schedule for active immunization adopted by the commissioner of public health in accordance with section 19a-7f of the Connecticut General Statutes. No child shall be permitted to continue to attend a child care program for more than thirty days unless such child continues to meet said requirements. 5.3.2 Prevention of sudden infant death syndrome and the use of safe-sleep practices health and safety standard Provide the standards, appropriate to the provider setting and age of children, that address the prevention of sudden infant death syndrome and use of safe sleeping practices for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-10(g)Infants under twelve (12) months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or bed designed for infant sleeping, with a snug fitting mattress unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for an alternative sleep position. (2) When infants can easily turn over from the supine to the prone position, they shall be put down to sleep on their back, but allowed to adopt whatever position they prefer for sleep. (3) Soft surfaces and gas-trapping objects such as pillows, quilts, sheepskins, soft bumpers or stuffed toys shall not be placed under or with an infant for sleeping and shall be kept out of the infant's crib or bed. (4) No infant shall be put to sleep on a sofa, soft mattress, waterbed or other soft surface. No infant shall be put to sleep in a child restraint system intended for use in a vehicle, an infant carrier, a swing or any place that is not specifically designed to be an infant bed unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for their use. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(f) Sleep Arrangements for Infants. Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or other piece of equipment designed for infant sleeping and appropriate for the particular infant under twelve months of age, with a snug fitting mattress covered by a tightly-fitted sheet unless the infant under twelve months of age. When infants under twelve months of age can easily tum over from the supine to the prone position, infants under twelve months of age shall be put down to sleep on their back, but allowed to adopt whatever position they prefer for sleep. No items, including, but not limited to, pillows, soft bumpers, toys and blankets, shall be placed with an infant under twelve months of age in a crib or hung over the side of a crib or other piece of equipment designed for sleeping, except for a pacifier without attachments, unless the infant under twelve months of age has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for such item's use. Bibs and garments with ties or hooks shall be removed from infants under twelve months of age that are placed to sleep. No toys or objects shall be attached to cribs or others pieces of equipment designed for sleeping. No infant under twelve months of age shall be put to sleep on a sofa, bed, couch, soft mattress, waterbed or other soft surface. No infant under twelve months of age shall be put to sleep or allowed to remain asleep in a child restraint system intended for use in a vehicle, an infant carrier, a swing or any place that is not specifically designed to be an infant bed unless the infant under twelve months of age has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for its use. No infant under twelve months of age shall be swaddled unless the infant under twelve months of age has written documentation from a physician, physician assistant or advanced practice registered nurse specifying instructions and a time frame for swaddling the infant under twelve months of age. Infants under twelve months of age shall be physically observed by the provider or staff at least every fifteen minutes to assess the infant's breathing, color, temperature and comfort. No child under three years of age shall have access to teething necklaces, teething bracelets or other jewelry that could present a choking or strangulation hazard. The provider shall post in a conspicuous place in the family child care home the requirements of this subsection pertaining to sleep arrangements and discuss with the child's parent(s) the requirements of this subsection pertaining to sleep arrangements prior to enrollment and reviewed as needed during the period of the child's enrollment. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Programs Serving Infants and Toddlers (c) Sleep Arrangements Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well constructed, free standing crib, bed or other piece of equipment designed for infant sleeping and appropriate for the particular child, with a snug fitting mattress unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for an alternative sleep position or alternate piece of equipment. When infants can easily turn over from the supine to the prone position, they shall be put down to sleep on their back, but allowed to adopt whatever position they prefer for sleep. Soft surfaces and gas- trapping objects such as pillows, blankets, quilts, sheepskins, soft bumpers or stuffed toys shall not be placed under or with an infant for sleeping and shall be kept out of infant's crib or bed. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A 5.3.3 Administration of medication, consistent with standards for parental consent health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the administration of medication for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-9a(b)(3) Order From An Authorized Prescriber/Parent’s Permission. Except for nonprescription topical medications described in section 19a-79-9a(a)(1) of the Regulations of the Connecticut State Agencies, no medication, prescription or nonprescription shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility for at least two years after the child is no longer attending the program. Such medications may include: (i) Oral medications; (ii) Topical medications; (iii) Inhalant medications; (iv) Injectable medications, by a premeasured, commercially prepared auto- injector, to a child with a medically diagnosed condition who may require emergency treatment; or (v) Injectable medication other than by a premeasured commercially prepared auto-injector. (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of the drug by the director, head teacher, program staff or group child care home provider. (E) Investigational drugs shall not be administered. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 17(b)(3): Administration of medications by unlicensed staff is permitted, provided the program has written policies and procedures governing administration, specified training is completed, administration is in accordance with a written order from an authorized prescriber, written parent permission is obtained, and specified documentation and storage and labeling requirements are followed. Order from an Authorized Prescriber and Parent's Permission (A) Except for nonprescription topical medication described in subdivision (I) of subsection (a) of this section, no medication, prescription or nonprescription, shall be administered to a child without the written order of an authorized prescriber and the written permission of the child's parent(s) which shall be on file at the family child care home. Such medication may include: (i (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of medication by the provider or substitute. (D)￿The parent shall be notified immediately of a significant medication error or a medication error, and be notified in writing not later than 72 hours after the significant medication error or medication error occurred and the error shall be documented in the medication administration record. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: License exempt child care centers that administer medications of any kind shall develop and implement written policies and procedures at the facility governing the administration of medications which shall include, but not be limited to, the types of medication that shall be administered, parental consent and prescriber authorizations, staff responsibilities, proper storage of medication and record keeping. Said policies and procedures shall be maintained onsite and shall reflect best practice. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Center -19a-79-9a(b)(3) Order From An Authorized Prescriber/Parent’s Permission. Except for nonprescription topical medications described in section 19a-79-9a(a)(1) of the Regulations of the Connecticut State Agencies, no medication, prescription or nonprescription shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility for at least two years after the child is no longer attending the program. Such medications may include: (i) Oral medications; (ii) Topical medications; (iii) Inhalant medications; (iv) Injectable medications, by a premeasured, commercially prepared auto- injector, to a child with a medically diagnosed condition who may require emergency treatment; or (v) Injectable medication other than by a premeasured commercially prepared auto-injector. (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of the drug by the director, head teacher, program staff or group child care home provider. (E) Investigational drugs shall not be administered. License-exempt: shall comply with sections 10-212a-1 through 10-212-a-10 of the Regulations of Connecticut State Agencies. (1) The operator shall maintain in the child care program a written statement signed by the operator or the operator’s designee attesting to the fact that a) prior to the administration of any medication, the staff who are responsible for administering the medications shall first be trained by a physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medications and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program as required herein; b) staff trained and approved to administer medication shall be present whenever a child who has orders to receive medication is enrolled and present at the facility; c) training requirements shall be conducted in accordance with sections 19a-79-9a(b)(1)(A) through 19a-79- 9a(b)(1)(C) of the Connecticut Statutes and Regulations for Child Care Centers and Group Child Care Homes. (2) The operator shall not deny services to a child on the basis of a child's known or suspected allergy or because a child has a prescription for an automatic pre- filled cartridge injector or similar automatic injectable equipment used to treat an allergic reaction or for injectable equipment used to administer glucagon, and shall not deny services to a child on the basis of a child's diagnosis of asthma or because a child has a prescription for an inhalant medication to treat asthma. b. Provide the standards, appropriate to the provider setting and age of children, that address obtaining permission from parents to administer medications to children for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-9a(b)(3) Order From An Authorized Prescriber/Parent’s Permission (A) Except for nonprescription topical medications described in section 19a-79-9a(a)(1) of the Regulations of the Connecticut State Agencies, no medication, prescription or nonprescription shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility for at least two years after the child is no longer attending the program. Such medications may include: (i) Oral medications; (ii) Topical medications; (iii) Inhalant medications; (iv) Injectable medications, by a premeasured, commercially prepared auto- injector, to a child with a medically diagnosed condition who may require emergency treatment; (v) Rectal medications; or (vi) Injectable medication other than by a premeasured commercially prepared auto-injector. (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of the drug by the director, head teacher, program staff or group child care home provider. (D) ￿The parent(s) shall be notified immediately of a significant medication error or a medication error and notified in writing not later than seventy-two hours after the significant medication error or medication error occurred, and the error shall be documented in the medication administration record. Significant medication errors shall also be reported immediately ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 17(b)(3) Order From An Authorized Prescriber and Parent's Permission (A) Except for nonprescription topical medication described in subdivision (I) of subsection (a) of this section, no medication, prescription or nonprescription, shall be administered to a child without the written order of an authorized prescriber and the written permission of the child's parent(s) which shall be on file at the family child care home. Such medication may include: (i (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of medication by the provider or substitute. (D)￿The parent shall be notified immediately of a significant medication error or a medication error, and be notified in writing not later than 72 hours after the significant medication error or medication error occurred and the error shall be documented iii. All CCDF-eligible licensed in-home care. Provide the standard: [x]Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: License exempt child care centers that administer medications of any kind shall develop and implement written policies and procedures at the facility governing the administration of medications which shall include, but not be limited to, the types of medication that shall be administered, parental consent and prescriber authorizations, staff responsibilities, proper storage of medication and record keeping. Said policies and procedures shall be maintained onsite and shall reflect best practice. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed center: 19a-79-9a(b)(3) Order From An Authorized Prescriber/Parent’s Permission (A) Except for nonprescription topical medications described in section 19a-79-9a(a)(1) of the Regulations of the Connecticut State Agencies, no medication, prescription or nonprescription shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility for at least two years after the child is no longer attending the program. Such medications may include: (i) Oral medications; (ii) Topical medications; (iii) Inhalant medications; (iv) Injectable medications, by a premeasured, commercially prepared auto- injector, to a child with a medically diagnosed condition who may require emergency treatment; (v) Rectal medications; or (vi) Injectable medication other than by a premeasured commercially prepared auto-injector. (xii) The name, address, telephone number, signature and relationship to the child of the parent(s) giving permission for the administration of the drug by the director, head teacher, program staff or group child care home provider. (D) ￿The parent(s) shall be notified immediately of a significant medication error or a medication error and notified in writing not later than seventy-two hours after the significant medication error or medication error occurred, and the error shall be documented in the medication administration record. Significant medication errors shall also be reported immediately License- Exempt: shall comply with sections 10-212a-1 through 10-212-a-10 of the Regulations of Connecticut State Agencies. (1) The operator shall maintain in the child care program a written statement signed by the operator or the operator’s designee attesting to the fact that a) prior to the administration of any medication, the staff who are responsible for administering the medications shall first be trained by a physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medications and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program as required herein; b) staff trained and approved to administer medication shall be present whenever a child who has orders to receive medication is enrolled and present at the facility; c) training requirements shall be conducted in accordance with sections 19a-79-9a(b)(1)(A) through 19a-79-9a(b)(1)(C) of the Connecticut Statutes and Regulations for Child Care Centers and Group Child Care Homes. (2) The operator shall not deny services to a child on the basis of a child's known or suspected allergy or because a child has a prescription for an automatic pre-filled cartridge injector or similar automatic injectable equipment used to treat an allergic reaction or for injectable equipment used to administer glucagon, and shall not deny services to a child on the basis of a child's diagnosis of asthma or because a child has a prescription for an inhalant medication to treat asthma. 