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: Practices that contribute to the prevention and control of infectious diseases are found throughout requirements in Iowa Administrative Rules 441.109. 109.4(3) Required Postings: a. Postings are required for the certificate of license, notice of exposure of children to a communicable disease, and notice of decision to deny, suspend, or revoke the center’s license or reduce the center’s license to a provisional status. The center’s license, reflecting current regulatory status, and all other required postings shall be conspicuously placed at the main entrance to the center. If the center is located in a building used for additional purposes and shares the main entrance to the building, the required postings shall be conspicuously placed in the center in an area that is frequented daily by parents or the public. 109.7(1)Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: (b) At least one hour of training regarding universal precautions and infectious disease control 109.9(1) Personnel records. The center shall maintain personnel information sufficient to ensure that persons employed in the center meet minimum staff and training requirements and do not pose any threat to the health, safety, or well-being of the children. Each employee’s file shall contain, at a minimum, the following: (d) A physical examination report. Personnel shall have good health as evidenced by a preemployment physical examination. Acceptable physical examinations shall be documented on Form 470-5152, Child Care Provider Physical Examination Report. The examination shall be performed within six months prior to beginning employment and shall be repeated at least every three years. 109.9(3) Immunization certificates. Signed and dated Iowa immunization certificates, provided by the state department of public health, shall be on file for each child enrolled as prescribed by the department of public health at 641￿Chapter 7. 109.10(1) Physical examination report. a. Preschool-age children. For each child five years of age and younger not enrolled in kindergarten, the child care center shall require an admission physical examination report, submitted within 30 days from the date of admission, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner. The date of the physical examination shall be no more than 12 months prior to the first day of attendance at the center. The written report shall include past health history, status of present health including allergies, medications, and acute or chronic conditions, and recommendations for continued care when necessary. Annually thereafter, a statement of health condition, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner, shall be submitted that includes any change in functioning, allergies, medications, or acute or chronic conditions. b. School-age children. For each child five years of age and older and enrolled in school, the child care center shall require, prior to admission, a statement of health status signed by the parent or legal guardian that certifies that the child is free of communicable disease and that specifies any allergies, medications, or acute or chronic conditions. The statement from the parent shall be submitted annually thereafter. 109.10(4) Daily contact. Each child shall have direct contact with a staff person upon arrival for early detection of apparent illness, communicable disease, or unusual condition or behavior which may adversely affect the child or the group. The center shall post notice at the main entrance to the center where it is visible to parents and the public of exposure of a child receiving care by the center to a communicable disease, the symptoms, and the period of communicability. If the center is located in a building used for other purposes and shares the main entrance to the building, the notice shall be conspicuously posted in the center in an area that is frequented daily by parents or the public. 109.10(5) Infectious disease control. Centers shall establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge, including blood. Soiled diapers shall be stored in containers separate from other waste 109.10(6) Quiet area for ill or injured. The center shall provide a quiet area under supervision for a child who appears to be ill or injured. The parents or a designated person shall be notified of the child’s status in the event of a serious illness or emergency. 109.10(7) Staff hand washing. The center shall ensure that staff demonstrate clean personal hygiene sufficient to prevent or minimize the transmission of illness or disease. All staff shall wash their hands at the following times: a. Upon arrival at the center. b. Immediately before eating or participating in any food service activity. c. After diapering a child. d. Before leaving the rest room either with a child or by themselves. e. Before and after administering nonemergency first aid to a child if gloves are not worn. f. After handling animals and cleaning cages. 109.10(8) Children’s hand washing. The center shall ensure that staff assist children in personal hygiene sufficient to prevent or minimize the transmission of illness or disease. For each infant or child with a disability, a separate cloth for washing and one for rinsing may be used in place of running water. Children’s hands shall be washed at the following times: a. Immediately before eating or participating in any food service activity. b. After using the rest room or being diapered. c. After handling animals. 109.10(14) Pets. Animals kept on site shall be in good health with no evidence of disease, be of such disposition as to not pose a safety threat to children, and be maintained in a clean and sanitary manner. Documentation of current vaccinations shall be available for all cats and dogs. No ferrets, reptiles, including turtles, or birds of the parrot family shall be kept on site. Pets shall not be allowed in kitchen or food preparation areas. 109.11(3)(8) Sufficient bathroom and diapering facilities are provided to attend immediately to children’s toileting needs and maintained to reduce the transmission of disease. 109.11(3)(10) Sanitation and safety procedures for the center are developed and implemented to reduce the risk of injury or harm to children and reduce the transmission of disease. 109.11(4) Bathroom facilities. At least one functioning toilet and one sink for each 15 children ages two years and older shall be provided in a room with natural or artificial ventilation. Training seats or chairs may be used for children under two years of age. New construction after November 1, 1995, shall provide for at least one sink in the same area as the toilet and, for centers serving children two weeks to two years of age, shall provide for at least one sink in the central diapering area. At least one sink shall be provided in program rooms for infants and toddlers or in an adjacent area other than the kitchen. New construction after April 1, 1998, shall have at least one sink provided in the program rooms for infants and toddlers. 109.12(5)b Each infant and toddler shall be diapered in a sanitary manner as frequently as needed at a central diapering area. Diapering, sanitation, and hand-washing procedures shall be posted and implemented in every diapering area. There shall be at least one changing table for every 15 infants. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Practices that contribute to the prevention and control of infectious diseases for Child Development Homes can found throughout requirements in Iowa Administrative Rules 441.110. 110.8(1)n Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice).(2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 110.8(1)p. The provider shall have written policies regarding the care of mildly ill children and the exclusion of children due to illness and shall inform parents of these policies. 110.8(3)d. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. 110.9(1) A provider file shall be maintained and shall contain the following: a. A physical examination report. Providers and all members of a provider’s household aged 18 years or older shall have good health as evidenced by a preregistration physical examination. Acceptable physical examinations shall be documented on Form 470-5152, Child Care Provider Physical Examination Report. All children residing in the household must have the medical documentation outlined in paragraphs 110.9(4)￿d,￿ ￿f,￿ and ￿g.￿ Children's Files 110.9(4)d. An admission physical examination report signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner. (1) The date of the physical examination shall not be more than 12 months before the child’s first day of attendance at the child development home. (2) The written report shall include the child’s past health history, status of the child’s present health, allergies and restrictive conditions, and recommendations for continued care when necessary. (3) For a child who is five years of age or older and enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the physical examination report. (4) The examination report or statement of health status shall be on file before the child’s first day of care. 110.9(4)e. For children under the age of six, a statement of health condition signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner and submitted annually from the date of the admission physical examination. For a child who is enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the statement of health. 110.9(4)g. A signed and dated immunization certificate provided by the Iowa department of public health. For the school-age child, a copy of the most recent immunization record shall be acceptable. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care homes accepting CCDF funds are required to meet minimum health and safety standards in Iowa Administrative Rules 441.120. 120.8(1)n. Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). (2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 120.8(3)e. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. Children's Files: 120.9(2)d. An admission physical examination report signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner. 120.9(2)e. For children under the age of six, a statement of health condition signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner submitted annually from the date of the admission physical examination. For a child who is enrolled in school, a statement of health status signed by the parent or legal guardian may be substituted for the statement of health. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: These requirements are found in Iowa Administrative Rules 441.109. 109.9(3) Immunization certificates. Signed and dated Iowa immunization certificates, provided by the state department of public health, shall be on file for each child enrolled as prescribed by the department of public health at 641￿Chapter 7. ii. All CCDF-eligible licensed family child care homes. Provide the standard: These requirements are found in Iowa Administrative Rules 441.110. 110.9(4) Children’s files. An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: 110.9(4 )g. A signed and dated immunization certificate provided by the Iowa department of public health. For the school-age child, a copy of the most recent immunization record shall be acceptable. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: These requirements are found in Iowa Administrative Rules 441.120 in the section on Children's Files. 120.9(1) An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. 120.9(2) The file shall contain: g. A signed and dated immunization certificate provided by the Iowa department of public health. For the school-age child, a copy of the most recent immunization record shall be acceptable. