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: Child Care Center and Letter of Compliance standards: Child Care Center 13A.16.11.01 and Letter of Compliance 13A.17.11.01 Exclusion for Acute Illness: A. Child care staff shall: (1) Monitor a child for signs and symptoms of acute illness; (2) Notify a child's parent or other designated person upon observing a sign or symptom of acute illness; and (3) Provide temporary isolation for the affected child in a suitably equipped separate area within sight and hearing of an adult. B. Except in centers for children with acute illness, an operator may not admit a child to care or allow a child to remain in care when the child is exhibiting symptoms of acute illness. C. A child may not be readmitted to care after an absence of 3 days or more due to illness without a written statement from the parent or physician that the child may return to a regular schedule. Child Care Center 13A.16.11.02 and Letter of Compliance 13A.17.11.02 Infectious and Communicable Disease: A. An operator shall immediately transmit to the health officer a report of the name and address of a child or a staff member who appears to be infected with a reportable communicable disease or who has been exposed to a reportable communicable disease as indicated in COMAR 10.06.01.03. B. Except in centers for children with acute illness, an operator may not knowingly admit to care or retain in care a child with a transmissible infection or a communicable disease during the period of exclusion recommended for that infection or disease as shown in the Communicable Disease Summary, as published by the Maryland Department of Health, unless the health officer grants approval for the child to attend child care during that period. Child Care Center 13A.16.11.03 and Letter of Compliance 13A.17.11.03 Preventing the Spread of Disease: A. A written handwashing procedure approved by the office shall be posted at each sink used for washing hands. B. Hands shall be washed according to the posted approved procedure by a center employee, substitute, volunteer, or child in care at least: (1) After toileting or diapering; (2) Before food preparation or eating; and (3) After an outdoor activity or handling an animal. C. Diapering shall be performed in accordance with a written diapering procedure approved by the office. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.05.03 Cleanliness and Sanitation: A. All areas of the home, including food preparation, service, and storage areas shall be maintained in a state of cleanliness so as not to endanger the children's health. B. Paper towels, a trash receptacle, soap, and toilet paper shall be placed within reach of a child capable of using the toilet without assistance. C. Trash, garbage, and wet or soiled diapers shall be disposed of in a clean and sanitary manner. D. After toileting and diapering, before food preparation and eating, after playing outdoors, after handling animals, and at other times when necessary to prevent the spread of disease, the provider or substitute shall: (1) Wash the provider's or substitute's hands thoroughly with soap and warm running water; and (2) Ensure that a child's hands are washed thoroughly, by the provider or by the child, with soap and warm running water. E. To assist in preventing the spread of disease, the provider or substitute shall: (1) Promptly change a child's diaper, clothing, and bedding when soiled or wet; (2) Follow diapering procedures designed to prevent the transmission of disease, which are established and supplied by the office; and (3) Maintain the surface used for diapering in a clean and sanitary manner. F. If used, portable toilets, also known as potty-chairs, shall be: (1) Placed on a nonabsorbent surface or mat; (2) Located away from food preparation, food service, and eating areas; and (3) Cleaned and sanitized after each use in accordance with procedures established by the office. 13A.15.11.02 Exclusion for Acute Illness: A. The provider or substitute shall: (1) Monitor children for signs and symptoms of acute illness; and (2) Notify immediately a child's parent or other person designated on the child's emergency card upon observing a sign or symptom of acute illness. B. The provider or substitute may not allow a child to enter or remain in care if the child is exhibiting symptoms of acute illness such as, but not limited to: (1) Vomiting; (2) Fever; (3) Seizures; (4) Severe pain; or (5) Diarrhea. 13A.15.11.03 Infectious and Communicable Disease: A provider or substitute may not knowingly care for a child who has a serious transmissible infection or communicable disease during the period of exclusion for that infection or disease shown in the Communicable Disease Summary, as published by the Maryland Department of Health. Large Family Child Care: 13A.18.11.01 Exclusion for Acute Illness: B. Child care staff shall: (1) Monitor a child for signs and symptoms of acute illness; (2) Notify a child's parent or other designated person upon observing a sign or symptom of acute illness; and (3) Provide temporary isolation for the affected child in a suitably equipped separate area within sight and hearing of an adult. B. Except in centers for children with acute illness, an operator may not admit a child to care or allow a child to remain in care when the child is exhibiting symptoms of acute illness. C. A child may not be readmitted to care after an absence of 3 days or more due to illness without a written statement from the parent or physician that the child may return to a regular schedule. 13A.18.11.02 Infectious and Communicable Disease: A. An operator shall immediately transmit to the health officer a report of the name and address of a child or a staff member who appears to be infected with a reportable communicable disease or who has been exposed to a reportable communicable disease as indicated in COMAR 10.06.01.03. B. Except in centers for children with acute illness, an operator may not knowingly admit to care or retain in care a child with a transmissible infection or a communicable disease during the period of exclusion recommended for that infection or disease as shown in the Communicable Disease Summary, as published by the Maryland Department of Health, unless the health officer grants approval for the child to attend child care during that period. 13A.18.11.03 Preventing the Spread of Disease: A. A written handwashing procedure approved by the office shall be posted at each sink used for washing hands. B. Hands shall be washed according to the posted approved procedure by a center employee, substitute, volunteer, or child in care at least: (1) After toileting or diapering; (2) Before food preparation or eating; and (3) After an outdoor activity or handling an animal. C. Diapering shall be performed in accordance with a written diapering procedure approved by the office. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The license- exempt provider will promptly change a child's diaper, clothing, and bedding when soiled or wet; Follow diapering procedures designed to prevent the transmission of disease; Maintain the surface used for diapering in a clean and sanitary manner located away from food preparation, food service, and eating areas; Wash hands thoroughly with soap and warm running water; Trash/garbage and wet or soiled diapers shall be disposed of in a clean and sanitary manner; Clean and sanitize after each use in accordance with procedures established by the office; and, Bio contaminants and biohazards shall be disposed of in a clean and sanitary manner. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The license- exempt provider will promptly change a child's diaper, clothing, and bedding when soiled or wet; Follow diapering procedures designed to prevent the transmission of disease; Maintain the surface used for diapering in a clean and sanitary manner located away from food preparation, food service, and eating areas; Wash hands thoroughly with soap and warm running water; Trash/garbage and wet or soiled diapers shall be disposed of in a clean and sanitary manner; Clean and sanitize after each use in accordance with procedures established by the office; and, Bio contaminants and biohazards shall be disposed of in a clean and sanitary manner. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center and Letter of Compliance standards: Child Care Center 13A.16.11.01 and Letter of Compliance 13A.17.11.01 Exclusion for Acute Illness: A. Child care staff shall: (1) Monitor a child for signs and symptoms of acute illness; (2) Notify a child's parent or other designated person upon observing a sign or symptom of acute illness; and (3) Provide temporary isolation for the affected child in a suitably equipped separate area within sight and hearing of an adult. B. Except in centers for children with acute illness, an operator may not admit a child to care or allow a child to remain in care when the child is exhibiting symptoms of acute illness. C. A child may not be readmitted to care after an absence of 3 days or more due to illness without a written statement from the parent or physician that the child may return to a regular schedule. Child Care Center 13A.16.11.02 and Letter of Compliance 13A.17.11.02 Infectious and Communicable Disease: A. An operator shall immediately transmit to the health officer a report of the name and address of a child or a staff member who appears to be infected with a reportable communicable disease or who has been exposed to a reportable communicable disease as indicated in COMAR 10.06.01.03. B. Except in centers for children with acute illness, an operator may not knowingly admit to care or retain in care a child with a transmissible infection or a communicable disease during the period of exclusion recommended for that infection or disease as shown in the Communicable Disease Summary, as published by the Maryland Department of Health, unless the health officer grants approval for the child to attend child care during that period. Child Care Center 13A.16.11.03 and Letter of Compliance 13A.17.11.03 Preventing the Spread of Disease: A. A written handwashing procedure approved by the office shall be posted at each sink used for washing hands. B. Hands shall be washed according to the posted approved procedure by a center employee, substitute, volunteer, or child in care at least: (1) After toileting or diapering; (2) Before food preparation or eating; and (3) After an outdoor activity or handling an animal. C. Diapering shall be performed in accordance with a written diapering procedure approved by the office. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center 13A.16.03.02 and Letter of Compliance 13A.17.03.04: Child Records: G. Unless a school-age child attends a school-age program located in the child’s school, the operator shall obtain, and maintain at the center, an immunization record showing that: (1) The child has had immunizations appropriate for the child's age which meet the immunization guidelines set by the Maryland Department of Health; (2) The child has had at least one dose of each vaccine appropriate for the child's age before entry and is scheduled to complete the required immunizations; (3) A licensed physician or a health officer has determined that immunization is medically contraindicated according to accepted medical standards; or (4) The parent objects to the child's immunization because it conflicts with the parent's bona fide religious beliefs and practices. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.03.02A(2)(b) Admission to Care: The provider may not admit a child to the home for child care or allow a child to remain in care unless the provider has received: (2)Unless the child is temporarily admitted or retained pursuant to §D of this regulation: (b) Evidence, on a form supplied or approved by the office, that the child has had immunizations appropriate for the child's age that meet the immunization guidelines set by the Maryland Department of Health. 13A.15.03.04C(2) Child Records: During the period of a child's enrollment and for 2 years after the child's disenrollment, a provider shall maintain a file for each child that includes records of: (2) The child’s health assessment, immunizations, and allergies, if any, to include: (a) As required by COMAR 10.11.04. Large Family Home 13A.18.03.04: Child Records G. Unless a school-age child attends a school-age program located in the child’s school, the operator shall obtain, and maintain at the center, an immunization record showing that: (1) The child has had immunizations appropriate for the child's age which meet the immunization guidelines set by the Maryland Department of Health; (2) The child has had at least one dose of each vaccine appropriate for the child's age before entry and is scheduled to complete the required immunizations; (3) A licensed physician or a health officer has determined that immunization is medically contraindicated according to accepted medical standards; or (4) The parent objects to the child's immunization because it conflicts with the parent's bona fide religious beliefs and practices. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt/informal care only monitors the immunization requirements for non- school-aged children. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13A.16.03.02 and Letter of Compliance 13A.17.03.04: Child Records: G. Unless a school-age child attends a school-age program located in the child’s school, the operator shall obtain, and maintain at the center, an immunization record showing that: (1) The child has had immunizations appropriate for the child's age which meet the immunization guidelines set by the Maryland Department of Health; (2) The child has had at least one dose of each vaccine appropriate for the child's age before entry and is scheduled to complete the required immunizations; (3) A licensed physician or a health officer has determined that immunization is medically contraindicated according to accepted medical standards; or (4) The parent objects to the child's immunization because it conflicts with the parent's bona fide religious beliefs and practices. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center 13A.16.06.06 Directors of Preschool Centers-Specific Requirements: In a preschool center with infants or toddlers in care, a director, in addition to meeting the requirements of §§B￿F of this regulation, as applicable, shall have: (1) 3 semester hours of approved training, or the equivalent, related to the care of infants and toddlers. 13A.16.08.08 Rest Time Supervision: During a rest period for a group of children who are younger than 2 years old: (1) The required staff/child ratio applicable to that group shall be maintained; and (2) Each staff member assigned to the group shall remain with the children. 13A.16.09.04 Rest Furnishings: A.(4) A crib with a snugly fitting mattress, moisture-proof mattress covering, and tight fitting sheet for each child in the center who is: (a) Younger than 12 months old; F. Soft bedding items, including but not limited to pillows, quilts, comforters, and crib bumpers, may not be used as rest furnishings for a child using a crib. G. A child under 12 months who falls asleep in a furnishing other than a crib shall be moved immediately to an approved sleeping arrangement specified at §A of this regulation. Letter Of Compliance: Not applicable as they do not serve children under age 2. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.06.02E(2): Training Requirements Sudden Infant Death Syndrome (SIDS) Training. (a) The office may not approve a request by an applicant or a provider to provide care for a child younger than 24 months old unless the applicant or provider presents evidence of having successfully completed, within 5 years before the date of the request, approved SIDS training. (b) SIDS training may not be used to satisfy the continued training requirements set forth in §B of this regulation. 13A.15.08.01D Supervision of Resting Children: (1) If a resting or napping child is younger than 2 years old, the provider or substitute shall: (a) Remain within sight and sound of the child; and (b) Observe the child at least every 15 minutes to determine that the child is safe, breathing normally, and in no physical distress. (2) If a resting or napping child is 2 years old or older, the child: (a) May be on a different level of the home from the provider or substitute if: (i) That level is approved by the office for child care use; and (ii) The provider has informed the child's parent that the child is permitted to be on a different level of the home; and (b) Shall be observed by the provider or substitute to ensure the child’s safety and comfort at intervals of at least every 15 minutes. (3) If a resting or napping child is in a different room from the provider or substitute and that room can be closed off from the rest of the home by a door, screen, or similar furnishing, the provider or substitute shall ensure that the door, screen, or similar furnishing remains open so that the view into the room is unobstructed. 13A.15.10.06 Rest Time Safety Unless specified otherwise in writing by the child's physician, a child who: (1) Cannot roll over without assistance shall be placed for sleep on the child's back; or (2) Is younger than 12 months old but can roll over unassisted shall be placed for sleep on the child's back, but may be allowed to adopt whatever position the child prefers for sleep. B. Unless the need for a positioning device that restricts a child’s movement while the child is resting is specified in writing by the child’s physician, an object or device, including, but not limited to, a strap, wedge, roll, or swaddling, that restricts movement may not be used with a child in a crib, portable crib, playpen, cot, bed, mat, or other rest furnishing. Large Family Child Care: 13A.18.06.05E(5): Child Care Home Directors: Unless previously approved by the office to direct a child care program serving children younger than 2 years old, have completed 3 semester hours of approved training, or the equivalent, related to the care of children younger than 2 years old; 13A.18.06.06E(2) Family Child Care Teachers: Unless previously qualified by the office to supervise an infant or a toddler: (a) Meet the requirements of §§A and B of this regulation and have completed 3 semester hours of approved training, or the equivalent, related to the care of children younger than 2 years old; 13A.18.08.08 Rest Time Supervision: During a rest period for a group of children who are younger than 2 years old: (1) The required staff/child ratio applicable to that group shall be maintained; and (2) Each staff member assigned to the group shall remain with the children. B. During a rest period for a group of children who are 2 years old or older: (1) The required staff/child ratio applicable to that group shall be maintained until all the children are resting quietly; and (2) Once all the children in the group are resting quietly: (a) At least one family child care teacher or aide assigned to the group shall continue to remain in the room with the children; and (b) Other staff members, if any, assigned to the group may leave the room but shall remain on the premises and within hearing range. C. To determine if a resting child is safe, breathing normally, and in no physical distress: (1) Each resting child shall be observed at intervals of at least every 15 minutes; and (2) A resting child younger than 12 months old shall be observed at least every 15 minutes. 13A.18.09.04 Rest Furnishings A(4) A crib, portable crib, or playpen with a snugly fitting mattress, moisture-proof mattress covering, and tight-fitting sheet for each child in the child care home who is: (a) Younger than 12 months old; F. Soft bedding items, including but not limited to pillows, quilts, comforters, and crib bumpers, may not be used as rest furnishings for a child using a crib, portable crib, or playpen. G. A child under 12 months who falls asleep in a furnishing other than a crib shall be moved immediately to an approved sleeping arrangement specified at §A(4) of this regulation. 13A.18.10.05 Rest Time Safety A. Unless specified otherwise in writing by the child's physician, a child who: (1) Cannot roll over without assistance shall be placed for sleep on the child's back; or (2) Is younger than 12 months old but can roll over unassisted shall be placed for sleep on the child's back, but may be allowed to adopt whatever position the child prefers for sleep. B. Unless the need for a positioning device is specified in writing by a child's physician, a restricting device of any type may not be applied to a resting 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have standards for prevention of sudden infant death syndrome and use of safe sleep practices for License-Exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all the safe sleep/sudden infant death prevention regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. Additionally, providers are required to provide the approved and age-appropriate rest furnishings, provide age-appropriate supervision to resting children, and complete visible checks on sleeping. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13A.16.06.06 Directors of Preschool Centers-Specific Requirements: In a preschool center with infants or toddlers in care, a director, in addition to meeting the requirements of §§B￿F of this regulation, as applicable, shall have: (1) 3 semester hours of approved training, or the equivalent, related to the care of infants and toddlers. 13A.16.08.08 Rest Time Supervision: During a rest period for a group of children who are younger than 2 years old: (1) The required staff/child ratio applicable to that group shall be maintained; and (2) Each staff member assigned to the group shall remain with the children. 13A.16.09.04 Rest Furnishings: A.(4) A crib with a snugly fitting mattress, moisture-proof mattress covering, and tight fitting sheet for each child in the center who is: (a) Younger than 12 months old; F. Soft bedding items, including but not limited to pillows, quilts, comforters, and crib bumpers, may not be used as rest furnishings for a child using a crib. G. A child under 12 months who falls asleep in a furnishing other than a crib shall be moved immediately to an approved sleeping arrangement specified at §A of this regulation. Letter of Compliance: Not applicable as they do not serve children under age 2. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center: The medication administration training includes safe and accurate administration of medication, including measuring, proper dosage, purpose of medication and the 6 Rights of Medication Administration. Allergic reaction is also discussed along with the proper administration of Asthma medications and treatment for Anaphylaxis. Participants will practice using the new Epi-pen. Additionally, Maryland requires providers to obtain a Medication Authorization form to be completed and signed by the child’s health care professional for all children who are prescribed medication that is to be administered while in child care. Providers are required to review children's forms including a listing of any medications administered to children. Only staff that have successfully completed the training are approved to administer medications as directed by the required medication forms. As well, the approved staff ensure that medication is stored according to COMAR requirements. 13A.16.03.04(I)(3) Child Records I. The operator shall record or maintain on file: (3) Child medication records required by COMAR 13A.16.11.04A(1) 13A.16.11.04 Medication Administration and Storage Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self- Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self- administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Letter of Compliance: 13A.17.03.04 Child Records 13A.17.11.04 Medication Administration and Storage: Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. (2) Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care (FCC): The medication administration training includes safe and accurate administration of medication, including measuring, proper dosage, purpose of medication and the 6 Rights of Medication Administration. Allergic reaction is also discussed along with the proper administration of Asthma medications and treatment for Anaphylaxis. Participants will practice using the new Epi-pen. Additionally, Maryland requires providers to obtain a Medication Authorization form to be completed and signed by the child’s health care professional for all children who are prescribed medication that is to be administered while in child care. Providers are required to review children's forms including a listing of any medications administered to children. Only staff that have successfully completed the training are approved to administer medications as directed by the required medication forms. As well, the approved staff ensure that medication is stored according to COMAR requirements. Family Child Care 13A.15.03.04C(5) Child Records Child medication records as required by COMAR 13A.15.11.04; 13A.15.06.02F(1)(b) Training Requirements F. The office may not approve an application for an initial registration or a continuing registration unless the applicant has completed: (1) Approved training in (b) Medication administration 13A.15.06.03(E)(2) Provider Substitute E. Before allowing a substitute to provide or to assist in providing care, the provider shall orient the substitute to child health and safety matters, including, but not limited to: (2) Medication administration information for each child authorized to receive medication; 13A.15.11.04 Medication Administration and Storage .04 Medication Administration and Storage. A. Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; and (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to the provider, substitute, or additional adult. F. Self- Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a)A provider may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §F(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the provider shall notify the child’s parent of that revocation. (c) The provider shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. G. Effective January 1, 2016, medication may be administered to a child in care only by an individual who has completed approved medication administration training, unless: (1) The individual is a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care has been delegated to the individual by a delegating nurse in accordance with COMAR 10.27.11. H. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Large Family Child Care (LFCCC): 13A.18.03.04(I)(3) Child Records I. The provider shall record or maintain on file: (3) Child medication records required by COMAR 13A.18.11.04D; 13A.18.11.04 Medication Administration and Storage A. Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the child care home before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as ￿take with food￿; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a registered health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each staff member designated by the provider to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one child care home staff member present who has completed medication administration training approved by the office. (2) Medication may be administered to a child in care only by a staff member who has completed approved medication administration training. G. The requirements of §F of this regulation shall not apply if: (1) The child care home employs a registered nurse, registered practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a staff member by a delegating nurse in accordance with COMAR 10.27.11. H. Self- Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a) A provider may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the provider shall notify the child’s parent of that revocation. (c) The provider shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form provided by the office, that is received by the provider (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center: The medication administration training includes safe and accurate administration of medication, including measuring, proper dosage, purpose of medication and the 6 Rights of Medication Administration. Allergic reaction is also discussed along with the proper administration of Asthma medications and treatment for Anaphylaxis. Participants will practice using the new Epi-pen. Additionally, Maryland requires providers to obtain a Medication Authorization form to be completed and signed by the child’s health care professional for all children who are prescribed medication that is to be administered while in child care. Providers are required to review children's forms including a listing of any medications administered to children. Only staff that have successfully completed the training are approved to administer medications as directed by the required medication forms. As well, the approved staff ensure that medication is stored according to COMAR requirements. 