5.3.4 Prevention of and response to emergencies due to food and allergic reactions health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of emergencies due to food and allergic reactions for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a79-3a(b)(7) The operator is responsible for requiring participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures. 19a-79-3a(d)(4) The operator shall implement and annually review policies, plans and procedures which shall include emergencies, including medical emergencies. 19a-79- 5a(a)(2)(E)The operator is responsible for maintaining a current record for each child enrolled which includes information regarding disabilities or special health care needs such as, allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease, and an individual plan of care for a child with special health care needs or disabilities, developed with the child's parent(s) and health care provider and updated, as necessary. Such plan shall include appropriate care of the child in the event of a medical or other emergency and shall be signed by the parent(s) and staff responsible for the care of the child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(b)(2) General health record (A) The provider shall have a complete and current general health record on file when the child begins attending the family child care home, signed and dated by a physician, physician assistant or advanced practice registered nurse, based on an examination within the past year for infants, toddlers and preschoolers or within the period allowed by schools for older children. A complete and current general health record shall include, but not be limited to, the following information pertaining to the child: (i) A statement about the child's general health and the presence of any known medical or emotional illness or disorder that would currently pose a risk to other children in care or which would currently affect the child's functional ability to participate safely in a child care setting; (ii) Allergies; (iii) Disabilities; 19a-87b-10(d) Individual Plan for Care The provider shall establish a planned program of developmentally appropriate activities at the family child care home, which promotes the social, intellectual, emotional and physical development of each child. (2) The provider shall have an understanding of the needs of children with disabilities or special health care needs receiving family child care services. (3) The provider shall maintain in the family child care home a written individual plan of care for each child with disabilities or special health care needs, including but not limited to, allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease who requires special care be taken or provided while the child is at the family child care home. Such plan shall be based on the recommendations of the child's primary health care iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Record Keeping (e)The operator shall ensure that the individual needs of each child are met and shall maintain at the child care program a written individual plan of care for each child with disabilities or special health care needs such as allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease when it is necessary that special care be taken or provided while the child is in attendance at the child care program. Such plan shall be based on the recommendations of the child’s primary health care provider, developed with the child’s parent(s) at intake, implemented and updated as necessary to meet the child’s changing needs. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and staff members responsible for the care of the child. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Center: 19a79-3a(b)(7) The operator is responsible for requiring participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures. 19a-79-3a(d)(4) The operator shall implement and annually review policies, plans and procedures which shall include emergencies, including medical emergencies. 19a-79- 5a(a)(2)(E)The operator is responsible for maintaining a current record for each child enrolled which includes information regarding disabilities or special health care needs such as, allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease, and an individual plan of care for a child with special health care needs or disabilities, developed with the child's parent(s) and health care provider and updated, as necessary. Such plan shall include appropriate care of the child in the event of a medical or other emergency and shall be signed by the parent(s) and staff responsible for the care of the child. Licensed Exempt: Record Keeping (e)The operator shall ensure that the individual needs of each child are met and shall maintain at the child care program a written individual plan of care for each child with disabilities or special health care needs such as allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease when it is necessary that special care be taken or provided while the child is in attendance at the child care program. Such plan shall be based on the recommendations of the child’s primary health care provider, developed with the child’s parent(s) at intake, implemented and updated as necessary to meet the child’s changing needs. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and staff members responsible for the care of the child. b. Provide the standards, appropriate to the provider setting and age of children, that address the response to emergencies due to food and allergic reactions for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(b)(6) Require participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures. 19a-79-3a(d)(4) The operator shall implement and annually review policies, plans and procedures which shall include emergencies, including medical emergencies. 19a-79-5a(a)(2)(E) The operator is responsible for maintaining a current record for each child which includes information regarding disabilities or special health care needs such as, allergies or special dietary needs, , when it is necessary that special care be taken or provided while a child is in attendance at the child care center or group child care home, and an individual plan of care for a child with special health care needs or disabilities, developed with the child’s parent(s) and health care provider, implemented and updated, as necessary. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and program staff responsible for the care of the child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(d) Individual Plan for Care (3) The provider shall maintain in the family child care home a written individual plan of care for each child with disabilities or special health care needs, including but not limited to, allergies and special dietary needs, who requires special care be taken or provided while the child is at the family child care home. Such plan shall be based on the recommendations of the child's primary health care provider, developed with the child's parent(s) at intake, implemented and updated as necessary to meet the child's changing needs. Such plan shall include appropriate care of the child in the event of a medical or other emergency and shall be signed by the provider, parent(s) and any approved staff members responsible for the care of the child. iii. All CCDF-eligible licensed in-home care. Provide the standard:: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Record Keeping (e)The operator shall ensure that the individual needs of each child are met and shall maintain at the child care program a written individual plan of care for each child with disabilities or special health care needs such as allergies and special dietary needs, when it is necessary that special care be taken or provided while the child is in attendance at the child care program. Such plan shall be based on the recommendations of the child’s primary health care provider, developed with the child’s parent(s) at intake, implemented and updated as necessary to meet the child’s changing needs. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and staff members responsible for the care of the child. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: License Center: 19a-79-3a(b)(6) Require participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures. 19a-79-3a(d)(4) The operator shall implement and annually review policies, plans and procedures which shall include emergencies, including medical emergencies. 19a-79-5a(a)(2)(E) The operator is responsible for maintaining a current record for each child which includes information regarding disabilities or special health care needs such as, allergies or special dietary needs, , when it is necessary that special care be taken or provided while a child is in attendance at the child care center or group child care home, and an individual plan of care for a child with special health care needs or disabilities, developed with the child’s parent(s) and health care provider, implemented and updated, as necessary. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and program staff responsible for the care of the child. License-exempt: Record Keeping (e)The operator shall ensure that the individual needs of each child are met and shall maintain at the child care program a written individual plan of care for each child with disabilities or special health care needs such as allergies and special dietary needs, when it is necessary that special care be taken or provided while the child is in attendance at the child care program. Such plan shall be based on the recommendations of the child’s primary health care provider, developed with the child’s parent(s) at intake, implemented and updated as necessary to meet the child’s changing needs. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and staff members responsible for the care of the child. 5.3.5 Building and physical premises safety, including the identification of and protection from hazards, bodies of water, and vehicular traffic health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from building and physical premises hazards for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-7a (a) The standards established by the following sources for the construction, renovation, alteration, expansion, conversion, maintenance and licensure of child day care centers and group day care homes, as they are amended from time to time, are incorporated and made a part of this section by reference: (1) State of Connecticut Basic Building Code, (2) State of Connecticut Fire Safety Code, (3) State of Connecticut Public Health Code, (4) local codes and ordinances. (b) Plans for new construction, expansion, renovation or conversion, indicating the proposed use and accompanied by a written narrative shall be submitted to the department prior to the start of construction. (1) Completed plans and specifications shall be submitted to and reviewed by the department on the basis of compliance with the Public Health Code. (2) Written approval by the local building inspector, local director of health or designee, local zoning and local fire marshal shall be submitted to the department, upon request of the department. (3) Approval by the department is required prior to the use of any space that has been newly constructed, expanded, renovated or converted. (4) All construction, remodeling, renovation, repairs or alterations of structures shall be done in such a manner to prevent hazards or unsafe physical or environmental conditions during periods of operation. (c) General requirements (1) Any operator is responsible for maintaining the child day care center or group day care home in compliance with section 19a-79-1a to section 19a-79-13, inclusive, of the Regulations of Connecticut State Agencies. (2) The building, equipment and services shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards. (3) Water supply, food service and sewage disposal facilities shall be in compliance with all applicable sections of the Public Health Code. (A) All water supplies shall be tested every two (2) years for lead content and the results submitted to the local and state health departments. (B) Whenever water is obtained from other than a department-approved public water supply, it shall be of a safe and sanitary quality and tested every two (2) years for bacterial and chemical quality and the results submitted to the local and state health departments. (C) Sanitary drinking fountains or individual disposable drinking cups shall be provided and accessible to the children at all times. (d) Basic requirements (1) Emergency vehicles shall have access to all child day care centers or group day care homes. (2) Established walkways shall be provided and properly maintained for each entrance and exit leading to a driveway or street. (3) In child day care centers that are licensed by January 1, 1994, a toilet and sink shall be designated for use by the staff and other adults. In child day care centers that are licensed or renovated after January 1, 1994, a room with a toilet and sink within the licensed child day care center shall be designated for the exclusive use of staff and other adults. (4) All windows that open to the outside and are used for ventilation shall be equipped with sixteen (16) mesh screening, and shall be protected to prevent falls. (5) Any unprotected glass doors, windows or mirrors to which children have access shall be protected to a height of thirty six (36) inches from the floor or surface on which a child stands. (6) Where overhead doors are accessible to the children, they shall be equipped with locking devices and spring protectors. (7) Exit doorways, stairs or hallways shall not be blocked by furniture, toys or play equipment. (8) There shall be an area available for the individual storage of each child's clothing and bedding. (9) Smoking is prohibited in all child day care centers or group day care homes and outdoor areas except in designated smoking areas, provided these areas are separate, properly ventilated and enclosed away from any children present at the facility. Signs shall be posted, visible to the public, on entrance to the facility