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers must follow safe sleep standards articulated in Iowa Administrative Rules 441.109 and outlined by the AAP for children under the age of 1. 109.12(5)e. The provider shall follow safe sleep practices as recommended by the American Academy of Pediatrics for infants under the age of one. Requirements are as follows: (1) Infants shall always be placed on their backs for sleep. (2) Infants shall be placed on a firm mattress with a tight fitted sheet that meets U.S. Consumer Product Safety Commission federal standards. (3) Infants shall not be allowed to sleep on a bed, sofa, air mattress or other soft surface. No child shall be allowed to sleep in any item not designed for sleeping including, but not limited to, an infant seat, car seat, swing, or bouncy seat. (4) No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose bedding shall be allowed in the sleeping area with the infant. (5) No co-sleeping shall be allowed. (6) Sleeping infants shall be actively observed by sight and sound. (7) If an alternate sleeping position is needed, a signed physician or physician assistant authorization with statement of medical reason is required. 109.12(5)f. A crib or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards or recommendations from the Consumer Product Safety Commission or ASTM International for juvenile products shall be provided for each child under two years of age if developmentally appropriate. Crib railings shall be fully raised and secured when the child is in the crib. A crib or criblike furniture shall be provided for the number of children present at any one time. The center shall develop procedures for maintaining all cribs or criblike furniture and bedding in a clean and sanitary manner. There shall be no restraining devices of any type used in cribs. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must follow safe sleep standards articulated in Iowa Administrative Rules 441.110 and outlined by the AAP for children under the age of 1. 110.8(5) Safe sleep. a. The provider shall follow safe sleep practices as recommended by the American Academy of Pediatrics for infants under the age of one. Infant sleep shall conform to the following standards: (1) Infants shall always be placed on their backs for sleep. (2) Infants shall be placed on a firm mattress with a tight fitted sheet that meets U.S. Consumer Product Safety Commission federal standards. (3) Infants shall not be allowed to sleep on a bed, sofa, air mattress or other soft surface. (4) No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose bedding shall be allowed in the sleeping area with the infant. (5) No co-sleeping shall be allowed. (6) Sleeping infants shall be actively observed by sight and sound. (7) If an alternate sleeping position is needed, a signed physician or physician assistant authorization with statement of medical reason is required. b. No child shall be allowed to sleep in any item not designed for sleeping including, but not limited to, an infant seat, car seat, swing, or bouncy seat. c. A crib or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards or recommendations from the Consumer Product Safety Commission or ASTM International for juvenile products shall be provided for each child under two years of age if developmentally appropriate. Crib railings shall be fully raised and secured when the child is in the crib. A crib or criblike furniture shall be provided for the number of children present at any one time. The home shall maintain all cribs or criblike furniture and bedding in a clean and sanitary manner. There shall be no restraining devices of any type used in cribs. d. All items used for sleeping must be used in compliance with manufacturer standards for age and weight 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Non-Registered Child Care Homes that receive CCDF funds must follow safe sleep standards articulated in Iowa Administrative Rules 441.120 and outlined by the AAP for children under the age of 1. 120.8(5) Safe sleep. a. The provider shall follow safe sleep practices as recommended by the American Academy of Pediatrics for infants under the age of one. Infant sleep shall conform to the following standards: (1) Infants shall always be placed on their backs for sleep. (2) Infants shall be placed on a firm mattress with a tight fitted sheet that meets U.S. Consumer Product Safety Commission federal standards. (3) Infants shall not be allowed to sleep on a bed, sofa, air mattress or other soft surface. (4) No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose bedding shall be allowed in the sleeping area with the infant. (5) No co-sleeping shall be allowed. (6) Sleeping infants shall be actively observed by sight and sound. (7) If an alternate sleeping position is needed, a signed physician or physician assistant authorization with statement of medical reason is required. b. No child shall be allowed to sleep in any item not designed for sleeping including, but not limited to, an infant seat, car seat, swing, or bouncy seat. c. A crib or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards or recommendations from the Consumer Product Safety Commission or ASTM International for juvenile products shall be provided for each child under two years of age if developmentally appropriate. Crib railings shall be fully raised and secured when the child is in the crib. A crib or criblike furniture shall be provided for the number of children present at any one time. The home shall maintain all cribs or criblike furniture and bedding in a clean and sanitary manner. There shall be no restraining devices of any type used in cribs. d. All items used for sleeping must be used in compliance with manufacturer standards for age and weight of the child vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers must follow medication administration requirements in Iowa Administrative code 441.109. 109.7(1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: e (3) Administration of medication, consistent with standards for parental consent. 109.10(3) Medications. The center shall have written procedures for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications, including the following: a. All medications shall be stored in their original containers, with accompanying physician or pharmacist’s directions and label intact and stored so they are inaccessible to children and the public. Nonprescription medications shall be labeled with the child’s name. b. For every day an authorization for medication is in effect and the child is in attendance, there shall be a notation of administration including the name of the medicine, date, time, dosage given or applied, and the initials of the person administering the medication or the reason the medication was not given. c. In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription. d. A child care staff member shall not provide medications to a child if the staff member has not completed preservice/orientation training that includes medication administration. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must follow medication administration requirements in Iowa Administrative Code 441.110 110.8(3)c Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. 110.10(1) a. Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (3) Administration of medication, consistent with standards for parental consent. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care Homes with a CCA Agreement (license-exempt) must follow medication administration requirements in Iowa Administrative Code 441.120. 120.8(3)c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. Medications shall not be provided to a child if the provider has not completed preservice/orientation training that includes medication administration. 120.10(1) a. Prior to issuance of a provider agreement, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (3) Administration of medication, consistent with standards for parental consent. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers must follow medication administration requirements in Iowa Administrative code 441.109. 109.7(1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: e (3) Administration of medication, consistent with standards for parental consent. 109.10(3) Medications. The center shall have written procedures for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications, including the following: a. All medications shall be stored in their original containers, with accompanying physician or pharmacist’s directions and label intact and stored so they are inaccessible to children and the public. Nonprescription medications shall be labeled with the child’s name. b. For every day an authorization for medication is in effect and the child is in attendance, there shall be a notation of administration including the name of the medicine, date, time, dosage given or applied, and the initials of the person administering the medication or the reason the medication was not given. c. In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription. d. A child care staff member shall not provide medications to a child if the staff member has not completed preservice/orientation training that includes medication administration. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must follow medication administration requirements in Iowa Administrative Code 441.110 110.8(3)c Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. 110.10(1) a. Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (3) Administration of medication, consistent with standards for parental consent. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care Homes with a CCA Agreement (license-exempt) must follow medication administration requirements in Iowa Administrative Code 441.120. 120.8(3)c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. Medications shall not be provided to a child if the provider has not completed preservice/orientation training that includes medication administration. 120.10(1) a. Prior to issuance of a provider agreement, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (3) Administration of medication, consistent with standards for parental consent. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers must follow these requirements in Iowa Administrative Code 441.109. 109.7(1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: e(4) Prevention of and response to emergencies due to food and allergic reactions 109.9(2)g. For any child with allergies, a written emergency plan is available in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 109.10(1) Physical examination report. a. Preschool-age children. For each child five years of age and younger not enrolled in kindergarten, the child care center shall require an admission physical examination report, submitted within 30 days from the date of admission, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner. The date of the physical examination shall be no more than 12 months prior to the first day of attendance at the center. The written report shall include past health history, status of present health including allergies, medications, and acute or chronic conditions, and recommendations for continued care when necessary. Annually thereafter, a statement of health condition, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner, shall be submitted that includes any change in functioning, allergies, medications, or acute or chronic conditions. b. School-age children. For each child five years of age and older and enrolled in school, the child care center shall require, prior to admission, a statement of health status signed by the parent or legal guardian that certifies that the child is free of communicable disease and that specifies any allergies, medications, or acute or chronic conditions. The statement from the parent shall be submitted annually thereafter. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must follow these requirements under Iowa Administrative Code 441.110 110.9(4)An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: d(2)The written report shall include the child’s past health history, status of the child’s present health, allergies and restrictive conditions, and recommendations for continued care when necessary 441.110.9(4)h. For any child with allergies, a written emergency care plan in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 441.IAC 110.10(1)a Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (4)Prevention and response to emergencies due to food and allergic reactions. All providers must complete this as a part of the health and safety training prior to becoming registered. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care Homes that receive CCDF funds must follow these requirements under 441 Iowa Administrative Code 441.120 120.9(2)h. For any child with allergies, a written emergency plan in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 120.10(1) Prior to the issuance of a provider agreement, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following content areas: d. Prevention of and response to emergencies due to food and allergic reactions vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers must follow these requirements in Iowa Administrative Code 441.109. 109.7(1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: e(4) Prevention of and response to emergencies due to food and allergic reactions 109.9(2)g. For any child with allergies, a written emergency plan is available in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 109.10(1) Physical examination report. a. Preschool-age children. For each child five years of age and younger not enrolled in kindergarten, the child care center shall require an admission physical examination report, submitted within 30 days from the date of admission, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner. The date of the physical examination shall be no more than 12 months prior to the first day of attendance at the center. The written report shall include past health history, status of present health including allergies, medications, and acute or chronic conditions, and recommendations for continued care when necessary. Annually thereafter, a statement of health condition, signed by a licensed medical doctor, doctor of osteopathy, chiropractor, physician’s assistant or advanced registered nurse practitioner, shall be submitted that includes any change in functioning, allergies, medications, or acute or chronic conditions. b. School-age children. For each child five years of age and older and enrolled in school, the child care center shall require, prior to admission, a statement of health status signed by the parent or legal guardian that certifies that the child is free of communicable disease and that specifies any allergies, medications, or acute or chronic conditions. The statement from the parent shall be submitted annually thereafter. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must follow these requirements under Iowa Administrative Code 441.110 110.9(4)An individual file for each child shall be maintained and updated annually or when the provider becomes aware of changes. The file shall contain: d(2)The written report shall include the child’s past health history, status of the child’s present health, allergies and restrictive conditions, and recommendations for continued care when necessary 441.110.9(4)h. For any child with allergies, a written emergency care plan in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 441.IAC 110.10(1)a Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (4)Prevention and response to emergencies due to food and allergic reactions. All providers must complete this as a part of the health and safety training prior to becoming registered. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care Homes that receive CCDF funds must follow these requirements under 441 Iowa Administrative Code 441.120 120.9(2)h. For any child with allergies, a written emergency plan in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises. 120.10(1) Prior to the issuance of a provider agreement, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following content areas: d. Prevention of and response to emergencies due to food and allergic reactions vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Iowa Administrative Code was updated and went into effect on 7/1/25. Practices that contribute to the identification of and protection from building and physical premises is found in 441 IAC 109.11 Physical Facilities. 109.11(1) Room size. The program room size must be a minimum of 80 square feet of useable floor space or sufficient floor space to provide 35 square feet of useable floor space per child. In rooms where floor space occupied by cribs is counted as useable floor space, there must be 40 square feet of floor space per child. Kitchens, bathrooms, halls, lobby areas, storage areas and other areas of the center not designed as activity space for children cannot be used as regular program space or counted as useable floor space. 109.11(2) Play equipment, materials and furniture. a. The center will provide sufficient and safe indoor play equipment, materials, and furniture that conform with the standards or recommendations of the Consumer Product Safety Commission (CPSC) (August 1, 2024) or the American Society for Testing and Materials (ASTM) (August 1, 2024) for juvenile products. Play equipment, materials, and furniture must meet the developmental, activity, and special needs of the children. b. Rooms must be arranged so as not to obstruct the direct observation of children by staff. Individual covered mats, beds, or cots and appropriate bedding will be provided for all children who nap. The center will develop procedures to ensure that all equipment and materials are maintained in a sanitary manner. Sufficient spacing must be maintained. The center shall provide sufficient toilet articles for each child for hand washing. 109.11(3) Indoor facility requirements. Ch 109, p.14 Human Services[441] IAC 3/19/25 a. The center shall ensure that: (1) The facility and premises are sanitary, safe and hazard-free. (2) The facility has sufficient: 1. Lighting. 2. Ventilation. 3. Heating and cooling. (3) Equipment placed in a program area is maintained so as not to result in injury to children. 109.11(4) Outdoor facility requirements. a. Centers must have a safe outdoor program area adjacent to the center, with sufficient square footage to accommodate at least 30 percent of the enrollment capacity at any one time at 75 square feet per child. The outdoor area must: (1) Be free from litter and unsafe materials and free from contamination by the drainage or ponding of sewage or storm water. (2) Include safe play equipment and an area of shade. (3) Include fencing to protect from bodies of water and vehicular traffic. b. The director or designated person must complete and keep a record of at least monthly inspections of the outdoor play area and equipment for the purpose of assessing and rectifying potential safety hazards. If the outdoor play area is not used for a period of time due to inclement weather conditions, the center shall document the reasons why the monthly inspection did not occur and must complete and document an inspection prior to resuming use of the area. c. Approval may be given by the department to waive the outdoor space requirement for programs of three hours or less, provided there is suitable substitute space and equipment available. d. Approval may be given by the department for centers operating in a densely developed area to use alternative outdoor play areas in lieu of adjacent outdoor play areas. 109.11(5) Bathroom facilities. At least one functioning toilet and one sink per 15 children two years of age and older must be provided in a room with natural or artificial ventilation. New construction after November 1, 1995, must provide for at least one sink in the same area as the toilet and, for centers serving children two weeks to two years of age, shall provide for at least one sink in the central diapering area. At least one sink must be provided in program rooms for infants and toddlers or in an adjacent area other than the kitchen. New construction after April 1, 1998, shall have at least one sink provided in the program rooms for infants and toddlers. 109.11(6) Telephone. A working nonpay telephone must be available in the center with emergency telephone numbers for police or 911, fire, ambulance, and poison control center posted in a conspicuous area. The street address and telephone number of the center must be included in the posting. A separate file or listing of emergency telephone numbers for each child shall be maintained. 109.11(7) Kitchen appliances. Gas or electric ranges or ovens shall not be placed in the program area. If kitchen appliances are maintained in the program area for food preparation activities, the area must be sectioned off and shall not be counted as useable floor space for room size. 109.11(8) Environmental hazards. a. Within one year of being issued an initial or renewal license, centers operating in facilities built prior to 1978 shall conduct a visual assessment for lead hazards that exist in the form of peeling, cracking or chipping paint or painted surfaces in need of repair. If these lead hazards are found, it shall be assumed that lead-based paint is present on the surfaces, and the surfaces shall be repaired by an Iowa certified lead safe renovator before a full license will be issued. b. Within one year of being issued an initial or renewal license, centers operating in facilities that are at ground level, use a basement area as program space, or have a basement beneath the program area shall have radon testing following the National Consensus Standards as outlined in 641￿Chapter 43. c. To reduce the risk of carbon monoxide poisoning, all centers shall, on an annual basis, have a professional inspect all fuel-burning appliances, including oil and gas furnaces, gas water heaters, gas ranges and ovens, and gas dryers, to ensure the appliances are in good working order with proper ventilation. All centers shall install one carbon monoxide detector on each floor of the center that is listed with Underwriters Laboratory (UL) as conforming to UL Standard 2034 (August 7, 2024). [ARC 9021C, IAB 3/19/25, effective 7/1/25] ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Home regulations in 441 IAC 110 address building and physical premises hazards in section 110.8(1) Facility Requirements and 110.8(2) Use of Outdoor Space "110.8(1) Facility requirements: a. The home shall have a nonpay, working landline or mobile telephone with emergency numbers posted for police, fire, ambulance, and the poison information center. The number for each child’s parent, for a responsible person who can be reached when the parent cannot, and for the child’s physician shall be written on paper and readily accessible by the telephone. The home must prominently display all emergency information, and all travel vehicles must have a paper copy of emergency parent contact information. b. Electrical wiring shall be maintained, and all accessible electrical outlets shall be tamper-resistant outlets or shall be safely capped. Electrical cords shall be properly used. Improper use includes the running of cords under rugs, over hooks, or through door openings or other use that has been known to be hazardous. c. Combustible materials shall be kept a minimum of three feet away from furnaces, stoves, water heaters, and gas dryers. d. Approved safety gates at stairways and doors shall be provided and used as needed. e. Annual laboratory analysis of a private water supply shall be conducted to show satisfactory bacteriological quality. When children under the age of two are to be cared for, the analysis shall include a nitrate analysis. When private water supplies are determined unsuitable for drinking, commercially bottled water or water treated through a process approved by the health department or designee shall be provided. f. A safety barrier shall surround any heating stove or heating element, in order to prevent burns. g. The home shall have at least one 2A 10BC-rated fire extinguisher located in a visible and readily accessible place on each child-occupied floor. h. The home shall have at least one single-station, battery-operated, UL-approved smoke detector in each child-occupied room and at the top of every stairway. Each smoke detector shall be installed according to the manufacturer’s recommendations. The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes. i. Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. ￿No smoking￿ signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: (1) The telephone number for reporting complaints, and (2) The Internet address of the department of public health (smokefreeair.iowa.gov). j. Homes served by a private sewage disposal system shall be operated and maintained to ensure the system is properly treating the wastewater and not creating an unsanitary condition in the environment. Discharge of untreated waste water from private sewage disposal systems is prohibited. Concerns about noncompliance shall be referred to the local county sanitarian. k. A provider operating in a facility built before 1978 shall assess and control lead hazards before being issued an initial child development home registration or a renewal of the registration. To comply with this requirement, the provider shall: (1) Determine if painted surfaces on the interior or exterior of the facility are chipping, peeling, or cracking or in need of repair. Painted surfaces include walls, ceilings, windows, doors, stairs, and woodwork; and (2) If painted surfaces are in need of repair, hire an Iowa certified lead-safe renovator to make repairs or take training to become an Iowa certified lead-safe renovator. Iowa lead-safe renovators shall apply interim controls on any chipping, peeling, or cracking paint found, using lead-safe work methods in accordance with and as defined by department of public health rules at 641￿Chapters 69 and 70. l. The child development home shall be located in a single-family residence that is owned, rented, or leased by the person, or, for dual registrations, at least one of the persons, who is named on the child development home’s certificate of registration. m. Any driver who transports children for any purpose shall have a valid driver’s license and adequate motor vehicle insurance that authorizes the driver to operate the type of vehicle being driven. Child restraint devices shall be utilized in compliance with Iowa Code section 321.446. n. Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). (2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. o. Using an injury report form, the provider shall document all injuries that require first aid or medical care. The form shall be completed on the date of occurrence, shared with the parent, and maintained in the child’s file. p. The provider shall have written policies regarding the care of mildly ill children and the exclusion of children due to illness and shall inform parents of these policies. q. The provider shall have written policy and procedures for responding to health- related emergencies. r. The certificate of registration shall be displayed in a conspicuous place. s. Serious injuries. (1) Serious injuries, as defined in Iowa Code section 702.18, that occur in a child care facility or when a child is in the care of child care facility staff shall be reported to the department within 24 hours of the incident. (2) Serious injuries shall be documented and information maintained in the child’s file as required by subrule 110.9(4)." "110.8(2) Use of outdoor space: a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shall have both sunshine and shade areas. The play area shall be kept free from litter, rubbish, and flammable materials and shall be free from contamination by the drainage or ponding of sewage, household waste, or storm water. b. When there is a swimming or wading pool on the premises: (1) The wading pool shall be drained daily and shall be inaccessible to children when it is not in use. (2) An aboveground or in-ground swimming pool that is not fenced shall be covered whenever the pool is not in use. The cover shall meet or exceed the ASTM International (formerly known as the American Society for Testing and Materials) specification intended to reduce the risk of drowning by inhibiting access to the water by children under five years of age. (3) An uncovered aboveground swimming pool shall be enclosed with an approved fence that is nonclimbable and is at least four feet high. (4) An uncovered in-ground swimming pool shall be enclosed with an approved fence that is nonclimbable and is at least four feet high and flush with the ground. c. If children are allowed to use an aboveground or in-ground swimming pool: (1) Written permission from parents shall be available for review. (2) Equipment needed to rescue a child or adult shall be readily accessible. (3) The child care provider shall accompany the children and provide constant supervision while the children use the pool. (4) The child care provider shall complete training in cardiopulmonary resuscitation for infants, toddlers, and children, according to the criteria of the American Red Cross or the American Heart Association." 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Regulations for Child Care Homes with a CCA Provider Agreement are found in 441 IAC 120. Building and physical premises hazards are addressed in sections 120.8(1) Facility requirements and 120.8(2) Use of outdoor space. "120.8(1) Facility requirements: a. The home shall have a nonpay, working landline or mobile telephone with emergency numbers posted for police, fire, ambulance, and the poison information center. The number for each child’s parent, for a responsible person who can be reached when the parent cannot, and for the child’s physician shall be written on paper and readily accessible by the telephone. The home must prominently display all emergency information, and all travel vehicles must have a paper copy of emergency parent contact information. b. Electrical wiring shall be maintained, and all accessible electrical outlets shall be tamper-resistant outlets or shall be safely capped. Electrical cords shall be properly used. Improper use includes the running of cords under rugs, over hooks, or through door openings or other use that has been known to be hazardous. c. Combustible materials shall be kept a minimum of three feet away from furnaces, stoves, water heaters, and gas dryers. d. Approved safety gates at stairways and doors shall be provided and used as needed. e. Annual laboratory analysis of a private water supply shall be conducted to show satisfactory bacteriological quality. When children under the age of two are to be cared for, the analysis shall include a nitrate analysis. When private water supplies are determined unsuitable for drinking, commercially bottled water or water treated through a process approved by the health department or designee shall be provided. f. A safety barrier shall surround any heating stove or heating element, in order to prevent burns. g. The home shall have at least one 2A 10BC-rated fire extinguisher located in a visible and readily accessible place on each child-occupied floor. h. The home shall have at least one single-station, battery-operated, UL-approved smoke detector in each child-occupied room and at the top of every stairway. Each smoke detector shall be installed according to manufacturer’s recommendations. The provider shall test each smoke detector monthly and keep a record of testing for inspection purposes. i. Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. ￿No smoking￿ signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: (1) The telephone number for reporting of complaints, and (2) The Internet address of the department of public health (smokefreeair.iowa.gov). j. Homes served by a private sewage disposal system shall be operated and maintained to ensure the system is properly treating the wastewater and not creating an unsanitary condition in the environment. Discharge of untreated waste water from private sewage disposal systems is prohibited. Concerns about noncompliance shall be referred to the local county sanitarian. k. A provider operating in a facility built before 1978 shall assess and control lead hazards before being issued an initial child care assistance provider agreement or a renewal of the provider agreement. To comply with this requirement, the provider shall: (1) Determine if painted surfaces on the interior or exterior of the facility are chipping, peeling, or cracking or in need of repair. Painted surfaces include walls, ceilings, windows, doors, stairs, and woodwork; and (2) If painted surfaces are in need of repair, hire an Iowa certified lead-safe renovator to make repairs or take training to become an Iowa certified lead-safe renovator. Iowa lead-safe renovators shall apply interim controls on any chipping, peeling, or cracking paint found, using lead-safe work methods in accordance with and as defined by department of public health rules at 641￿Chapters 69 and 70. l. The child care home shall be located in a single-family residence that is owned, rented, or leased by the provider. m. Any driver who transports children for any purpose shall have a valid driver’s license and adequate motor vehicle insurance that authorizes the driver to operate the type of vehicle being driven. Child restraint devices shall be utilized in compliance with Iowa Code section 321.446. n. Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). (2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. o. Using an injury report form, the provider shall document all injuries that require first aid or medical care. The form shall be completed on the date of occurrence, shared with the parent, and maintained in the child’s file. p. Serious injuries. (1) Serious injuries, as defined in Iowa Code section 702.18, that occur in a child care home or when a child is in the care of child care home staff shall be reported to the department within 24 hours of the incident. (2) Serious injuries shall be documented and information maintained in the child’s file as required by subrule 120.9(2)." "120.8(2) Use of outdoor space: a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shall have both sunshine and shade areas. The play area shall be kept free from litter, rubbish, and flammable materials and shall be free from contamination by the drainage or ponding of sewage, household waste, or storm water. b. When there is a swimming or wading pool on the premises: (1) The wading pool shall be drained daily and shall be inaccessible to children when it is not in use. (2) An aboveground or in-ground swimming pool that is not fenced shall be covered whenever the pool is not in use. The cover shall meet or exceed the ASTM International (formerly known as the American Society for Testing and Materials) specification intended to reduce the risk of drowning by inhibiting access to the water by children under five years of age. (3) An uncovered aboveground swimming pool shall be enclosed with an approved fence that is nonclimbable and is at least four feet high. (4) An uncovered in-ground swimming pool shall be enclosed with an approved fence that is nonclimbable and is at least four feet high and flush with the ground. c. If children are allowed to use an aboveground or in-ground swimming pool: (1) Written permission from parents shall be available for review. (2) Equipment needed to rescue a child or adult shall be readily accessible. (3) The child care provider shall accompany the children and provide constant supervision while the children use the pool. (4) The child care provider shall complete training in cardiopulmonary resuscitation for infants, toddlers, and children, according to the criteria of the American Red Cross or the American Heart Association." vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: IAC 441.109.11(4) outline requirements for outdoor facility requirements. Health and Safety: Building and Physical Premises Safety (vehicular traffic and bodies of water) 109.11(4)(3): Include fencing to protect from bodies of water and vehicular traffic. ii. All CCDF-eligible licensed family child care homes. Provide the standard: IAC 441.110.8(2) outline requirements for pools. 