13A.16.03.04(I)(3) Child Records I. The operator shall record or maintain on file: (3) Child medication records required by COMAR 13A.16.11.04A(1) 13A.16.11.04 Medication Administration and Storage Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self- Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self- administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Letter of Compliance: 13A.17.03.04 Child Records 13A.17.11.04 Medication Administration and Storage: Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. (2) Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center 13A.16.03.04(I)(3) and Letter of Compliance 13A.17.03.02(I)(3): Child Records I. The operator shall record or maintain on file: (3) Child medication records required by COMAR 13A.16.11.04A(1) and 13A.17.11.04. Child Care Center 13A.16.11.04A(1)(a) and Letter of Compliance 13A.17.11.04A(1)(a): Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered; Child Care Center 13A.16.11.04 and Letter of Compliance 13A.17.11.04 F. Self- Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. or tap here to enter text. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.03.04C(5) Child Records Child medication records as required by COMAR 13A.15.11.04. Large Family Child Care: 13A.18.03.04(I)(3) Child Records I. The provider shall record or maintain on file: (3) Child medication records required by COMAR 13A.18.11.04D. Family Child Care 13A.15.11.04A(1)(a) and Large Family Child Care 13A.18.11.04A(1)(a): Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered. Family Child Care 13A.15.11.04 and Large Family Child Care 13A.18.11.04 F. Self- Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License - Exempt/Informal Providers: The standard is addressed as the parent authorizes the Informal Provider to administer medication as noted by the healthcare provider. The parent attests that they have administered at least one dose of the medication to the child without adverse effects and certifies they have the legal authority, understand the risk, and do consent to medical treatment by the provider, including the administration of medication for the named child. The Emergency Care & Medication Authorization Form is completed, dated, and signed and is required at the initial application, each informal provider renewal, and at any medical or medication prescription change. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13A.16.03.04(I)(3) and Letter of Compliance 13A.17.03.02(I)(3): Child Records I. The operator shall record or maintain on file: (3) Child medication records required by COMAR 13A.16.11.04A(1) and 13A.17.11.04. Child Care Center 13A.16.11.04A(1)(a) and Letter of Compliance 13A.17.11.04A(1)(a): Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered; Child Care Center 13A.16.11.04 and Letter of Compliance 13A.17.11.04 F. Self- Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. or tap here to enter text. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Providers are required to maintain and review children's records for information pertaining to allergies and asthma including allergy action plans for children with allergies. The regulations also require providers to maintain and post a planned weekly menu of the food and snacks to be served to the children for up to 4 weeks in case of a possible allergic reaction. Additionally, all providers and child care staff are required to complete the Basic Health and Safety training and Emergency Preparedness training which includes information about the prevention of and response to emergencies related to food and allergic reactions. Child Care Center 13A.16.03.04D(2) and Letter of Compliance 13A.17.03.04D(2) Child Records: Unless a parent objects to a child's medical examination because of bona fide religious beliefs and practices, a health assessment of the child shall be provided by the child's parent that: (2) If applicable, includes a statement of allergies Child Care Center 13A.16.06.05 Staff Records C(1)(a) and Letter of Compliance 13A.17.06.05B(1) Staff Records: During an individual’s employment at the center and for 2 years after the date of the individual’s last employment there, maintain a record for each individual that includes: (1) The individual’s: (a) Training, including initial and yearly basic health and safety training, if required under this subtitle; Child Care Center 13A.16.10.01A and Letter of Compliance 13A.17.10.01A A. Emergency and Disaster Plan. (1) At least one center employee shall: (a) Complete emergency preparedness training that is approved by the office; and (b) As part of the approved emergency preparedness training, prepare a written emergency and disaster plan for the center. Child Care Center 13A.16.12.01E and Letter of Compliance 13A.17.12.01E Food Service: E. Menus. An operator shall: (1) Post in a conspicuous place a weekly planned menu of foods and beverages furnished by the center for meals and snacks; and (2) Keep a dated record of food actually served in the center, and to each child on a modified diet, on file for at least 4 weeks, correcting the planned menu if necessary. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Providers are required to maintain and review children's records for information pertaining to allergies and asthma including allergy action plans for children with allergies. The regulations also require providers to maintain and post a planned weekly menu of the food and snacks to be served to the children for up to 4 weeks in case of a possible allergic reaction. Additionally, all providers and child care staff are required to complete the Basic Health and Safety training and Emergency Preparedness training which includes information about the prevention of and response to emergencies related to food and allergic reactions. Family Child Care 13A.15.03.04C(2) Child Records: During the period of a child's enrollment and for 2 years after the child's disenrollment, a provider shall maintain a file for each child that includes records of: (2) The child’s health assessment, immunizations, and allergies, 13A.15.06.02A(3) & (4) Training Requirements A. Preservice Training. An individual who applies for an initial registration shall: (3) Complete approved training on emergency and disaster planning; (4) Effective January 1, 2020, complete approved basic health and safety training within 90 days of initial registration; Large Family Child