indicating that smoking is prohibited except in designated areas. Matches and lighters shall be inaccessible to children at all times. (10) Electrical outlets shall be provided with safety covers or approved safety outlets. The use and maintenance of electrical cords, appliances and adaptors shall be in full compliance with state codes. (11) Toilet and washing facilities (A) Where toilets and sinks are shared by children and adults, a written policy shall be developed and implemented that requires supervision of children when using the shared toilet room. (B) Programs shall provide changing and sanitary facilities appropriate to meet the individual needs of children who are enrolled at the facility who need assistance with toileting or who are not independent with toileting. (C) For programs serving children under six (6) years of age there shall be at least one (1) toilet and one (1) sink with hot and cold running water for every sixteen (16) children, or fraction thereof. Standard size toilets and sinks shall be adapted for children's use. Facilities using potty chairs in addition to the required toilets shall ensure that they are of a nonporous, synthetic product, and emptied into the toilet, cleaned and disinfected after each individual use. (D) For programs serving only school age children, there shall be at least one (1) toilet and one (1) sink with running water for every twenty-five (25) children, or fraction thereof. Toilet facilities shall be designed in such a manner to allow individual privacy. (E) Sinks with running water shall be readily accessible to the toilet rooms if not located within them. Toilet tissue, soap, single use disposable towels and a waste receptacle shall be accessible to the toilets and sinks. Staff and children shall wash their hands with soap and water after toileting. (F) Each toilet room shall be well lighted and ventilated to the outside atmosphere. (G) In child day care centers constructed or renovated after January 1, 1994, all toilet facilities shall be mechanically ventilated to the outside atmosphere. (e) Environmental requirements (1) Every area used by children shall be adequately ventilated and have a thermometer affixed to the wall. The ambient air temperature shall be at least sixty-five (65) degrees Fahrenheit as measured three (3) feet from the floor. (2) When the temperature exceeds eighty (80) degrees Fahrenheit, the operator shall provide more fluids and increase ventilation. (3) The water heating equipment shall deliver water at the tap, the temperature of which shall be within a range of sixty (60) degrees Fahrenheit to one hundred fifteen (115) degrees Fahrenheit. It shall have the capacity to deliver the required amounts at all times in conformance with the State of Connecticut Basic Building Code. (4) Only central heating or permanently installed heating systems shall be used. Portable space heaters are prohibited. (5) Walls, ceilings, floors and rugs shall be maintained in a state of good repair and be washable or easily cleanable. Rugs, if used, shall be secured to the floor. (6) Hot water or steam pipes located in areas accessible to children shall have adequate protective covering which is maintained safely and in good repair. (7) Each level of the child day care center or group day care home shall be provided with a telephone in working order located within the licensed program space accessible to staff for emergency purposes. Emergency telephone numbers shall be posted in an area adjacent to the phone. (8) All spaces occupied by people, equipment within buildings, approaches to buildings and parking lots shall have a minimum of one (1) foot candle of lighting per square foot. (9) Child day care centers and group day care homes shall have at least fifty (50) foot candles of light per square foot in rooms used by children for reading, painting and other close work. There shall be at least thirty (30) foot candles of light in other work or play areas. In child day care centers and group day care homes constructed or renovated after January 1, 1994, all rooms and toilet rooms shall have at least one (1) light fixture switch at each entrance. All areas accessible to children shall have light fixtures that are shielded or shatter proof. (10) Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. (11) Garbage and rubbish shall be kept in containers constructed of durable material approved by the local health director. Receptacles shall be in good repair to prevent infestations by rodents, insects and other pests and to prevent odors, injuries and other nuisance conditions. The garbage and rubbish shall be moved to an exterior waste storage area at least daily. (12) Stairs must be properly protected and maintained in good repair. There must be handrails installed at a height usable by children. (13) Toxic plants and materials are prohibited in areas accessible to children. (14) Any pet or animal present at the facility, indoors or outdoors, shall be in good health, show no evidence of carrying disease and be a friendly companion for the children. (15) When pets are kept on the premises, procedures for their care and maintenance and access to the children shall be written and implemented. (16) There shall be effective measures taken to prevent vermin from entering or breeding in the child day care center or group day care home. All openings to the outer air used for ventilation shall be screened with a minimum of sixteen (16) mesh screening and doors shall be provided to prevent the entrance of vectors. (17) If the child day care center or group day care home uses the basement level or the first floor of a building, a minimum of one (1) radon test shall be conducted using a device or service listed by the National Radon Proficiency Program and approved by the department. (A) This test shall be completed during the months of November through April and the results posted with the license. The department and the local director of health shall be notified of the results. (B) When confirmatory sampling results of radon gas in the air are equal to or greater than 4.0 picocuries per liter (pCi/L), the operator shall ensure that the radon gas is reduced to below 4.0 pCi/L. A qualified residential mitigation service provider as defined in sections 19a-14b and 20-420 of the Connecticut General Statutes shall be hired to reduce the level of radon gas in the air. (18) Child day care centers and group day care homes that utilize combustible fuel shall be equipped with at least one (1) operable carbon monoxide (CO) detector on each occupied level of the facility. CO detectors shall comply with Underwriters Laboratories (UL) Standards for Safety, and shall be operated in accordance with the manufacturer's instructions. (g) Equipment. All equipment shall be of such design and material as to be readily cleaned and safe for children. (1) Equipment shall not be colored or covered by any poisonous material. All solid constituents of paint for equipment and toys, and pigment coloring in paints, pencils, crayons and inks, to be used by the children shall be non-toxic. Equipment shall be sturdy, safely constructed and free from protruding nails, rust, toxic material and other hazards. (2) Adequate equipment for rest shall be provided. An individual cot shall be provided for any child who regularly remains five (5) hours or longer per day. When cots are shared, they shall be washed and disinfected and linens changed between children. In a group day care home, an individual mat or individual sleeping bag may be substituted for the individual cot. (3) Metal equipment shall be free from rust or chipping paint. (4) Hardware such as air conditioners, water heaters or fuse boxes shall be inaccessible to children. (5) The materials and equipment available and used by children shall be developmentally appropriate for the ages of the children served. (h) Outdoor play space (2) Where swings, seesaws or climbing apparatus are used, the surface in the space shall be protected with a minimum of eight (8) inches of impact absorbing materials, e.g., sand or its equivalent. (3) The playground shall be free of glass, debris, holes and other hazards. (4) Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. (5) Outside equipment shall be anchored for stability. Anchors shall be buried below ground level. (6) The operator shall provide documentation to the department, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. (7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four (4) feet in height. (B) When there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four (4) feet high or higher, with locked entrances, which totally and effectively bars access to the water by children. (C) On and after January 1, 2010, a rooftop used as a play area shall be enclosed with a wall, fence or permanent physical barrier not less than six (6) feet high and the bottom edge shall be no more than three and one half (3 1/2) inches from the base or floor. The wall, fence or permanent physical barrier shall be designed to prevent children from climbing it. (8) Drinking water shall be available and accessible. (9) Outdoor equipment shall be arranged in such a way as to avoid accidents. (i) Swimming, wading and bathing facilities. Swimming, wading and bathing facilities, if provided, shall comply with the provisions of sections 19-13- B33b, 19-13-B34 and 19-13-B36 of the Regulations of Connecticut State Agencies. No wading pools shall be used. No day care child shall be permitted in a hot tub, spa or sauna. Hot tubs, spas and saunas shall be locked and inaccessible to children. (j) No dangerous weapon as described in section 53-206 of the Connecticut General Statutes or facsimile of a firearm as defined in section 53-206c of the Connecticut General Statutes shall be permitted on the premises of the child day care center or group day care home unless the carrier of such weapon or facsimile firearm is a peace officer as defined in section 53a-3 of the Connecticut General Statutes. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9. Requirements for the Physical Environment (a) Cleanliness The facility and equipment shall be kept in a clean and sanitary condition and shall not pose a health hazard to children. The commissioner, upon inspection, may require the provider to correct any violation of this section that may put children at risk of injury. (b) Freedom from Hazards The facility and equipment shall be in good repair, and reasonably free from anything that may be potentially dangerous to children. The commissioner, upon inspection, may require the provider to correct any condition under this section that may put children at risk. (c) Absence of Potentially Harmful Substances and Materials All potentially harmful substances and materials, including but not limited to, cleaning supplies, cosmetics, toiletries, medication, alcoholic beverages and other toxins shall be inaccessible to children. Poisonous and unidentified plants shall be removed from the area, protected by barriers, or kept out of the reach of children. Bio contaminants, including but not limited to, blood, bodily fluids or excretions that may spread infectious disease, shall be disposed of in a safe manner and in accordance with manufacturer's instructions, when applicable. ( d) Fire Safety The provider shall ensure that the family child care home provides a reasonable degree of safety from fire, which shall include, but not be limited to, the following requirements: (5) Emergency Plan The provider shall have a written plan for the protection of children and child care staff in the event of emergencies, including, but not limited to, fire, medical, weather related, man-made disaster, natural disasters or acts of terrorism. The plan shall address the evacuation and removal of children to a safe location, sheltering in place if evacuation is not feasible, lock-down procedures, plans for continuation of operations, communication and reunification with parents, and accommodations for infants and toddlers, children with disabilities and children with chronic medical conditions, made in consultation with the child's parent(s). The provider and all child care staff shall be periodically instructed and kept informed of their duties under the plan and shall practice at least quarterly an emergency evacuation drill which includes the demonstration of the provider, staff and children exiting the residence of the family child care home. A written log of the practiced drills shall be maintained at the family child care home for one year. ( 6) Smoke Detectors The provider shall have smoke detectors, in operating condition, placed in the home so as to protect children's sleeping areas, play areas and the basement. There shall be at least one smoke detector on each level of the family child care home. (7) Carbon Monoxide Detector Family child care homes that utilize combustible fuel shall be equipped with at least one operable carbon monoxide (CO) detector on each occupied level of the home. CO detectors shall comply with Underwriters Laboratories standards for safety, and shall be operated in accordance with the manufacturer's instructions. (8) Fire Extinguisher (A) The provider shall have easily accessible to the area of child care a minimum of one ABC multi-purpose fire extinguisher in operating condition that contains at least five pounds of fire extinguishing agent and shall have knowledge of its use and the ability to manage its use. (B) Each fire extinguisher shall be installed according to the manufacturer's instructions, at a height not to exceed five feet above the floor. Extinguishers shall not be obstructed or obscured in order to allow for immediate access. (9) Safe Heating Systems and Devices (A) The provider shall show documentation that any auxiliary heater installed after original construction of the facility has been inspected and approved for proper and safe installation by an authorized licensed professional and, where applicable, the local building official. All devices shall be safely located, shall be properly cleaned and maintained with a barrier where necessary for the protection of children receiving family child care services. (B) No heating system or device shall pose a hazard to children. (e) Safe Storage of Guns, Ammunition and other Weapons The provider shall protect children from guns, ammunition and weapons stored at the facility. ( 1) All guns shall be stored unloaded. (2) Ammunition shall be stored and locked in a separate location away from the guns and inaccessible to children. (3) All guns and weapons shall be kept locked or stored in a locked storage area that is known to the provider. (4) Locks shall be openable with a key, combination, or other similar unlocking mechanism that prevents unauthorized persons from obtaining access. ( f) Safe Space (1) There shall be sufficient indoor and outdoor play space to ensure appropriate activities, safety and comfort for the children at the facility. When outdoor play space does not exist at the facility, the provider shall identify alternate outdoor play space and develop a written plan that ensures the safe transportation of children to and from the alternate outdoor play space. The outdoor play space shall be protected from traffic, bodies of water, gullies, and other hazards by barriers that bar access to such hazards and are safe for children. (2) When