110.8(2) Use of outdoor space. a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shallcer have both sunshine and shade areas. The play area shall be kept free from litter, rubbish, and flammable materials and shall be free from contamination by the drainage or ponding of sewage, household waste, or storm water. b. When there is a swimming or wading pool on the premises: (1) The wading pool shall be drained daily and shall be inaccessible to children when it is not in use. (2) An aboveground or in-ground swimming pool that is not fenced shall be covered whenever the pool is not in use. The cover shall meet or exceed the ASTM International (formerly known as the American Society for Testing and Materials) specification intended to reduce the risk of drowning by inhibiting access to the water by children under five years of age. (3) An uncovered aboveground swimming pool shall be enclosed with an approved fence that is non-climbable and is at least four feet high. (4) An uncovered in-ground swimming pool shall be enclosed with an approved fence that is non-climbable and is at least four feet high and flush with the ground. c. If children are allowed to use an aboveground or in-ground swimming pool: (1) Written permission from parents shall be available for review. (2) Equipment needed to rescue a child or adult shall be readily accessible. (3) The child care provider shall accompany the children and provide constant supervision while the children use the pool. (4) The child care provider shall complete training in cardiopulmonary resuscitation for infants, toddlers, and children, according to the criteria of the American Red Cross or the American Heart Association. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: IAC 441.120.8(2) outline requirements for pools. 120.8(2) Use of outdoor space. a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shall have both sunshine and shade areas. The play area shall be kept free from litter, rubbish, and flammable materials and shall be free from contamination by the drainage or ponding of sewage, household waste, or storm water. b. When there is a swimming or wading pool on the premises: (1) The wading pool shall be drained daily and shall be inaccessible to children when it is not in use. (2) An aboveground or in-ground swimming pool that is not fenced shall be covered whenever the pool is not in use. The cover shall meet or exceed the ASTM International (formerly known as the American Society for Testing and Materials) specification intended to reduce the risk of drowning by inhibiting access to the water by children under five years of age. (3) An uncovered aboveground swimming pool shall be enclosed with an approved fence that is non-climbable and is at least four feet high. (4) An uncovered in-ground swimming pool shall be enclosed with an approved fence that is non-climbable and is at least four feet high and flush with the ground. c. If children are allowed to use an aboveground or in-ground swimming pool: (1) Written permission from parents shall be available for review. (2) Equipment needed to rescue a child or adult shall be readily accessible. (3) The child care provider shall accompany the children and provide constant supervision while the children use the pool. (4) The child care provider shall complete training in cardiopulmonary resuscitation for infants, toddlers, and children, according to the criteria of the American Red Cross or the American Heart Association vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: IAC 441.109.11(4) outline requirements for outdoor facility requirements. Health and Safety: Building and Physical Premises Safety (vehicular traffic and bodies of water) 109.11(4)(3): Include fencing to protect from bodies of water and vehicular traffic. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Home regulations in 441 IAC 110.8(2)a 110.8(2) Use of outdoor space. a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shall have both sunshine and shade areas 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Child Care Homes accepting CCDF follow regulations in 441 IAC 120 rules 120.8(2) Use of outdoor space. a. A safe outdoor play area shall be maintained in good condition throughout the year. The play area shall be fenced off when located on a busy thoroughfare or near a hazard which may be injurious to a child and shall have both sunshine and shade areas vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Standards are found in Iowa Administrative Code 441.109 109.4(2) Required written policies. The child care center owner, board or director shall:￿(b.) Develop and implement policies for enrollment and discharge of children, field trips and non-center activities, discipline, nutrition, health and safety policies and, if transporting children, transportation policy. 109.7(1)(e) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training:￿ (6) Prevention of shaken baby syndrome and abusive head trauma. 109.12(2) Discipline. The center shall have a written policy on the discipline of children which provides for positive guidance, with direction for resolving conflict and the setting of well-defined limits. The written policy shall be provided to staff at the start of employment and to parents at time of admission. The center shall not use as a form of discipline: a. A curriculum or program of activities that promotes self-esteem and positive self-image; social interaction; self-expression and communication skills; creative expression; and problem-solving skills. b. A balance of active and quiet activities; individual and group activities; indoor and outdoor activities; and staff-initiated and child-initiated activities. c. Activities which promote both gross and fine motor development. d. Experiences in harmony with the ethnic and cultural backgrounds of the children. e. A supervised nap or quiet time for all children under the age of six not enrolled in school who are present at the center for five or more hours. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards are found in Iowa Administrative Code 441.110 110.8(6) Discipline. Discipline shall conform to the following standards: a. Corporal punishment, including spanking, shaking and slapping, shall not be used. b. Punishment that is humiliating or frightening or that causes pain or discomfort to the child shall not be used. c. Punishmentshall not be administered because of a child’sillness, or progress or lack of progress in toilet training, nor shall punishment or threat of punishment be associated with food or rest. d. No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child’s family. e. Discipline shall be designed to help the child develop self-control, self-esteem, and respect for the rights of others. 110.10(1) Required training. a. Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas: (6) Prevention of shaken baby syndrome and abusive head trauma. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Standards are found in Iowa Administrative Code 441.120 120.8(6) Discipline. Discipline shall conform to the following standards: a. Corporal punishment, including spanking, shaking and slapping, shall not be used. b. Punishment that is humiliating or frightening or that causes pain or discomfort to the child shall not be used. c. Punishment shall not be administered because of a child’s illness, or progress or lack of progress in toilet training, nor shall punishment or threat of punishment be associated with food or rest. d. No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child’s family. e. Discipline shall be designed to help the child develop self- control, self-esteem, and respect for the rights of others. 441￿120.10(237A) Professional development. 120.10(1) Prior to the issuance of a provider agreement, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following content areas: f. Prevention of shaken baby syndrome and abusive head trauma. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Standards are found in Iowa Administrative Code 441.109 109.4(2) Required written policies. The child care center owner, board or director shall:￿(b.) Develop and implement policies for enrollment and discharge of children, field trips and non-center activities, discipline, nutrition, health and safety policies and, if transporting children, transportation policy. 109.7(1)(e) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training:￿ (6) Prevention of shaken baby syndrome and abusive head trauma. 109.12(2) Discipline. The center shall have a written policy on the discipline of children which provides for positive guidance, with direction for resolving conflict and the setting of well-defined limits. The written policy shall be provided to staff at the start of employment and to parents at time of admission. The center shall not use as a form of discipline: a. A curriculum or program of activities that promotes self-esteem and positive self-image; social interaction; self-expression and communication skills; creative expression; and problem-solving skills. b. A balance of active and quiet activities; individual and group activities; indoor and outdoor activities; and staff-initiated and child-initiated activities. c. Activities which promote both gross and fine motor development. d. Experiences in harmony with the ethnic and cultural backgrounds of the children. e. A supervised nap or quiet time for all children under the age of six not enrolled in school who are present at the center for five or more hours. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards are found in Iowa Administrative Code 441.110 110.8(6) Discipline. Discipline shall conform to the following standards: a. Corporal punishment, including spanking, shaking and slapping, shall not be used. b. Punishment that is humiliating or frightening or that causes pain or discomfort to the child shall not be used. c. Punishmentshall not be administered because of a child’sillness, or progress or lack of progress in toilet training, nor shall punishment or threat of punishment be associated with food or rest. d. No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child’s family. e. Discipline shall be designed to help the child develop self-control, self-esteem, and respect for the rights of others. 