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Title 28, Part CLXV Louisiana Administrative Code April 2025 6 care, according to the schedule approved by the Office of Public Health, Department of Health and Hospitals: a. if vaccination is contraindicated for medical reasons, the parent shall provide a written statement from a physician indicating said medical reasons; or b. if the parent objects to the immunizations for any other reason, the parent shall provide a written statement of dissent. 11. Emergency Preparedness Disaster Plan. Develop, practice and train on, and follow, a written emergency preparedness disaster plan that includes at a minimum: a. procedures for evacuation, relocation, shelter-in- place, lock-down, communication and reunification with families, continuity of operations, accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions; b. procedures for all adults living in, or working in the residence where care is provided, or working on the property where care is provided; c. posting in a visibly accessible area all appropriate emergency phone numbers, such as fire and police, hospitals and Louisiana Poison Control, and the physical address and phone number for the residence in which care is provided; and d. be reviewed annually for accuracy and updated as changes occur. 12. First Aid Supplies. Maintain first aid supplies in the residence. 13. Inspections. Allow inspection of the residence where care is provided by department staff and other authorized inspection personnel and parents of children in care, during normal working hours or when children are in care. 14. Supervision. Children shall be supervised at all times in the home, on the property, on field trips, on non- vehicular excursions, and during all water activities and water play activities. 15. Group Size. A provider may care for a maximum of six children. 16. Child-to-Staff Ratios. The maximum child-to-staff ratio shall be 6:1. 17. Safe Sleep Practices a. Only one infant shall be placed in a crib. b. All infants shall be placed on their backs for sleeping.

i. Written authorization from a physician is required for any other sleeping position.

ii. Written notice of the specifically authorized sleeping position shall be posted on or near the crib. c. Infants shall not be placed in positioning devices, unless the provider has written authorization from a physician to use a positioning device. d. Written authorization from a physician is required for a child to sleep in a car seat or other similar device and shall include the amount of time that the child is allowed to remain in said device. e. “Back to Sleep” signs shall be posted in the room where infants sleep. f. Infants who use pacifiers shall be offered their pacifier when they are placed to sleep, but it shall not be placed back in the mouth once the child is asleep. g. Bibs shall not be worn by any child while asleep. h. Nothing shall be placed over the head or face of an infant. i. A safety approved crib shall be assigned to and available for each infant in care. j. Children are prohibited from sleeping in playpens or cribs with mesh sides. k. Cribs shall be free of toys, including stuffed animals, and other soft or loose bedding, including comforters, blankets, sheets, bumper pads, pillows, and wedges when the infant is in the crib. Mattresses for cribs must have a properly fitted, clean sheet. 18. Health Related Policies. The provider shall have a written copy of all health-related policies including policies regarding accidents, allergic reactions, fever, illness, immunizations, and infection and injuries, and shall provide a copy to the parent or guardian of each child in care. 19. Immediate Parental Notification. The parent shall be immediately notified in the following circumstances: a. blood not contained in an adhesive strip; b. head or neck or eye injury; c. human bite that breaks the skin; d. animal bite; e. impaled object; f. broken or dislodged teeth; g. allergic reaction skin changes (e.g. rash, spots, swelling, etc.); h. unusual breathing; i. symptoms of dehydration; j. temperature reading over 101 degrees oral, 102 degrees rectal, or 100 degrees axillary; or k. injury or illness requiring professional medical attention. 20. Biocontaminants. Staff shall properly dispose of all biocontaminants to safeguard against the spread of infectious disease.