there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four feet high or higher, which totally and effectively bars access to the water by the children. All entries and exits through such fence or barrier shall have self-closing, self-latching devices or locks. When an outside wall of the facility that serves as one side of the fence or barrier to the body of water has a doorway, such doorway shall remain locked. Shallow wading pools that are not fenced shall be emptied after each use and shall not collect water. Decorative ponds, fish ponds, fountains or similar bodies of water that do not have a fence or barrier as required in this subdivision, shall be completely covered with a childproofing grate or other barrier to prevent access to children. (3) No child in care shall be permitted in a hot tub, spa or sauna. Hot tubs, spas and saunas shall be locked and inaccessible to children. (4) Locks shall be operable with a key, combination, or other similar unlocking mechanism that prevents unauthorized persons from obtaining access. (g) Proper Ventilation, Light, Temperature, and Window Safety The ventilation, light and temperature outside of the facility shall ensure the health and comfort of the children in care. When the temperature exceeds eighty degrees Fahrenheit, the provider shall provide the children with additional fluids and increase ventilation. The room temperature where children are present at the family child care home shall not be lower than sixty five degrees Fahrenheit when measured three feet from the floor. The provider shall implement measures that prevent children from falling from accessible windows above the ground floor. (h) Adequate Washing, Toileting, Sewage and Garbage Facilities The washing and toileting facilities shall be adequate to ensure the health, safety and comfort of the children in care. The water temperature at the tap shall be within the range of sixty degrees Fahrenheit to one hundred twenty degrees Fahrenheit. A mechanism for individual hand drying shall be accessible. Sewage and garbage disposal systems shall ensure a sanitary environment. Garbage and trash shall be disposed of properly and kept covered. (i) Adequate and Safe Water At least one water sample from a sink used for drinking, beverage and food preparation shall be tested for lead, and the results of such sample shall be submitted to the Office at the time of initial application. The water sample shall have been standing in plumbing pipes at least six hours and the test must be conducted not more than twelve months prior to the date of application. If the family child care home is not served by a public water system that is regulated by the Department of Public Health, the provider shall also show proof from analysis dated not more than twelve months prior to the date of initial application and as often as the Office deems necessary, that the water supply is potable, adequate and safe. The water analysis shall include, but not be limited to, tests for bacteria, physical parameters ( color, odor, turbidity, pH), and sanitary chemicals (nitrogen series, chloride, surfactants, hardness, iron, manganese and sodium). Additional tests may be required as deemed necessary by the commissioner. The analysis of samples shall be conducted by an environmental laboratory registered by the Connecticut Department of Public Health pursuant to section 19a-29a of the Connecticut General Statutes. (j) Pasteurization of Milk Supply Milk or milk products provided by the provider for consumption by the children receiving family child care services shall be pasteurized. (k) Working Telephone The provider shall have a working telephone at the family child care home, with emergency numbers for fire, ambulance, police or 911, parents, emergency caregivers, and poison control posted in an area where family child care services are provided and that is readily accessible and known to the provider and staff. (/) Safe Transportation The provider shall utilize safe transportation for children when transportation is required for an emergency or a child care activity. This shall include, but not be limited to, the use of child auto safety restraints according to section 14-IOOa of the Connecticut General Statutes. The provider shall be responsible for compliance with all applicable motor vehicle laws when transporting children. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Physical Plant and Program Practices (a) The building and equipment shall be maintained sanitary and free of health and safety hazards. (b) Potentially hazardous substances and materials in the child care program shall be handled in a safe manner and stored in a separate locked area. (c) Programs that serve children less than school age and are located in a building constructed prior to 1978 shall include an inspection for evident sources of lead paint in all areas used for childcare. Chipping paint found in such programs shall undergo chemical analysis. A full comprehensive lead inspection of such programs shall be required when the chemical analysis shows evidence of lead. Programs that serve children less than school age, shall be free of sources of lead poisoning. (d) All manufacturer guidelines shall be followed for furniture, equipment and any toy that is used by, or around children. Any furniture, equipment and toy that has been identified as unsafe, or has been subject by the United States Consumer Product Safety Commission guidelines or law, shall be removed or repaired as indicated. (e) The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. (f) Swimming pools and bathing facilities, when provided, shall comply with the applicable provisions of sections 19-13-B33b of the Regulations of Connecticut State Agencies. (g) At all times the child care program is in operation, there shall be at least one portable, readily accessible first aid kit, on site at the child care program and on field trips. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 19a-79-7a (a) The standards established by the following sources for the construction, renovation, alteration, expansion, conversion, maintenance and licensure of child day care centers and group day care homes, as they are amended from time to time, are incorporated and made a part of this section by reference: (1) State of Connecticut Basic Building Code, (2) State of Connecticut Fire Safety Code, (3) State of Connecticut Public Health Code, (4) local codes and ordinances. (b) Plans for new construction, expansion, renovation or conversion, indicating the proposed use and accompanied by a written narrative shall be submitted to the department prior to the start of construction. (1) Completed plans and specifications shall be submitted to and reviewed by the department on the basis of compliance with the Public Health Code. (2) Written approval by the local building inspector, local director of health or designee, local zoning and local fire marshal shall be submitted to the department, upon request of the department. (3) Approval by the department is required prior to the use of any space that has been newly constructed, expanded, renovated or converted. (4) All construction, remodeling, renovation, repairs or alterations of structures shall be done in such a manner to prevent hazards or unsafe physical or environmental conditions during periods of operation. (c) General requirements (1) Any operator is responsible for maintaining the child day care center or group day care home in compliance with section 19a-79-1a to section 19a-79-13, inclusive, of the Regulations of Connecticut State Agencies. (2) The building, equipment and services shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards. (3) Water supply, food service and sewage disposal facilities shall be in compliance with all applicable sections of the Public Health Code. (A) All water supplies shall be tested every two (2) years for lead content and the results submitted to the local and state health departments. (B) Whenever water is obtained from other than a department-approved public water supply, it shall be of a safe and sanitary quality and tested every two (2) years for bacterial and chemical quality and the results submitted to the local and state health departments. (C) Sanitary drinking fountains or individual disposable drinking cups shall be provided and accessible to the children at all times. (d) Basic requirements (1) Emergency vehicles shall have access to all child day care centers or group day care homes. (2) Established walkways shall be provided and properly maintained for each entrance and exit leading to a driveway or street. (3) In child day care centers that are licensed by January 1, 1994, a toilet and sink shall be designated for use by the staff and other adults. In child day care centers that are licensed or renovated after January 1, 1994, a room with a toilet and sink within the licensed child day care center shall be designated for the exclusive use of staff and other adults. (4) All windows that open to the outside and are used for ventilation shall be equipped with sixteen (16) mesh screening, and shall be protected to prevent falls. (5) Any unprotected glass doors, windows or mirrors to which children have access shall be protected to a height of thirty six (36) inches from the floor or surface on which a child stands. (6) Where overhead doors are accessible to the children, they shall be equipped with locking devices and spring protectors. (7) Exit doorways, stairs or hallways shall not be blocked by furniture, toys or play equipment. (8) There shall be an area available for the individual storage of each child's clothing and bedding. (9) Smoking is prohibited in all child day care centers or group day care homes and outdoor areas except in designated smoking areas, provided these areas are separate, properly ventilated and enclosed away from any children present at the facility. Signs shall be posted, visible to the public, on entrance to the facility indicating that smoking is prohibited except in designated areas. Matches and lighters shall be inaccessible to children at all times. (10) Electrical outlets shall be provided with safety covers or approved safety outlets. The use and maintenance of electrical cords, appliances and adaptors shall be in full compliance with state codes. (11) Toilet and washing facilities (A) Where toilets and sinks are shared by children and adults, a written policy shall be developed and implemented that requires supervision of children when using the shared toilet room. (B) Programs shall provide changing and sanitary facilities appropriate to meet the individual needs of children who are enrolled at the facility who need assistance with toileting or who are not independent with toileting. (C) For programs serving children under six (6) years of age there shall be at least one (1) toilet and one (1) sink with hot and cold running water for every sixteen (16) children, or fraction thereof. Standard size toilets and sinks shall be adapted for children's use. Facilities using potty chairs in addition to the required toilets shall ensure that they are of a nonporous, synthetic product, and emptied into the toilet, cleaned and disinfected after each individual use. (D) For programs serving only school age children, there shall be at least one (1) toilet and one (1) sink with running water for every twenty-five (25) children, or fraction thereof. Toilet facilities shall be designed in such a manner to allow individual privacy. (E) Sinks with running water shall be readily accessible to the toilet rooms if not located within them. Toilet tissue, soap, single use disposable towels and a waste receptacle shall be accessible to the toilets and sinks. Staff and children shall wash their hands with soap and water after toileting. (F) Each toilet room shall be well lighted and ventilated to the outside atmosphere. (G) In child day care centers constructed or renovated after January 1, 1994, all toilet facilities shall be mechanically ventilated to the outside atmosphere. (e) Environmental requirements (1) Every area used by children shall be adequately ventilated and have a thermometer affixed to the wall. The ambient air temperature shall be at least sixty-five (65) degrees Fahrenheit as measured three (3) feet from the floor. (2) When the temperature exceeds eighty (80) degrees Fahrenheit, the operator shall provide more fluids and increase ventilation. (3) The water heating equipment shall deliver water at the tap, the temperature of which shall be within a range of sixty (60) degrees Fahrenheit to one hundred fifteen (115) degrees Fahrenheit. It shall have the capacity to deliver the required amounts at all times in conformance with the State of Connecticut Basic Building Code. (4) Only central heating or permanently installed heating systems shall be used. Portable space heaters are prohibited. (5) Walls, ceilings, floors and rugs shall be maintained in a state of good repair and be washable or easily cleanable. Rugs, if used, shall be secured to the floor. (6) Hot water or steam pipes located in areas accessible to children shall have adequate protective covering which is maintained safely and in good repair. (7) Each level of the child day care center or group day care home shall be provided with a telephone in working order located within the licensed program space accessible to staff for emergency purposes. Emergency telephone numbers shall be posted in an area adjacent to the phone. (8) All spaces occupied by people, equipment within buildings, approaches to buildings and parking lots shall have a minimum of one (1) foot candle of lighting per square foot. (9) Child day care centers and group day care homes shall have at least fifty (50) foot candles of light per square foot in rooms used by children for reading, painting and other close work. There shall be at least thirty (30) foot candles of light in other work or play areas. In child day care centers and group day care homes constructed or renovated after January 1, 1994, all rooms and toilet rooms shall have at least one (1) light fixture switch at each entrance. All areas accessible to children shall have light fixtures that are shielded or shatter proof. (10) Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. (11) Garbage and rubbish shall be kept in containers constructed of durable material approved by the local health director. Receptacles shall be in good repair to prevent infestations by rodents, insects and other pests and to prevent odors, injuries and other nuisance conditions. The garbage and rubbish shall be moved to an exterior waste storage area at least daily. (12) Stairs must be properly protected and maintained in good repair. There must be handrails installed at a height usable by children. (13) Toxic plants and materials are prohibited in areas accessible to children. (14) Any pet or animal present at the facility, indoors or outdoors, shall be in good health, show no evidence of carrying disease and be a friendly companion for the children. (15) When pets are kept on the premises, procedures for their care and maintenance and access to the children shall be written and implemented. (16) There shall be effective measures taken to prevent vermin from entering or breeding in the child day care center or group day care home. All openings to the outer air used for ventilation