110.10(1) Required training. a. Prior to registration, the provider shall complete minimum health and safety trainings, approved by the department, in all of the following areas:￿(6) Prevention of shaken baby syndrome and abusive head trauma. b. Prior to registration, the provider shall complete two hours of Iowa’s training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Standards are found in Iowa Administrative Code 441.120 120.8(6) Discipline. Discipline shall conform to the following standards: a. Corporal punishment, including spanking, shaking and slapping, shall not be used. b. Punishment that is humiliating or frightening or that causes pain or discomfort to the child shall not be used. c. Punishment shall not be administered because of a child’s illness, or progress or lack of progress in toilet training, nor shall punishment or threat of punishment be associated with food or rest. d. No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child’s family. e. Discipline shall be designed to help the child develop self- control, self-esteem, and respect for the rights of others. 441￿120.10(237A) Professional development. 120.10(1) Prior to the issuance of a provider agreement, the providershall complete minimum health and safety trainings, approved by the department, in all of the following content areas: f. Prevention of shaken baby syndrome and abusive head trauma. 120.10(2) Prior to issuance of a provider agreement, the provider shall complete two hours of Iowa’s training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Standards are found in Iowa Administrative Code 109.10(3). Infectious disease control. Centers must establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily fluids that include blood, bodily excrement or discharge. Soiled diapers shall be stored in containers separate from other waste. Sanitation and safety procedures for the center are developed and implemented to reduce the risk of injury or harm to children and reduce the transmission of disease. 109.11(8) Environmental hazards. a. Within one year of being issued an initial or renewal license, centers operating in facilities built prior to 1978 shall conduct a visual assessment for lead hazards that exist in the form of peeling, cracking or chipping paint or painted surfaces in need of repair. If these lead hazards are found, it shall be assumed that lead-based paint is present on the surfaces, and the surfaces shall be repaired by an Iowa certified leadsafe renovator before a full license will be issued. b. Within one year of being issued an initial or renewal license, centers operating in facilities that are at ground level, use a basement area as program space, or have a basement beneath the program area shall have radon testing following the National Consensus Standards as outlined in 641￿Chapter 43. c. To reduce the risk of carbon monoxide poisoning, all centers shall, on an annual basis, have a professional inspect all fuel-burning appliances, including oil and gas furnaces, gas water heaters, gas ranges and ovens, and gas dryers, to ensure the appliances are in good working order with proper ventilation. All centers shall install one carbon monoxide detector on each floor of the center that is listed with Underwriters Laboratory (UL) as conforming to UL Standard 2034 (August 7, 2024). [ARC 9021C, IAB 3/19/25, effective 7/1/25] ii. All CCDF-eligible licensed family child care homes. Provide the standard: Regulations for Child Development Homes are found in 441 IAC 110. 110.8(1)(c) Combustible materials shall be kept a minimum of three feet away from furnaces, stoves, water heaters, and gas dryers. 110.8(1)(e) Annual laboratory analysis of a private water supply shall be conducted to show satisfactory bacteriological quality. When children under the age of two are to be cared for, the analysis shall include a nitrate analysis. When private water supplies are determined unsuitable for drinking, commercially bottled water or water treated through a process approved by the health department or designee shall be provided. 110.8(1)(i) Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. ￿No smoking￿ signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: (1) The telephone number for reporting complaints, and (2) The Internet address of the department of public health (smokefreeair.iowa.gov). 110.8(1)(k) A provider operating in a facility built before 1978 shall assess and control lead hazards before being issued an initial child development home registration or a renewal of the registration. To comply with this requirement, the provider shall: (1) Determine if painted surfaces on the interior or exterior of the facility are chipping, peeling, or cracking or in need of repair. Painted surfaces include walls, ceilings, windows, doors, stairs, and woodwork; and (2) If painted surfaces are in need of repair, hire an Iowa certified lead-safe renovator to make repairs or take training to become an Iowa certified lead-safe renovator. Iowa lead-safe renovators shall apply interim controls on any chipping, peeling, or cracking paint found, using lead-safe work methods in accordance with and as defined by department of public health rules at 641￿Chapters 69 and 70. 110.8(1)(n) Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). (2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 110.8(3) Medication and hazardous materials. a. All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a child. b. A first-aid kit shall be available and easily accessible whenever children are in the child development home, in the outdoor play area, in vehicles used to transport children, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children. The kit shall, at a minimum, include adhesive bandages, bottled water, disposable tweezers, and disposable plastic gloves. c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Regulations for Child Care Homes with a CCA Provider Agreement are found in 441 IAC 120. 120.8(1)(c) Combustible materials shall be kept a minimum of three feet away from furnaces, stoves, water heaters, and gas dryers. 120.8(1)(e) Annual laboratory analysis of a private water supply shall be conducted to show satisfactory bacteriological quality. When children under the age of two are to be cared for, the analysis shall include a nitrate analysis. When private water supplies are determined unsuitable for drinking, commercially bottled water or water treated through a process approved by the health department or designee shall be provided. 120.8(1)(i) Smoking and the use of tobacco products shall be prohibited at all times in the home and in every vehicle in which children receiving care in the home are transported. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during the home’s hours of operation. ￿No smoking￿ signs shall be posted at every entrance of the child care home and in every vehicle used to transport children. All signs shall include: (1) The telephone number for reporting of complaints, and (2) The Internet address of the department of public health (smokefreeair.iowa.gov). 120.8(1)(k) k. A provider operating in a facility built before 1978 shall assess and control lead hazards before being issued an initial child care assistance provider agreement or a renewal of the provider agreement. To comply with this requirement, the provider shall: (1) Determine if painted surfaces on the interior or exterior of the facility are chipping, peeling, or cracking or in need of repair. Painted surfaces include walls, ceilings, windows, doors, stairs, and woodwork; and (2) If painted surfaces are in need of repair, hire an Iowa certified lead-safe renovator to make repairs or take training to become an Iowa certified lead-safe renovator. Iowa lead-safe renovators shall apply interim controls on any chipping, peeling, or cracking paint found, using lead-safe work methods in accordance with and as defined by department of public health rules at 641￿Chapters 69 and 70. 120.8(1)(n) Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice). (2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 120.8(3) Medication and hazardous materials. a. All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a child. b. A first-aid kit shall be available and easily accessible whenever children are in the child care home, in the outdoor play area, in vehicles used to transport children, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children. The kit shall, at a minimum, include adhesive bandages, bottled water, disposable tweezers, and disposable plastic gloves. c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. Medications shall not be provided to a child if the provider has not completed preservice/orientation training that includes medication administration. e. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Regulations for Licensed centers are found in 441 IAC 109. 109.10(4) Daily contact. Each child shall have direct contact with a staff person upon arrival for early detection of apparent illness, communicable disease, or unusual condition or behavior which may adversely affect the child or the group. The center shall post notice at the main entrance to the center where it is visible to parents and the public of exposure of a child receiving care by the center to a communicable disease, the symptoms, and the period of communicability. If the center is located in a building used for other purposes and shares the main entrance to the building, the notice shall be conspicuously posted in the center in an area that is frequented daily by parents or the public. 109.10(5) Infectious disease control. Centers shall establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. 109.10(6) Quiet area for ill or injured. The center shall provide a quiet area under supervision for a child who appears to be ill or injured. The parents or a designated person shall be notified of the child’s status in the event of a serious illness or emergency 109.10(7) Staff hand washing. The center shall ensure that staff demonstrate clean personal hygiene sufficient to prevent or minimize the transmission of illness or disease. All staff shall wash their hands at the following times: a. Upon arrival at the center. b. Immediately before eating or participating in any food service activity. c. After diapering a child. d. Before leaving the rest room either with a child or by themselves. e. Before and after administering nonemergency first aid to a child if gloves are not worn. f. After handling animals and cleaning cages. 109.10(8) Children’s hand washing. The center shall ensure that staff assist children in personal hygiene sufficient to prevent or minimize the transmission of illness or disease. For each infant or child with a disability, a separate cloth for washing and one for rinsing may be used in place of running water. Children’s hands shall be washed at the following times: a. Immediately before eating or participating in any food service activity. b. After using the rest room or being diapered. c. After handling animals 109.10(14) Pets. Animals kept on site shall be in good health with no evidence of disease, be of such disposition as to not pose a safety threat to children, and be maintained in a clean and sanitary manner. Documentation of current vaccinations shall be available for all cats and dogs. No ferrets, reptiles, including turtles, or birds of the parrot family shall be kept on site. Pets shall not be allowed in kitchen or food preparation areas. 109.11(4) Bathroom facilities. At least one functioning toilet and one sink for each 15 children ages two years and older shall be provided in a room with natural or artificial ventilation. Training seats or chairs may be used for children under two years of age. New construction after November 1, 1995, shall provide for at least one sink in the same area as the toilet and, for centers serving children two weeks to two years of age, shall provide for at least one sink in the central diapering area. At least one sink shall be provided in program rooms for infants and toddlers or in an adjacent area other than the kitchen. New construction after April 1, 1998, shall have at least one sink provided in the program rooms for infants and toddlers. 109.12(4) Play equipment, materials and furniture. The center shall provide sufficient and safe indoor play equipment, materials, and furniture that conform with the standards or recommendations of the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products. Play equipment, materials, and furniture shall meet the developmental, activity, and special needs of the children. Rooms shall be arranged so as not to obstruct the direct observation of children by staff. Individual covered mats, beds, or cots and appropriate bedding shall be provided for all children who nap. The center shall develop procedures to ensure that all equipment and materials are maintained in a sanitary manner. Sufficient spacing shall be maintained between equipment to reduce the transmission of disease, to allow ease of movement and participation by children and to allow staff sufficient space to attend to the needs of the children during routine care and emergency procedures. The center shall provide sufficient toilet articles for each child for hand washing. Parents may provide items for oral hygiene (if appropriate to the developmental age and needs of the child). The center shall ensure that sanitary procedures are followed for use and storage of the articles. 109.12(5)(b) Each infant and toddler shall be diapered in a sanitary manner as frequently as needed at a central diapering area. Diapering, sanitation, and hand-washing procedures shall be posted and implemented in every diapering area. There shall be at least one changing table for every 15 infants. 109.12(5)(d) Safe, washable toys, large enough so they cannot be swallowed and with no removable parts, shall be provided. All hard-surface toys used by children shall be sanitized daily. Licensed Centers must follow handling and storage of hazardous materials and disposal of bio-contaminates. Medications must be stored in a way inaccessible to children, hazardous materials must be inaccessible. Child Care Centers are required to establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge including blood. Centers must have emergency plan for chemical spills. Infectious Disease Control is outlined in Iowa Administrative Rules 441.109.10(5) and Comm 204 starting at Page 75 states that centers shall establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge, including blood. Soiled diapers shall be stored in containers separate from other waste. In the Comm 204, first is the rule, verbatim. Second is what is called the Recommendation and Rationale for Implementation. The rule states that they shall follow universal precautions however separate rule citations also requires that all staff take Universal Precautions training within the first 3 months of employment, to ensure they know what universal precautions are. Additionally, OSHA requirements are outlined regarding biohazard material. Physical Facility Administrative Rule Requirements (441 IAC 109.11(7) also address requirements regarding environmental hazards such as lead based paint, radon, and carbon monoxide poisoning. Specifics can be found in Comm 204 starting on Page 98. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Regulations for Child Development Homes are found in 441 IAC 110. 110.8(1)(n) Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice).(2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 110.8(1)(p) The provider shall have written policies regarding the care of mildly ill children and the exclusion of children due to illness and shall inform parents of these policies. 110.8(3) Medications and hazardous materials. a. All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a child. b. A first-aid kit shall be available and easily accessible whenever children are in the child development home, in the outdoor play area, in vehicles used to transport children, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children. The kit shall, at a minimum, include adhesive bandages, bottled water, disposable tweezers, and disposable plastic gloves. c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Regulations for Child Development Homes are found in 441 IAC 120. 120.8(1)(n) Providers shall inform parents of the presence of any pet in the home. (1) Each dog or cat in the household shall undergo an annual health examination by a licensed veterinarian. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. This examination shall verify that the animal’s routine immunizations, particularly rabies, are current and that the animal shows no evidence of endoparasites (roundworms, hookworms, whipworms) and ectoparasites (fleas, mites, ticks, lice).(2) Each pet bird in the household shall be purchased from a dealer licensed by the Iowa department of agriculture and land stewardship and shall be examined by a veterinarian to verify that the bird is free of infectious diseases. Acceptable veterinary examinations shall be documented on Form 470-5153, Veterinary Health Certificate. Children shall not handle pet birds. (3) Aquariums shall be well maintained and installed in a manner that prevents children from accessing the water or pulling over a tank. (4) All animal waste shall be immediately removed from the children’s areas and properly disposed of. Children shall not perform any feeding or care of pets or cleanup of pet waste. (5) No animals shall be allowed in the food preparation, food storage, or serving areas during food preparation and serving times. 120.8(3) Medications and hazardous materials. a. All medicines and poisonous, toxic, or otherwise unsafe materials shall be secured from access by a child. b. A first-aid kit shall be available and easily accessible whenever children are in the child development home, in the outdoor play area, in vehicles used to transport children, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children. The kit shall, at a minimum, include adhesive bandages, bottled water, disposable tweezers, and disposable plastic gloves. c. Medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered. d. Medications shall not be provided to a child if the provider has not completed preservice/orientation training that includes medication administration. e. The provider shall establish procedures related to infectious disease control and handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Licensed Centers, must follow these requirements when transporting per Iowa Administrative Rules 441.109.10(12). Drivers transporting must have a valid driver's license and insurance authorizing the vehicle driver to operate the type of car being driven. Child restraint devices must be compliant with Iowa Code 321.446. Drivers shall not operate a vehicle while under the influence of alcohol, illegal drugs, prescription or nonprescription drugs that could impair the drivers’ ability to operate a motor vehicle. Vehicles that are owned or leased by the center shall receive regular maintenance and inspection according to manufacturer recommended guidelines for vehicle and tire maintenance and inspection. Child care centers are required to have a photocopy of valid drivers license for staff involved in transportation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All Child Development Homes must follow these requirements when transporting per Iowa Administrative Rules 441.110.8(1). Drivers transporting must have a valid driver's license and insurance authorizing the vehicle driver to operate the type of car being driven. Child restraint devices must be compliant with Iowa Code 321.446. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A, all in-home care is paid with state funds and not CCDF-eligible. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per Iowa Administrative Rules 441.120.8 (1) CCDF-eligible license exempt home must follow these requirements when transporting. Drivers transporting must have a valid driver's license and insurance authorizing the vehicle driver to operate the type of car being driven. Child restraint devices must be compliant with Iowa Code 321.446. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: 441.109.7(1) outlines the training requirements within the first three months of employment in licensed centers, including Certification in infant, child, and adult first aid that uses nationally recognized curriculum or is received from a nationally recognized training organization. Valid certificate indicating date of training and expiration date shall be maintained. ii. All CCDF-eligible licensed family child care homes. Provide the standard: This requirement was identified as a possible non-compliance in Iowa's monitoring visit results dated 1/17/24. The Lead Agency needs additional time to change administrative rules as we are currently under a rules moratorium. Current policy does not specify pediatric in regards to first aid. 441.110.10(1)c states that Child Development Homes must obtain: Certification in American red Cross, American Heart Association, American Safety and Health Institute, or MEDIC First Aid or equivalent approved by the department. Valid certificate indicating the date of training and expiration date shall be maintained. Certification in first aid that uses nationally recognized curriculum or is received from a nationally recognized training organization. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: This requirement was identified as a possible non-compliance in Iowa's monitoring visit results dated 1/17/24. The Lead Agency needs additional time to change administrative rules as we are currently under a rules moratorium. Current policy does not specify pediatric in regards to first aid. 441.120.10(3) requires Non-Registered Child Care Homes that receive CCDF funds to obtain: Certification in American red Cross, American Heart Association, American Safety and Health Institute, or MEDIC First Aid or equivalent approved by the department. Valid certificate indicating the date of training and expiration date shall be maintained. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: 441.109.7(1) Licensed Centers must have infant, child, and adult cardiopulmonary resuscitation or equivalent approved by the department. Valid certificate indicating the date of training and expiration date shall be maintained. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 441.110.10(1) Child Development Homes must have infant, child, and adult cardiopulmonary resuscitation or equivalent approved by the department. Valid certificate indicating the date of training and expiration date shall be maintained. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 441.120.10(3) Non-Registered Child Care Homes that receive CCDF funds must have infant, child, and adult cardiopulmonary resuscitation or equivalent approved by the department. Valid certificate indicating the date of training and expiration date shall be maintained. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Standards are found in Iowa Administrative Code 441.109 109.4(3) Required postings￿(b.) Postings are required for mandatory reporter requirements, the notice of availability of the handbook required in subrule 109.4(5), and the program activities and shall be placed in an area that is frequented daily by parents or the public. 109.4(4) Mandatory reporters. Requirements and procedures for mandatory reporting of suspected child abuse as defined in Iowa Code section 232.69 shall be posted where they can be read by staff and parents. Methods of identifying and reporting suspected child abuse and neglect shall be discussed with all staff within 30 days of employment. 