shall be screened with a minimum of sixteen (16) mesh screening and doors shall be provided to prevent the entrance of vectors. (17) If the child day care center or group day care home uses the basement level or the first floor of a building, a minimum of one (1) radon test shall be conducted using a device or service listed by the National Radon Proficiency Program and approved by the department. (A) This test shall be completed during the months of November through April and the results posted with the license. The department and the local director of health shall be notified of the results. (B) When confirmatory sampling results of radon gas in the air are equal to or greater than 4.0 picocuries per liter (pCi/L), the operator shall ensure that the radon gas is reduced to below 4.0 pCi/L. A qualified residential mitigation service provider as defined in sections 19a-14b and 20-420 of the Connecticut General Statutes shall be hired to reduce the level of radon gas in the air. (18) Child day care centers and group day care homes that utilize combustible fuel shall be equipped with at least one (1) operable carbon monoxide (CO) detector on each occupied level of the facility. CO detectors shall comply with Underwriters Laboratories (UL) Standards for Safety, and shall be operated in accordance with the manufacturer's instructions. (g) Equipment. All equipment shall be of such design and material as to be readily cleaned and safe for children. (1) Equipment shall not be colored or covered by any poisonous material. All solid constituents of paint for equipment and toys, and pigment coloring in paints, pencils, crayons and inks, to be used by the children shall be non-toxic. Equipment shall be sturdy, safely constructed and free from protruding nails, rust, toxic material and other hazards. (2) Adequate equipment for rest shall be provided. An individual cot shall be provided for any child who regularly remains five (5) hours or longer per day. When cots are shared, they shall be washed and disinfected and linens changed between children. In a group day care home, an individual mat or individual sleeping bag may be substituted for the individual cot. (3) Metal equipment shall be free from rust or chipping paint. (4) Hardware such as air conditioners, water heaters or fuse boxes shall be inaccessible to children. (5) The materials and equipment available and used by children shall be developmentally appropriate for the ages of the children served. (h) Outdoor play space (2) Where swings, seesaws or climbing apparatus are used, the surface in the space shall be protected with a minimum of eight (8) inches of impact absorbing materials, e.g., sand or its equivalent. (3) The playground shall be free of glass, debris, holes and other hazards. (4) Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. (5) Outside equipment shall be anchored for stability. Anchors shall be buried below ground level. (6) The operator shall provide documentation to the department, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. (7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four (4) feet in height. (B) When there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four (4) feet high or higher, with locked entrances, which totally and effectively bars access to the water by children. (C) On and after January 1, 2010, a rooftop used as a play area shall be enclosed with a wall, fence or permanent physical barrier not less than six (6) feet high and the bottom edge shall be no more than three and one half (3 1/2) inches from the base or floor. The wall, fence or permanent physical barrier shall be designed to prevent children from climbing it. (8) Drinking water shall be available and accessible. (9) Outdoor equipment shall be arranged in such a way as to avoid accidents. (i) Swimming, wading and bathing facilities. Swimming, wading and bathing facilities, if provided, shall comply with the provisions of sections 19-13- B33b, 19-13-B34 and 19-13-B36 of the Regulations of Connecticut State Agencies. No wading pools shall be used. No day care child shall be permitted in a hot tub, spa or sauna. Hot tubs, spas and saunas shall be locked and inaccessible to children. (j) No dangerous weapon as described in section 53-206 of the Connecticut General Statutes or facsimile of a firearm as defined in section 53-206c of the Connecticut General Statutes shall be permitted on the premises of the child day care center or group day care home unless the carrier of such weapon or facsimile firearm is a peace officer as defined in section 53a-3 of the Connecticut General Statutes. License-exempt: Physical Plant and Program Practices (a) The building and equipment shall be maintained sanitary and free of health and safety hazards. (b) Potentially hazardous substances and materials in the child care program shall be handled in a safe manner and stored in a separate locked area. (c) Programs that serve children less than school age and are located in a building constructed prior to 1978 shall include an inspection for evident sources of lead paint in all areas used for childcare. Chipping paint found in such programs shall undergo chemical analysis. A full comprehensive lead inspection of such programs shall be required when the chemical analysis shows evidence of lead. Programs that serve children less than school age, shall be free of sources of lead poisoning. (d) All manufacturer guidelines shall be followed for furniture, equipment and any toy that is used by, or around children. Any furniture, equipment and toy that has been identified as unsafe, or has been subject by the United States Consumer Product Safety Commission guidelines or law, shall be removed or repaired as indicated. (e) The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. (f) Swimming pools and bathing facilities, when provided, shall comply with the applicable provisions of sections 19-13-B33b of the Regulations of Connecticut State Agencies. (g) At all times the child care program is in operation, there shall be at least one portable, readily accessible first aid kit, on site at the child care program and on field trips. b. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from bodies of water for the following CCDF- eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-8a(h)(7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four feet in height. (B) Unless otherwise specified in this subdivision, when there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four feet high or higher which totally and effectively bars access to the water by children. All entries and exits through such fence or barrier shall have self-closing, self- latching devices or locks. When an outside wall of the child care center or group child care home that serves as one side of the fence or barrier to the body of water has a doorway, such doorway shall remain locked. Decorative ponds, fishponds, fountains or similar bodies of water that do not have a fence or barrier as required in this subdivision, shall be completely covered with a childproofing grate or other barrier to prevent access to children. Locks shall be openable with a key, combination, fingerprint, magnet or other unlocking mechanism that prevents an unauthorized person from obtaining access. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9( f) Safe Space (1) There shall be sufficient indoor and outdoor play space to ensure appropriate activities, safety and comfort for the children at the facility. When outdoor play space does not exist at the facility, the provider shall identify alternate outdoor play space and develop a written plan that ensures the safe transportation of children to and from the alternate outdoor play space. The outdoor play space shall be protected from traffic, bodies of water, gullies, and other hazards by barriers that bar access to such hazards and are safe for children. (2) When there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four feet high or higher, which totally and effectively bars access to the water by the children. All entries and exits through such fence or barrier shall have self-closing, self-latching devices or locks. When an outside wall of the facility that serves as one side of the fence or barrier to the body of water has a doorway, such doorway shall remain locked. Shallow wading pools that are not fenced shall be emptied after each use and shall not collect water. Decorative ponds, fish ponds, fountains or similar bodies of water that do not have a fence or barrier as required in this subdivision, shall be completely covered with a childproofing grate or other barrier to prevent access to children. (3) No child in care shall be permitted in a hot tub, spa or sauna. Hot tubs, spas and saunas shall be locked and inaccessible to children. (4) Locks shall be operable with a key, combination, or other similar unlocking mechanism that prevents unauthorized persons from obtaining access. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Physical Plant and Program Practices (e)The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Center: 19a-79-(h)(7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four feet in height. (B) Unless otherwise specified in this subdivision, when there is a swimming pool or any other body of water at the facility or near enough to the facility to attract or be accessible to children at any time of the year, there shall be a sturdy fence or barrier, four feet high or higher which totally and effectively bars access to the water by children. All entries and exits through such fence or barrier shall have self-closing, self- latching devices or locks. When an outside wall of the child care center or group child care home that serves as one side of the fence or barrier to the body of water has a doorway, such doorway shall remain locked. Decorative ponds, fishponds, fountains or similar bodies of water that do not have a fence or barrier as required in this subdivision, shall be completely covered with a childproofing grate or other barrier to prevent access to children. Locks shall be openable with a key, combination, fingerprint, magnet or other unlocking mechanism that prevents an unauthorized person from obtaining access. Licensed-exempt: Physical Plant and Program Practices (e)The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. c. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from vehicular traffic hazards for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(m) The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting children enrolled in any child day care center or group day care home. 19a-79-(h)(7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four (4) feet in height. (C) On and after January 1, 2010, a rooftop used as a play area shall be enclosed with a wall, fence or permanent physical barrier not less than six (6) feet high and the bottom edge shall be no more than three and one half (3 1/2) inches from the base or floor. The wall, fence or permanent physical barrier shall be designed to prevent children from climbing it. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9( f) Safe Space (1) There shall be sufficient indoor and outdoor play space to ensure appropriate activities, safety and comfort for the children at the facility. When outdoor play space does not exist at the facility, the provider shall identify alternate outdoor play space and develop a written plan that ensures the safe transportation of children to and from the alternate outdoor play space. The outdoor play space shall be protected from traffic, bodies of water, gullies, and other hazards by barriers that bar access to such hazards and are safe for children. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Physical Plant and Program Practices (e)The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed center: 19a-79-3a(m) The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting children enrolled in any child day care center or group day care home. 19a-79-(h)(7) The outdoor play area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. (A) Fences used to protect children from hazards shall be at least four (4) feet in height. (C) On and after January 1, 2010, a rooftop used as a play area shall be enclosed with a wall, fence or permanent physical barrier not less than six (6) feet high and the bottom edge shall be no more than three and one half (3 1/2) inches from the base or floor. The wall, fence or permanent physical barrier shall be designed to prevent children from climbing it. License-exempt: Physical Plant and Program Practices (e)The outdoor area shall be protected from traffic, bodies of water, gullies and other hazards by barriers in a manner safe for children. Fences used to protect children from hazards shall be at least four feet in height. 5.3.6 Prevention of shaken baby syndrome, abusive head trauma, and maltreatment health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of shaken baby syndrome and abusive head trauma and indicate the age of children it applies to for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(b)(8) The operator is responsible for managing child behavior using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. (A) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, techniques used to manage child behaviors in the facility prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self- esteem. (B) The operator shall document that the child’s parent(s) has been informed of the techniques used to manage child behaviors in the facility prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The OEC was issued a non-compliance for this requirement by OCC on December 13, 2021 and September 19, 2023. Specifically, OEC does not have requirements for licensed center and group home providers that address prevention of shaken baby syndrome and abusive head trauma. The OEC has pending regulatory changes in which this requirement is addressed. The above citation, 19a-79- 3a(b)(7)(C) is the proposed change to the regulation that addresses the non- compliance. There have been significant delays in getting this rule change passed. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(k)(1) The provider shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not restrain children except in appropriate circumstances for the protection and safety of the children or others. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a- 101 to section 17a-101e, inclusive, of the Connecticut General Statutes. The operator shall implement specific written policies, plans and/or procedures which shall be maintained in the child care program and shall cover, at a minimum, the areas of discipline, child abuse and neglect, program operation, personnel and supervision. The operator shall ensure all program staff are trained on the child care program’s policies, plans and procedures. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: License Center: 19a-79-3a(b)(8) The operator is responsible for managing child behavior using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. (A) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, techniques used to manage child behaviors in the facility prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self- esteem. (B) The operator shall document that the child’s parent(s) has been informed of the techniques used to manage child behaviors in the facility prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The OEC was issued a non-compliance for this requirement by OCC on December 13, 2021 and September 19, 2023. Specifically, OEC does not have requirements for licensed center and group home providers that address prevention of shaken baby syndrome and abusive head trauma. The OEC has pending regulatory changes in which this requirement is addressed. The above citation, 19a-79- 3a(b)(7)(C) is the proposed change to the regulation that addresses the non- compliance. There have been significant delays in getting this rule change passed. License-exempt: The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. The operator shall implement specific written policies, plans and/or procedures which shall be maintained in the child care program and shall cover, at a minimum, the areas of discipline, child abuse and neglect, program operation, personnel and supervision. The operator shall ensure all program staff are trained on the child care program’s policies, plans and procedures. b. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of child maltreatment and indicate the age of children it applies to for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(b)(8) The operator is responsible for managing child behavior using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. (A) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (B) The operator shall document that the child’s parent(s) has been informed of the techniques used to manage child behaviors in the facility [have been discussed with the child’s parent(s)] prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection Page 9 of 48 and safety of the child or others, using least restrictive methods, as appropriate. (D) The operator and staff shall not engage in, nor allow, anyone else to engage in any sexual activity with the [day care] children in care while in attendance at the program. (ages 0-12)19a-79-3a(b) (6) Require participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures; and (7) Be responsible for managing children using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(j) The provider is responsible for the behavior management methods used in the family child care home and shall communicate them to staff. (l) The provider shall use only developmentally appropriate behavior management methods such as positive guidance, redirection, and setting clear limits that encourage children to develop self- control, self-discipline, and positive self-esteem, while also protecting them from harm to themselves or others. (2) The provider shall discuss behavior management methods used in the family child care home with the child's parent(s) prior to enrollment and regularly during the period a child remains enrolled. 19a87b-10(j) Appropriate Discipline Practices The provider is responsible for the behavior management methods used in the family child care home and shall communicate them to staff. (l) The provider shall use only developmentally appropriate behavior management methods such as positive guidance, redirection, and setting clear limits that encourage children to develop self- control, self-discipline, and positive self-esteem, while also protecting them from harm to themselves or others. (2) The provider shall discuss behavior management methods used in the family child care home with the child's parent(s) prior to enrollment and regularly during the period a child remains 19a-87b-10(k) Child Protection (1) The provider shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not restrain children except in appropriate circumstances for the protection and safety of the children or others. The provider shall not engage in nor allow anyone else to engage in any sexual activity with the children in care. (2) The provider or substitute shall notify the Office no later than the next business day of: (A) The death of any child enrolled in the family child care home, if the child died while receiving family child care services or if the child died of a contagious disease. (B) Any injury to a child that occurs while the child is receiving family child care services which results in a diagnosed fracture, diagnosed second or third degree bum, diagnosed concussion, the child being admitted to a hospital or the child's death. (3) The provider shall report actual or suspected child abuse or neglect or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by sections 17a-101 to 17a-l Ole, inclusive, of the Connecticut General Statutes. (ages 0-12) iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: ages 0- 12)Administration (a) The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. (3) The operator and staff shall not engage in, nor allow anyone to engage in, sexual contact with the children. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. The operator shall implement specific written policies, plans and/or procedures which shall be maintained in the child care program and shall cover, at a minimum, the areas of discipline, child abuse and neglect, program operation, personnel and supervision. The operator shall ensure all program staff are trained on the child care program’s policies, plans and procedures. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Center: 19a-79-3a(b)(8) The operator is responsible for managing child behavior using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. (A) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (B) The operator shall document that the child’s parent(s) has been informed of the techniques used to manage child behaviors in the facility [have been discussed with the child’s parent(s)] prior to enrollment and reviewed as needed during the period of the child’s enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection Page 9 of 48 and safety of the child or others, using least restrictive methods, as appropriate. (D) The operator and staff shall not engage in, nor allow, anyone else to engage in any sexual activity with the [day care] children in care while in attendance at the program. (ages 0-12)19a-79-3a(b) (6) Require participation by new staff in employee orientation, and assure annual training for all current staff on the child care center or group child care home policies, plans and procedures; and (7) Be responsible for managing children using techniques based on developmentally appropriate practice and communicate acceptable techniques to all staff. These standards apply to children ages five to age thirteen, or less than nineteen years of age with special needs requiring the child to receive supplementary care and attending school. License-exempt: The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. The operator shall implement specific written policies, plans and/or procedures which shall be maintained in the child care program and shall cover, at a minimum, the areas of discipline, child abuse and neglect, program operation, personnel and supervision. The operator shall ensure all program staff are trained on the child care program’s policies, plans and procedures. 5.3.7 Emergency preparedness and response planning standard Identify by checking below that the emergency preparedness and response planning due to natural disasters and human-caused events standard includes procedures in the following areas: i. [x] Evacuation ii. [x] Relocation iii. [x] Shelter-in-place iv. [x] Lock down v. Staff emergency preparedness [x] Training [x] Practice drills vi. Volunteer emergency preparedness [x] Training [x] Practice drills vii. [x] Communication with families viii. [x] Reunification with families ix. [x] Continuity of operations x. Accommodation of [x] Infants [x] Toddlers [x] Children with disabilities [x] Children with chronic medical conditions xi. If any of the above are not checked, describe: 5.3.8 Handling and storage of hazardous materials and the appropriate disposal of biocontaminants health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the handling and storage of hazardous materials for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-7a (e)(10):Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. 19a-79-10(e)(6): A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. 19a-79-10(e)(9): Disposable diapers shall be discarded in a covered receptacle immediately after diapering. Programs that monitor children with diabetes must follow 19a-79-13(d)(3) which requires the operator obtain a signed agreement from the child's parent(s) that the parent(s) agrees to check and maintain the child's equipment (finger stick blood glucose tests) in accordance with manufacturer's instructions, restocks supplies and removes material to be discarded from the facility on a daily basis. All materials to be discarded shall be kept locked until it is given to the child's parent(s) for disposal. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9(c): All potentially harmful substances and materials, including but not limited to, cleaning supplies, cosmetics, toiletries, medication, alcoholic beverages and other toxins shall be inaccessible to children. Poisonous and unidentified plants shall be removed from the area, protected by barriers, or kept out of the reach of children. Bio contaminants, including but not limited to, blood, bodily fluids or excretions that may spread infectious disease, shall be disposed of in a safe manner and in accordance with manufacturer's instructions, when applicable. 19a-87b-9(h); Sewage and garbage disposal systems shall ensure a sanitary environment. Garbage and trash shall be disposed of properly and kept covered. 19a-87b-18(d)(3), The provider shall obtain a signed agreement from the child's parent or guardian that the parent or guardian agrees to check and maintain the child's equipment (finger stick blood glucose strips) in accordance with manufacturer's instructions, restock supplies, and removes material to be discarded from the family child care home on a daily basis. All materials to be discarded shall be kept locked until it is given to the child's parent or guardian for disposal. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Physical Plant and Program Practices (b) Potentially hazardous substances and materials in the child shall be handled in a safe manner and stored in a separate locked area. Programs Serving Infants and Toddlers: (6) Disposable diapers shall be discarded in a covered receptacle immediately after diapering. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed centers: 19a-79-7a (e)(10):Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. 19a-79-10(e)(6): A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. 19a-79-10(e)(9): Disposable diapers shall be discarded in a covered receptacle immediately after diapering. Programs that monitor diabetes must follow 19a-79-13(d)(3) which requires the operator obtain a signed agreement from the child's parent(s) that the parent(s) agrees to check and maintain the child's equipment (finger stick blood glucose tests) in accordance with manufacturer's instructions, restocks supplies and removes material to be discarded from the facility on a daily basis. All materials to be discarded shall be kept locked until it is given to the child's parent(s) for disposal. License Exempt: Physical Plant and Program Practices (b) Potentially hazardous substances and materials in the child shall be handled in a safe manner and stored in a separate locked area. b. Provide the standards, appropriate to the provider setting and age of children, that address the disposal of bio contaminants for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-7a (e)(10) Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. 19a-79-7a(e )(11) Garbage and rubbish shall be kept in containers constructed of durable material approved by the local health director. Receptacles shall be in good repair to prevent infestations by rodents, insects and other pests and to prevent odors, injuries and other nuisance conditions. The garbage and rubbish shall be moved to an exterior waste storage area at least daily. 19a-79-10 (e) (5) Disposable paper sheets shall be used and discarded immediately after each diapering. (6) A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9(c) Absence of Potentially Harmful Substances and Materials All potentially harmful substances and materials, including but not limited to, cleaning supplies, cosmetics, toiletries, medication, alcoholic beverages and other toxins shall be inaccessible to children. Poisonous and unidentified plants shall be removed from the area, protected by barriers, or kept out of the reach of children. Bio contaminants, including but not limited to, blood, bodily fluids or excretions that may spread infectious disease, shall be disposed of in a safe manner and in accordance with manufacturer's instructions, when applicable. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Physical Plant and Program Practices (b) Potentially hazardous substances and materials in the child care program shall be handled in a safe manner and stored in a separate locked area. Bio contaminants, including but not limited to, blood, bodily fluids or excretions that may spread infectious disease, shall be disposed of in a safe manner and in accordance with manufacturer's instructions, when applicable. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed centers: 19a-79-7a (e)(10) Potentially hazardous substances in the child day care centers and group day care homes shall be stored in a separate locked area. 19a-79-7a(e )(11) Garbage and rubbish shall be kept in containers constructed of durable material approved by the local health director. Receptacles shall be in good repair to prevent infestations by rodents, insects and other pests and to prevent odors, injuries and other nuisance conditions. The garbage and rubbish shall be moved to an exterior waste storage area at least daily. 19a-79-10 (e) (5) Disposable paper sheets shall be used and discarded immediately after each diapering. (6) A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. License-exempt: Physical Plant and Program Practices (b) Potentially hazardous substances and materials in the child care program shall be handled in a safe manner and stored in a separate locked area. Bio contaminants, including but not limited to, blood, bodily fluids or excretions that may spread infectious disease, shall be disposed of in a safe manner and in accordance with manufacturer's instructions, when applicable. 5.3.9 Precautions in transporting children health and safety standard Provide the standards, appropriate to the provider setting and age of children, that address precautions in transporting children for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(m) The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting children enrolled in any child care center or group child care home. 19a-79-5a(a)(1)(D)(iv): The operator is responsible for maintaining specific written permission forms signed by the parent(s) authorizing: (iv)Transportation services. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 9(f) Safe Space (1) There shall be sufficient indoor and outdoor play space to ensure appropriate activities, safety and comfort for the children at the facility. When outdoor play space does not exist at the facility, the provider shall identify alternate outdoor play space and develop a written plan that ensures the safe transportation of children to and from the alternate outdoor play space. 19a-87b-9(l) Safe Transportation The provider shall utilize safe transportation for children when transportation is required for an emergency or a child care activity. This shall include, but not be limited to, the use of child auto safety restraints according to section 14-IOOa of the Connecticut General Statutes. The provider shall be responsible for compliance with all applicable motor vehicle laws when transporting children. 19a-87b-10(b)(3)(D) Written Permission from the Parent -Transportation of the child from the family child care home by the provider or staff. (F) Arrangements for transitioning children to and from school including, but not limited to, transportation, exact bus pick up and drop off locations, and supervision to be provided during transitioning. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Administration (j)The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting enrolled children. Record Keeping (a)(3) Specific written permission forms signed by the parent(s) authorizing: the operator to use previously selected emergency policies of the child care program, which shall accompany the child on trips away from the premises; the name and telephone number of one responsible person other than the parent(s) who can remove the child from the child care program; any activity away from the premises. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed center: 19a-79-3a(m) The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting children enrolled in any child care center or group child care home. 19a-79-5a(a)(1)(D)(iv): The operator is responsible for maintaining specific written permission forms signed by the parent(s) authorizing: (iv)Transportation services. License-exempt: Administration (j)The operator shall be responsible for compliance with all applicable motor vehicle laws when transporting enrolled children. Record Keeping (a)(3) Specific written permission forms signed by the parent(s) authorizing: the operator to use previously selected emergency policies of the child care program, which shall accompany the child on trips away from the premises; the name and telephone number of one responsible person other than the parent(s) who can remove the child from the child care program; any activity away from the premises. 5.3.10 Pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address pediatric first aid for all staff for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79(e) At all times the child day care center or group day care home is in operation, there shall be present at least one (1) staff member who has successfully completed within the past three (3) years a department approved first aid course that meets the following requirements: (A) It shall be at least six (6) hours in length. (B) Instruction shall include, but not necessarily be limited to: (i) the recognition and emergency management of bleeding, burns, poisoning, anaphylaxis, respiratory distress including choking, Musculo-skeletal injury, seizures, wounds including insect bites, head injuries, shock, loss of consciousness, dental emergencies, child abuse and sexual abuse; (ii) communicable disease prevention, recognition and management, which includes: a discussion of transmission through the intestinal tract, the respiratory system and direct contact; hygiene, including hand washing, cleaning and disinfection; diapering techniques; signs and symptoms of illness, including fever, rash and vomiting; temperature taking; education in specific communicable disease, including, but not necessarily limited to, diarrheal diseases, bacterial meningitis, chicken pox, hepatitis, strep throat, head lice, scabies and vaccine-preventable diseases; and (iii) accident prevention and safety including, but not necessarily limited to: safety for the indoor environment and outdoor play area, first aid supplies, child restraint systems and seat belt safety in accordance with section 14-100a of the Connecticut General Statutes and section 14- 100a-1 of the Regulations of Connecticut State Agencies. (C) Instruction shall be provided by a person who meets at least one of the following requirements: (i) a first aid instructor currently certified by the American Red Cross, American Safety and Health Institute, Medic First Aid International, Inc., National Safety Council or an American Heart Association Heartsaver Instructor or BLS Instructor, (ii) a physician, physician assistant, advanced practice registered nurse or registered nurse licensed in this or another state or (iii) an emergency medical technician or paramedic. (D) The course outline and all other written materials used in the course shall be submitted to the department and shall not be used without approval by the department. (f) The child day care center or group day care home shall keep on file written verification of compliance with subsection (e) of this section for each staff member who the child day care center or group day care home designates to meet the requirements of such subsection. Such verification shall be maintained for three (3) years after the date that staff member completed first aid training for group day care homes and child day care centers. Verification shall include: written verification of first aid training by a representative of the organization, physician, physician assistant, advanced practice registered nurse, registered nurse, emergency medical technician or paramedic who conducted the training. 19a-79-13(b)(1): Prior to the administration of finger stick blood glucose tests, the director, head teacher, program staff or group day care home provider shall have completed the following training requirements: (A) a course approved by the department in first aid, as verified by a valid first aid certificate on file at the facility. All caretakers, teachers, and directors in Care 4 Kids programs must have completed a first aid course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 6(c) applies. Training Requirements (1) Any application for licensure submitted to the Office shall, before final approval of the application is given, include verification of the applicant's current certification in first aid by the American Red Cross, the American Heart Association, the National Safety Council, American Safety and Health Institute, or Medic First Aid International, Inc. or a current certification based on a first aid course approved on or before March 17, 2018 by the Office under section l 9a- 79-4a( e) of the Regulations of Connecticut State Agencies. Such first aid certification shall be based on a hands on demonstration of the applicant's ability to provide first aid. (2) Thereafter, the provider shall maintain verification of current certification in first and written verification of such training shall be kept on file at the family child care home. 19a-87b- 18(b)(1)(A): Prior to the administration of finger stick blood glucose tests, the provider or substitute shall have completed the following training requirements: (A) A course in first aid described in section 19a-87b-6(c) of the Regulations of Connecticut State Agencies, as verified by a valid first aid certificate on file at the family child care home. All staff in Care 4 Kids programs must have completed a first aid course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All caretakers, teachers, and director must complete a training in the administration of first aid appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed center: 19a-79(e) At all times the child day care center or group day care home is in operation, there shall be present at least one (1) staff member who has successfully completed within the past three (3) years a department approved first aid course that meets the following requirements: (A) It shall be at least six (6) hours in length. (B) Instruction shall include, but not necessarily be limited to: (i) the recognition and emergency management of bleeding, burns, poisoning, anaphylaxis, respiratory distress including choking, Musculo-skeletal injury, seizures, wounds including insect bites, head injuries, shock, loss of consciousness, dental emergencies, child abuse and sexual abuse; (ii) communicable disease prevention, recognition and management, which includes: a discussion of transmission through the intestinal tract, the respiratory system and direct contact; hygiene, including hand washing, cleaning and disinfection; diapering techniques; signs and symptoms of illness, including fever, rash and vomiting; temperature taking; education in specific communicable disease, including, but not necessarily limited to, diarrheal diseases, bacterial meningitis, chicken pox, hepatitis, strep throat, head lice, scabies and vaccine-preventable diseases; and (iii) accident prevention and safety including, but not necessarily limited to: safety for the indoor environment and outdoor play area, first aid supplies, child restraint systems and seat belt safety in accordance with section 14-100a of the Connecticut General Statutes and section 14- 100a-1 of the Regulations of Connecticut State Agencies. (C) Instruction shall be provided by a person who meets at least one of the following requirements: (i) a first aid instructor currently certified by the American Red Cross, American Safety and Health Institute, Medic First Aid International, Inc., National Safety Council or an American Heart Association Heartsaver Instructor or BLS Instructor, (ii) a physician, physician assistant, advanced practice registered nurse or registered nurse licensed in this or another state or (iii) an emergency medical technician or paramedic. (D) The course outline and all other written materials used in the course shall be submitted to the department and shall not be used without approval by the department. (f) The child day care center or group day care home shall keep on file written verification of compliance with subsection (e) of this section for each staff member who the child day care center or group day care home designates to meet the requirements of such subsection. Such verification shall be maintained for three (3) years after the date that staff member completed first aid training for group day care homes and child day care centers. Verification shall include: written verification of first aid training by a representative of the organization, physician, physician assistant, advanced practice registered nurse, registered nurse, emergency medical technician or paramedic who conducted the training. 19a-79-13(b)(1): Prior to the administration of finger stick blood glucose tests, the director, head teacher, program staff or group day care home provider shall have completed the following training requirements: (A) a course approved by the department in first aid, as verified by a valid first aid certificate on file at the facility. All caretakers, teachers, and directors in Care 4 Kids programs must have completed a first aid course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. License-exempt: All caretakers, teachers, and director must complete a training in the administration of first aid appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. b. Provide the standards, appropriate to the provider setting and age of children, that address pediatric cardiopulmonary resuscitation for all staff for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-4(a)(e))(1) applies. At all times the child day care center is in operation there shall be present at least one (1) staff member who has current certification in cardiopulmonary resuscitation (CPR) in accordance with section 19a-79 of the Connecticut General Statutes, appropriate for all of the children served at the child day care center. (Written verification for each staff member who the child day care center or group day care home designates to meet the requirements shall be kept on filefor three (3) years after the date that staff member completed CPR training as required for child day care centers only. Verification shall include: (1) written verification or certification in CPR from an organization specified in accordance with section 19a-79(a)(5) of the Connecticut General Statutes that is signed and dated by a representative of the specified organization. 19a-79- 4a(d)(6): When children are participating in swimming or wading as part of the program, whether at the facility or on a field trip, there shall be a qualified program staff member present and directly supervising the children who shall be at least twenty (20) years of age and who is certified in cardiopulmonary resuscitation in accordance with section 19a-79 of the Connecticut General Statutes. The operator shall verify that there is a person directly supervising the children who holds a current lifeguard certification accepted by the department. All caretakers, teachers, and directors must complete a CPR course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 6(c) applies. Training Requirements (1) Any application for licensure submitted to the Office shall, before final approval of the application is given, include verification of the applicant's current certification in cardiopulmonary resuscitation in accordance with section 19a-79 of the Connecticut General Statutes, appropriate for all of the children served at the family child care home. Such cardiopulmonary resuscitation certifications shall be based on a hands on demonstration of the applicant's ability to provide cardiopulmonary resuscitation. (2) Thereafter, the provider shall maintain verification of current certification in cardiopulmonary resuscitation and written verification of such training shall be kept on file at the family child care home. All staff must complete a CPR course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staffing (e): Staff acting in a lifeguard capacity shall meet the requirements of section 19a- 113a of the Connecticut General Statutes (certified in CPR by the American Heart Association, the American Red Cross, the American Safety and Health Institute or an organization using guidelines for CPR and emergency cardiovascular care published by the American Heart Association and the International Liaison Committee on Resuscitation. All caretakers, teachers, and directors must complete a CPR course appropriate for all of the children served or all required topics of the Care 4 Kids’ Federal Online Health and Safety Orientation. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: License Center- CGS 19a-79(a)(5) establish appropriate child care center staffing requirements for employees certified in cardiopulmonary resuscitation by the American Red Cross, the American Heart Association, the National Safety Council, American Safety and Health Institute, Medic First Aid International, Inc. or an organization using guidelines for cardiopulmonary resuscitation and emergency cardiovascular care published by the American Heart Association and International Liaison Committee on Resuscitation. All teachers and directors at CCDF providers complete a health and safety orientation training that includes content related to pediatric cardiopulmonary resuscitation. Licensed exempt -Staffing (e)Staff acting in a lifeguard capacity shall meet the requirements of section 19a-113a of the Connecticut General Statutes (certified in CPR by the American Heart Association, the American Red Cross, the American Safety and Health Institute or an organization using guidelines for CPR and emergency cardiovascular care published by the American Heart Association and the International Liaison Committee on Resuscitation).Staffing (e)Staff acting in a lifeguard capacity shall meet the requirements of section 19a-113a of the Connecticut General Statutes (certified in CPR by the American Heart Association, the American Red Cross, the American Safety and Health Institute or an organization using guidelines for CPR and emergency cardiovascular care published by the American Heart Association and the International Liaison Committee on Resuscitation). All teachers and directors at CCDF providers complete a health and safety orientation training that includes content related to pediatric cardiopulmonary resuscitation. 