441￿109.7 Professional growth and development. The center director, on-site supervisor, and staff counted as part of the staff ratio shall meet the following minimum staff training requirements: (1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: a. Two hours of Iowa’s training for mandatory reporting of child abuse. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must complete two hours of Iowa's training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. These requirements ensure that Iowa child care providers comply with child abuse reporting requirements in the Child Abuse Prevention and Treatment Act 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Non-Registered Child Care Homes that receive CCDF funds must complete two hours of Iowa's training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. These requirements ensure that Iowa child care providers comply with child abuse reporting requirements in the Child Abuse Prevention and Treatment Act. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Standards are found in Iowa Administrative Code 441.109 109.4(3) Required postings￿(b.) Postings are required for mandatory reporter requirements, the notice of availability of the handbook required in subrule 109.4(5), and the program activities and shall be placed in an area that is frequented daily by parents or the public. 109.4(4) Mandatory reporters. Requirements and procedures for mandatory reporting of suspected child abuse as defined in Iowa Code section 232.69 shall be posted where they can be read by staff and parents. Methods of identifying and reporting suspected child abuse and neglect shall be discussed with all staff within 30 days of employment. 441￿109.7 Professional growth and development. The center director, on-site supervisor, and staff counted as part of the staff ratio shall meet the following minimum staff training requirements: (1) Required training within the first three months of employment. During their first three months of employment, all staff shall receive the following training: a. Two hours of Iowa’s training for mandatory reporting of child abuse. Iowa Code Section 232.69, a report shall be made within twenty-four hours. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Child Development Homes must complete two hours of Iowa's training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. These requirements ensure that Iowa child care providers comply with child abuse reporting requirements in the Child Abuse Prevention and Treatment Act. In accordance to Iowa Code Section 232.69, a report shall be made within twenty- four hours. 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: N/A, Iowa does not have CCDF-eligible licensed-exempt centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Non-Registered Child Care Homes that receive CCDF funds must complete two hours of Iowa's training for mandatory reporting of child abuse as required by Iowa Code section 232.69. The provider shall maintain a valid certificate indicating expiration date. These requirements ensure that Iowa child care providers comply with child abuse reporting requirements in the Child Abuse Prevention and Treatment Act. In accordance to Iowa Code Section 232.69, a report shall be made within twenty-four hours vi. All CCDF-eligible license-exempt in-home care. Provide the standard: N/A, all in- home care is paid with state funds and not CCDF-eligible. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A, Iowa does not have separate standards for out-of-school programs, they are licensed centers. 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: Child Care Centers: 109.15(1) Nutritionally balanced meals or snacks. The center shall serve each child a full, nutritionally balanced meal or snack as defined by the USDA Child and Adult Care Food Program (CACFP) guidelines and shall ensure that staff provide supervision at the table during snacks and meals. Children remaining at the center two hours or longer shall be offered food at intervals of not less than two hours or more than three hours apart unless the child is asleep. 109.15(2) Menu planning. The center shall follow the minimum CACFP menu patterns for meals and snacks and serving sizes for children aged infant to 13 years. Menus shall be planned at least one week in advance, made available to parents, and kept on file at the center. Substitutions in the menu, including substitutions made for infants, shall be noted and kept on file. Foods with a high incident rate of causing choking in young children shall be avoided or modified. Provisions of this subrule notwithstanding, exceptions shall be allowed for special diets because of medical reasons in accordance with the child’s needs and written instructions of a licensed physician or health care provider. 109.15(3) Feeding of children under two years of age. a. All children under 12 months of age shall be fed on demand, unless the parent provides other written instructions. Meals and snacks provided by the center shall follow the CACFP infant menu patterns. Foods shall be appropriate for the infant’s nutritional requirements and eating abilities. Menu patterns may be modified according to written instructions from the parent, physician or health care provider. Special formulas prescribed by a physician or health care provider shall be given to a child who has a feeding problem. b. All children under six months of age shall be held or placed in a sitting-up position sufficient to prevent aspiration during feeding. No bottles shall be propped for children of any age. A child shall not be placed in a crib with a bottle or left sleeping with a bottle. Spoon feeding shall be adapted to the developmental capabilities of the child. c. Single-service, ready-to-feed formulas, concentrated or powdered formula following the manufacturer’s instructions or breast milk shall be used for children 12 months of age and younger unless otherwise ordered by a parent or physician. d. Whole milk for children under age two who are not on formula or breast milk unless otherwise directed by a physician. e. Cleaned and sanitized bottles and nipples shall be used for bottles prepared on site. Prepared bottles shall be kept under refrigeration when not in use. 109.15(4) Food brought from home. a. The center shall establish policies regarding food brought from home for children under five years of age who are not enrolled in school. A copy of the written policy shall be given to the parent at admission. Food brought from home for children under five years of age who are not enrolled in school shall be monitored and supplemented if necessary to ensure CACFP guidelines are maintained. b. The center may not restrict a parent from providing meals brought from home for school-age children or apply nutritional standards to the meals. c. Perishable foods brought from home shall be maintained to avoid contamination or spoilage. d. Snacks that may not meet CACFP nutrition guidelines may be provided by parents for special occasions such as birthdays or holidays. 109.15(5) Food preparation, storage, and sanitation. Centers shall ensure that food preparation and storage procedures are consistent with the recommendations of the National Health and Safety Performance Standards and provide: a. Sufficient refrigeration appropriate to the perishable food to prevent spoilage or the growth of bacteria. b. Sanitary and safe methods in food preparation, serving, and storage sufficient to prevent the transmission of disease, infestation of insects and rodents, and the spoilage of food. Staff preparing food who have injuries on their hands shall wear protective gloves. Staff serving food shall have clean hands or wear protective gloves and use clean serving utensils. c. Sanitary methods for dish-washing techniques sufficient to prevent the transmission of disease. d. Sanitary methods for garbage disposal sufficient to prevent the transmission of disease and infestation of insects and rodents. 109.15(6) Water supply. The center shall ensure that suitable water and sanitary drinking facilities are available and accessible to children. Centers that serve infants and toddlers shall provide individual cups for drinking in addition to drinking fountains that may be available in the center. a. Private water supplies shall be of satisfactory bacteriological quality as shown by an annual laboratory analysis. Water for the analysisshall be drawn between May 1 and June 30 of each year. When the center provides care for children under two years of age, a nitrate analysis shall also be obtained. b. When public or private water supplies are determined unsuitable for drinking, commercially bottled water certified as chemically and bacteriologically potable or water treated through a process approved by the health department or designee shall be provided. Child Development Homes 110.8(7) Meals and snacks. a. Regular meals and midmorning or midafternoon snacks shall be provided. The meals and snacks shall be well-balanced, nourishing, and in appropriate amounts as defined by the USDA Child and Adult Care Food Program. b. Children may bring food to the child development home for their own consumption but shall not be required to provide their own food. c. Clean, sanitary drinking water shall be readily available to children in indoor and outdoor areas, throughout the day Child Care Homes with a CCA Agreement (licensed-exempt): 120.8(7) Meals and snacks. a. Regular meals and snacks that are well-balanced and nourishing shall be provided. b. Children may bring food to the child care home for their own consumption but shall not be required to provide their own food. c. Clean, sanitary drinking water shall be readily available to children in indoor and outdoor areas, throughout the day. ii. Access to physical activity. Describe: Child Care Centers 109.4(2) c. Develop a curriculum or program structure that uses developmentally appropriate practices and an activity program appropriate to the developmental level and needs of the children. 109.12(1) Activities. The center shall have a written curriculum or program structure that uses developmentally appropriate practices and a written program of activities planned according to the developmental level of the children. The center shall post a schedule of the program in a visible place. The child care program shall complement but not duplicate the school curriculum. The program shall be designed to provide children with: b. A balance of active and quiet activities; individual and group activities; indoor and outdoor activities; and staff-initiated and child-initiated activities. c. Activities which promote both gross and fine motor development. Child Development Homes 110.8(8) There shall be an activity program which promotes self-esteem and exploration and includes: a. Active play. b. Quiet play. c. Activities for large muscle development. d. Activities for small muscle development. e. Play equipment and materials in a safe condition, for both indoor and outdoor activities which are developmentally appropriate for the ages and number of children present. iii. Caring for children with special needs. Describe: Child Care Centers 109.12(3) Policies for children requiring special accommodations. Reasonable accommodations, based on the special needs of the child, shall be made in providing care to a child with a disability. Accommodation can be a specific treatment prescribed by a professional or a parent, or a modification of equipment, or removal of physical barriers. The accommodation shall be recorded in the child’s file. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A