5.3.11 Identification and reporting of child abuse and neglect health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the identification of child abuse and neglect for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: 19a-79-3a(2)(B) The prohibition of abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment including, but not limited to, spanking, slapping, pinching, shaking or striking children, and physical restraint, unless such restraint is necessary to protect the health and safety of the child or others; and (C) Child abuse and neglect, including child protection and mandated reporting. All caretakers, teachers, and directors in Care 4 Kids programs must have completed the Recognition and Reporting of Child Abuse training which is a required topic of the Care 4 Kids’ Federal Online Health and Safety Orientation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 19a-87b- 10(k) Child Protection (1) The provider shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not restrain children except in appropriate circumstances for the protection and safety of the children or others. The provider shall not engage in nor allow anyone else to engage in any sexual activity with the children in care. All caretakers, teachers, and directors in Care 4 Kids programs must have completed the Recognition and Reporting of Child Abuse training which is a required topic of the Care 4 Kids’ Federal Online Health and Safety Orientation. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Administration (a)The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self- esteem. All caretakers, teachers, and directors in Care 4 Kids programs must have completed the Recognition and Reporting of Child Abuse training which is a required topic of the Care 4 Kids’ Federal Online Health and Safety Orientation. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed Centers: 19a-79-3a(2)(B) The prohibition of abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment including, but not limited to, spanking, slapping, pinching, shaking or striking children, and physical restraint, unless such restraint is necessary to protect the health and safety of the child or others; and (C) Child abuse and neglect, including child protection and mandated reporting. All caretakers, teachers, and directors in Care 4 Kids programs must have completed the Recognition and Reporting of Child Abuse training which is a required topic of the Care 4 Kids’ Federal Online Health and Safety Orientation. License- Exempt: Administration (a)The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. All caretakers, teachers, and directors in Care 4 Kids programs must have completed the Recognition and Reporting of Child Abuse training which is a required topic of the Care 4 Kids’ Federal Online Health and Safety Orientation. b. Provide your standards, appropriate to the provider setting and age of children, that address the reporting of child abuse and neglect for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: CGS § 17a-101(c) The Commissioner of Children and Families shall develop an educational training program and refresher training program for the accurate and prompt identification and reporting of child abuse and neglect. Such training program and refresher training program shall be made available to all persons mandated to report child abuse and neglect at various times and locations throughout the state as determined by the Commissioner of Children and Families. 19a-79-3a(b)(8)(E): The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (B) The operator shall document that the techniques used to manage child behaviors in the facility have been discussed with the child's parent(s) prior to enrollment and reviewed as needed during the period of the child's enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate (D) The operator and staff shall not engage in, nor allow, anyone else to engage in any sexual activity with the day care children while in attendance at the program. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. ii. All CCDF-eligible licensed family child care homes. Provide the standard: CGS § 17a-101(c) The Commissioner of Children and Families shall develop an educational training program and refresher training program for the accurate and prompt identification and reporting of child abuse and neglect. Such training program and refresher training program shall be made available to all persons mandated to report child abuse and neglect at various times and locations throughout the state as determined by the Commissioner of Children and Families. 19a-87b-10(k)(1): The provider shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not restrain children except in appropriate circumstances for the protection and safety of the children or others. The provider shall not engage in nor allow anyone else to engage in any sexual activity with the children in care. The provider shall report actual or suspected child abuse or neglect or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by sections 17a-101 to 17a-l Ole, inclusive, of the Connecticut General Statutes. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: CGS § 17a- 101(c) The Commissioner of Children and Families shall develop an educational training program and refresher training program for the accurate and prompt identification and reporting of child abuse and neglect. Such training program and refresher training program shall be made available to all persons mandated to report child abuse and neglect at various times and locations throughout the state as determined by the Commissioner of Children and Families. License-exempt requirements: Administration - The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The operator and staff shall not engage in, nor allow anyone to engage in, sexual contact with the children. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: licensed center: CGS § 17a-101(c) The Commissioner of Children and Families shall develop an educational training program and refresher training program for the accurate and prompt identification and reporting of child abuse and neglect. Such training program and refresher training program shall be made available to all persons mandated to report child abuse and neglect at various times and locations throughout the state as determined by the Commissioner of Children and Families. 19a-79-3a(b)(8)(E): The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (B) The operator shall document that the techniques used to manage child behaviors in the facility have been discussed with the child's parent(s) prior to enrollment and reviewed as needed during the period of the child's enrollment. (C) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate (D) The operator and staff shall not engage in, nor allow, anyone else to engage in any sexual activity with the day care children while in attendance at the program. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. licensed exempt: CGS § 17a-101(c) The Commissioner of Children and Families shall develop an educational training program and refresher training program for the accurate and prompt identification and reporting of child abuse and neglect. Such training program and refresher training program shall be made available to all persons mandated to report child abuse and neglect at various times and locations throughout the state as determined by the Commissioner of Children and Families. License-exempt requirements: Administration - The operator and staff shall be responsible for managing children using techniques that are based on developmentally appropriate practice and communicate acceptable techniques to all staff. (1) The operator and staff shall manage child behavior using techniques based on developmentally appropriate practice, including positive guidance, redirection and setting clear limits that encourage children to develop self-control, self-discipline and positive self-esteem. (2) While children are in attendance at the program the operator and staff shall not engage in, nor allow, abusive, neglectful, physical, corporal, humiliating or frightening treatment or punishment, including, but not limited to, spanking, slapping, pinching, shaking or striking children, and shall not tie nor bind children and shall not physically restrain children except for the protection and safety of the child or others, using least restrictive methods, as appropriate. The operator and staff shall not engage in, nor allow anyone to engage in, sexual contact with the children. The operator and staff shall report actual or suspected child abuse or neglect, or the imminent risk of serious harm of any child to the Department of Children and Families as mandated by section 17a-101 to section 17a-101e, inclusive, of the Connecticut General Statutes. c. Confirm if child care providers must comply with the Lead Agency’s procedures for reporting child abuse and neglect as required by the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a(b)(2)(B)(i): [x] Yes, confirmed. [ ] No. If no, describe: 5.3.12 Additional optional standards In addition to the required health and safety standards, does the Lead Agency require providers to comply with the following optional standards? [x] Yes. [ ] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: Center Regs-19a-79-6a(a)(2) A nutritionally adequate meal and snack shall be provided by the child care center or group child care home, or the parent(s) according to the following schedule. (A) Children who stay on the licensed premises less than five hours shall have a nutritious snack. (B) Children who stay on the licensed premises longer than five but less than eight hours shall have one meal and one nutritious snack. (C) Children who stay on the licensed premises eight hours or more shall have one meal plus two nutritious snacks, or two meals plus one nutritious snack. (D) Meals and snacks provided by the child care center or group child care home shall meet the nutrition standards in 7 CFR 226.20, as amended from time to time. Family Regs-19a-87b-10(c)(2) Good Nutrition and Hygiene. The family child care program shall include adequate and nutritious meals and snacks, prepared and stored in a safe and sanitary manner including proper refrigeration for perishable foods. Drinking water shall be made available and offered to children throughout the day. ii. Access to physical activity. Describe: Center Regs-19a-79-8a(a)(1) The use of a variety of indoor and outdoor equipment and outdoor environments based on the children’s interest, individual needs and the learning to be addressed; (2) A flexible schedule that allows time for children to make choices, continue projects over time, and transition from one activity to another; and (3) Learning experiences that are relevant to the children’s lives and cultural context. (4) A balance of child-initiated and teacher- initiated experiences; (5) Exploration and discovery; (6) The use of a variety of materials that support active engagement and promote skills across areas of learning and development; (7) Rest, sleep or quiet activities; (8) Nutritious meals and snacks; (9) Toileting and clean up; (10) Individual and small group activities; and (11) Moderate and vigorous physical activity for children three years of age and older unless a child has a disability or is experiencing a developmental delay, as defined in section 10-76a of the Connecticut General Statutes, which prevents such child from engaging in such physical activity. Such activity shall take place outdoors. Family Regs-19a-87b-10(c) The provider is responsible for ensuring that the physical needs of the children are adequately met while receiving family child care services, including the following: (I) Sufficient Play Equipment There shall be a sufficient quantity and variety of indoor and outdoor equipment which is appropriate to the needs of the children, their developmental levels and interests and is available for their use. There shall be equipment that encourages large and fine muscle activity, solitary and group play and quiet play. (4) Flexible and Balanced Schedule The provider shall develop and implement a written schedule that is flexible, with time for free choice play, outdoor play, snacks, meals and a rest period. (d) Individual Plan for Care The provider shall establish a planned program of developmentally appropriate activities at the family child care home, which promotes the social, intellectual, emotional and physical development of each child. iii. Caring for children with special needs. Describe: Center Regs: 19a-79- 5a(a)(2)(E) Information regarding disabilities or special health care needs such as, allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease when it is necessary that special care be taken or provided while a child is in attendance at the child care center or group child care home, and an individual plan of care for a child with special health care needs or disabilities, developed with the child’s parent(s) and health care provider, implemented and updated, as necessary. The individual plan of care shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent(s) and program staff responsible for the care of the child. Family Regs: 19a-87b-10(c) Meeting Children's Physical Needs The provider is responsible for ensuring that the physical needs of the children are adequately met while receiving family child care services, including the following: 19a-87b-10(d)(2) The provider shall have an understanding of the needs of children with disabilities or special health care needs receiving family child care services. (3) The provider shall maintain in the family child care home a written individual plan of care for each child with disabilities or special health care needs, including but not limited to, allergies, special dietary needs, dental problems, hearing or visual impairments, chronic illness, developmental variations or history of contagious disease who requires special care be taken or provided while the child is at the family child care home. Such plan shall be based on the recommendations of the child's primary health care provider, developed with the child's parent(s) at intake, implemented and updated as necessary to meet the child's changing needs. Such plan shall include appropriate care of the child in the event of a medical or other emergency and shall be signed by the provider, parent( s) and any approved staff members responsible for the care of the child. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A