Care: 13A.18.06.05E(3)(d) Child Care Home Directors: E. Except as set forth at §F of this regulation, to qualify as a director in a large family child care home, an individual shall: (3) Have successfully completed: (d) Effective January 1, 2020, approved basic health and safety training within 90 days of employment; 13A.18.06.06B(1)(e) Family Child Care Teachers: To qualify or continue to qualify as a family child care teacher, an individual: (1) Shall hold or have successfully completed: (e) Effective January 1, 2020, approved basic health and safety training within 90 days of employment; 13A.18.06.07A(3) Aides: An aide shall: (3) Effective January 1, 2020, complete the approved basic health and safety training within 90 days of employment; Large Family Child Care 13A.18.03.04D(2) Child Records: Unless a parent objects to a child's medical examination because of bona fide religious beliefs and practices, a health assessment of the child shall be provided by the child's parent that: (2) If applicable, includes a statement of allergies Large Family Child Care 13A.18.10.01A Emergency and Disaster Plan. (1) The provider or a staff member shall: (a) Complete emergency preparedness training that is approved by the office; and (b) As part of the approved emergency preparedness training, prepare a written emergency and disaster plan for the child care home. Large Family Child Care 13A.18.12.01I Food Service E. Menus. An operator shall: (1) Post in a conspicuous place a weekly planned menu of foods and beverages furnished by the center for meals and snacks; and (2) Keep a dated record of food actually served in the center, and to each child on a modified diet, on file for at least 4 weeks, correcting the planned menu if necessary. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt providers are required to maintain each child’s Emergency Care and Medication Authorization form. This form contains the child’s health emergency and medical information, including known allergies, reactions, and any prescribed medications. License-exempt providers must complete and gain an annual certification from Basic Health & Safety training through our online training or approved the Maryland State Department of Education local trainer’s courses. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Providers are required to maintain and review children's records for information pertaining to allergies and asthma including allergy action plans for children with allergies. The regulations also require providers to maintain and post a planned weekly menu of the food and snacks to be served to the children for up to 4 weeks in case of a possible allergic reaction. Additionally, all providers and child care staff are required to complete the Basic Health and Safety training and Emergency Preparedness training which includes information about the prevention of and response to emergencies related to food and allergic reactions. Child Care Center 13A.16.03.04D(2) and Letter of Compliance 13A.17.03.04D(2) Child Records: Unless a parent objects to a child's medical examination because of bona fide religious beliefs and practices, a health assessment of the child shall be provided by the child's parent that: (2) If applicable, includes a statement of allergies Child Care Center 13A.16.06.05 Staff Records C(1)(a) and Letter of Compliance 13A.17.06.05B(1) Staff Records: During an individual’s employment at the center and for 2 years after the date of the individual’s last employment there, maintain a record for each individual that includes: (1) The individual’s: (a) Training, including initial and yearly basic health and safety training, if required under this subtitle; Child Care Center 13A.16.10.01A and Letter of Compliance 13A.17.10.01A A. Emergency and Disaster Plan. (1) At least one center employee shall: (a) Complete emergency preparedness training that is approved by the office; and (b) As part of the approved emergency preparedness training, prepare a written emergency and disaster plan for the center. Child Care Center 13A.16.12.01E and Letter of Compliance 13A.17.12.01E Food Service: E. Menus. An operator shall: (1) Post in a conspicuous place a weekly planned menu of foods and beverages furnished by the center for meals and snacks; and (2) Keep a dated record of food actually served in the center, and to each child on a modified diet, on file for at least 4 weeks, correcting the planned menu if necessary. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: The medication administration training includes safe and accurate administration of medication, including measuring, proper dosage, purpose of medication and the 6 Rights of Medication Administration. Allergic reaction is also discussed along with the proper administration of Asthma medications and treatment for Anaphylaxis. Participants will practice using the new Epi-pen. Additionally, Maryland requires providers to obtain a Medication Authorization form to be completed and signed by the child’s health care professional for all children who are prescribed medication that is to be administered while in child care. Providers are required to review children's forms including a listing of any medications administered to children. Only staff that have successfully completed the training are approved to administer medications as directed by the required medication forms. Also, the approved staff ensure that medication is stored according to COMAR requirements. Child Care Center 13A.16.11.04 and Letter of Compliance13A.17.11.04: Medication Administration and Storage Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Child Care Center 13A.16.10.01(C) and Letter of Compliance 13A.17.10.01(C): Safety C. An operator shall post, immediately accessible to each telephone in the facility, a notice stating the: (1) 9-1-1 emergency telephone number to summon fire, police, and rescue services; (2) Facility's name, address, and telephone number; (3) Telephone number of the Child Protective Services unit of the local department of social services; (4) Telephone number of a poison control facility; (5) Name and telephone number of the local health department or a physician to consult about issues regarding health and illnesses; (6) Name and telephone number of the available adult as required by COMAR; and (7) Telephone number of the office. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care 13A.15.11.04 and Large Family Child Care 13A.18.11.04: Medication Administration and Storage .04 Medication Administration and Storage. A. Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received by the provider or substitute before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; and (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to the provider, substitute, or additional adult. F. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, a provider shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self- administer medication. (2) Revocation of Authorization to Self-Administer. (a)A provider may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §F(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the provider shall notify the child’s parent of that revocation. (c) The provider shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. G. Effective January 1, 2016, medication may be administered to a child in care only by an individual who has completed approved medication administration training, unless: (1) The individual is a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care has been delegated to the individual by a delegating nurse in accordance with COMAR 10.27.11. H. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Family Child Care 13A.15.10.01(A): Child Safety (2) Contains: (a) The name of, and contact information for, the local emergency operations center; (b) A list of local emergency services numbers; and (c) The radio station call sign and frequency for the local Emergency Alert System (EAS) Large Family Child Care 13A.18.10.01(C): Safety C. A provider shall post, immediately accessible to each telephone in the child care home, a notice stating the: (1) 9-1-1 emergency telephone number to summon fire, police, and rescue services; (2) Child care home's name, address, and telephone number; (3) Telephone number of the protective services unit of the local department of social services; (4) Telephone number of a poison control center; (5) Name and telephone number of the local health department or a physician to consult about issues regarding health and illnesses; (6) Name and telephone number of the available adult as required by COMAR 13A.18.08.02D; and (7) Telephone number of the office. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt providers must complete and sign the Medication Authorization form with the child’s health care professional and parent, giving permission to administer the required medication during care hours. Scholarship] Informal Child Care (License-exempt): The informal child care provider submits application documentation required for approval. This type of care addresses all children in care ages 0-13, and up to age 19 years for children with special needs. The Health & Safety and Child Care Provider Agreement contains the standards for the health and safety of children in informal child care requiring both the parent and the provider to initial each standard and to sign agreement acknowledgement. ￿Directions: Read each standard carefully. The parent and the provider must initial each item to document that the standard has been reviewed and is met. All standards must be met to authorize informal child care. … (Required. EACH item must be initialed by parent and provider.)￿ 33. Prevention/response to emergencies due to food and allergic reactions. Both parent and provider must also sign attesting: ￿Acknowledgement: I have reviewed each standard and acknowledge by my initials that each has been met to ensure the health and safety of each child in care. Further, I have read the Statement of Understanding and attest that I understand my rights and responsibilities.￿ Parent’s Statement of Understanding: 25. I will prepare, and keep up-to-date a completed, signed and dated Emergency Care & Medication Authorization (ECMA) form for each child and discuss with my Informal Child Care Provider. h. This authorization gives the Informal Care Provider permission to administer if needed prescribed medication and care as directed by the healthcare provider. i. I attest that any prescribed medication has been administered at home to my child at least once and observed that there have been no negative reactions. j. I will ensure prescribed medications are available during child care an stocked in the Emergency Preparedness Kit (aka Emergency Ready-to-Go-Pack) as appropriate. k. I will keep the Informal Provider up-to-date regarding any special instructions or prescribed medications, l. This signature also authorizes the responsible person (Informal Care Provider) to have my child(ren) transported to the nearest hospital in emergencies requiring immediate medical attention. 26. I have provided the provider with a written list (if applicable) of the food(s) to which my child is allergic and steps to be taken in a detailed treatment plan, which includes the names, doses, and methods of administration of any medications that the child should receive in the event of a reaction. Informal Provider’s Statement of Understanding 36. I have obtained from the parent a written list (if applicable) of the food(s) to which my child is allergic and steps to be taken in a detailed treatment plan, which includes the names, doses, and methods of administration of any medications that the child should receive in the event of a reaction. 38. I will discuss and prepare with the parent, and keep up-to-date a completed, signed and dated Emergency Care & Medication Authorization (ECMA) form for each child. a. The parent’s authorization gives me, the informal provider, permission to administer prescribed medication and care as directed by the healthcare provider. b. The parent has attested that any prescribed medication has been administered at home to their child at least once and observed that there have been no negative reactions. c. I will ensure prescribed medications are available during child care and stocked in the Emergency Preparedness Kit (aka Emergency Ready-to-Go-Pack) as appropriate. d. I will discuss with the parent and keep up-to-date regarding any special instructions or prescribed medications, g. In emergencies requiring immediate medical attention, the parent’s signature authorizes me to take a child(ren) to the nearest hospital emergency room for care. The parent’s signature also authorizes me to transport the child(ren) to the hospital. Providers are also required to meet the standard of completing certificates in Basic Health and Safety Training, without which they cannot be approved. Emergency Documents are required to be kept readily on-hand in a Ready-to-Go- Pack binder, including the Emergency Preparedness Plan (EPP), Emergency Care and Medical Authorization Forms (ECMA), and any supporting documentation. The EPP includes listing of their emergency telephone numbers including toll-free Poison Control 1-800-222-1222. Review of standards takes place during care location inspections. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13A.16.11.04 and Letter of Compliance13A.17.11.04: Medication Administration and Storage Medication Administration. (1) Medication, whether prescription or nonprescription, may not be administered to a child in care unless: (a) Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the center before the medication is administered; and (b) A licensed health practitioner has approved the administration of the medication and the medication dosage. (2) A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. (3) If medication is by prescription, it shall be labeled by the pharmacy or physician with: (a) The child's name; (b) The date of the prescription; (c) The name of the medication; (d) The medication dosage; (e) The administration schedule; (f) The administration route; (g) If applicable, special instructions, such as "take with food"; (h) The duration of the prescription; and (i) An expiration date that states when the medication is no longer useable. B. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. C. Medication shall be administered according to the instructions on the label of the medication container or a licensed health practitioner's written instructions, whichever are more recently dated. D. Recording Requirements. (1) Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. (2) Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child’s record. E. Medication Storage. (1) Each medication shall be: (a) Labeled with the child's name, the dosage, and the expiration date; (b) Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and (c) Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency or returned to the child's parent upon expiration or discontinuation. (2) All medications shall be stored to make them inaccessible to children in care but readily accessible to each employee designated by the operator to administer medication. F. Medication Administration Training. (1) Whenever children in care are present, there shall be at least one center employee present who has completed medication administration training approved by the office. Medication may be administered to a child in care only by an employee who has completed approved medication administration training. G. Section F of this regulation does not apply if: (1) The center employs a registered nurse, licensed practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or (2) Responsibility for administering medication to children in care is delegated to a center employee by a delegating nurse in accordance with COMAR 10.27.11. H. Self-Administration of Medication. (1) Before a child may self-administer medication while in care, the operator shall: (a) Have a written order from the child’s physician and the written request of the child’s parent for the child’s self-administration of medication; (b) In consultation with the child’s parent, establish a written procedure for self administration of medication by the child based on the physician’s written order; and (c) Authorize the child to self-administer medication. (2) Revocation of Authorization to Self-Administer. (a) An operator may revoke a child’s authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. (b) Immediately upon revoking the child’s authorization to self-administer medication, the operator shall notify the child’s parent of that revocation. (c) The operator shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. I. Medical Cannabis. (1) The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01￿10.62.37. (2) The administration of medical cannabis that includes smoking or vaping is prohibited. Child Care Center 13A.16.10.01(C) and Letter of Compliance 13A.17.10.01(C): Safety C. An operator shall post, immediately accessible to each telephone in the facility, a notice stating the: (1) 9-1-1 emergency telephone number to summon fire, police, and rescue services; (2) Facility's name, address, and telephone number; (3) Telephone number of the Child Protective Services unit of the local department of social services; (4) Telephone number of a poison control facility; (5) Name and telephone number of the local health department or a physician to consult about issues regarding health and illnesses; (6) Name and telephone number of the available adult as required by COMAR; and (7) Telephone number of the office. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: All facilities must comply with all applicable state and local fire, zoning, health, safety and environmental codes, be in good repair, free of health and safety hazards including infestation by insects and rodents; have operable and safe utilities for lighting and heating; hot and cold running water; working, accessible toilet; operable refrigerator, stove, and telephone. In addition, providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards including bodies of water, vehicular traffic and other potentially hazardous items. 13A.16.05.01 Child Care Center and 13A.17.05.01 Letter of Compliance Building Safety: An operator shall provide a building for a center that is: (1) Maintained in good repair; (2) Free from health and safety hazards as identified by the office; and (3) Clean and free from infestation of insects and rodents. 13A.15.05.12C, D & E Child Care Center and Letter of Compliance 13A.17.05.12C, D & E Outdoor Activity Area C. Usable play space may include only the area and the activity equipment approved for use by children in care. D. The activity area shall be free from potential hazards to child health or safety. E. All outdoor activity equipment shall be safe, in good repair, clean, and nontoxic. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All facilities must comply with all applicable state and local fire, zoning, health, safety and environmental codes, be in good repair, free of health and safety hazards including infestation by insects and rodents; have operable and safe utilities for lighting and heating; hot and cold running water; working, accessible toilet; operable refrigerator, stove, and telephone. In addition, providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards including bodies of water, vehicular traffic and other potentially hazardous items. 13A.15.05.01 Family Child Care and 13A.18.05.01 Suitability of the Home The home shall: A. Comply with all applicable State and local fire, zoning, health, safety, and environmental codes; B. Be in good repair; C. Be free of health or safety hazards, including infestation by insects and rodents. 13A.15.05.05 Family Child Care and 13A.18.05.12 Large Family Child Care Outdoor Activity Area Outdoor Activity Area. A. There shall be ample, accessible space for outdoor activity that is free from conditions that may be dangerous to the health or safety of children in care. B. If required by the office, the outdoor activity area shall be enclosed to protect children in care from accessible hazards such as a heavily trafficked area, a body of water, or environmental hazards. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: MSDE does not have requirements for identification of and protection from building and physical premises hazards for license-exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all building and physical premises safety hazards regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. In the meantime, the vendor inspects the care location to ensure it complies with safety requirements. The specialist checks to ensure the care location is in good repair, free of health and safety hazards, including infestation by insects and rodents; has operable and safe utilities for lighting and heating, hot and cold running water; working, accessible toilet; and an operable refrigerator, stove, and telephone. In addition, providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards, including bodies of water, vehicular traffic, and other potentially hazardous items. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All facilities must comply with all applicable state and local fire, zoning, health, safety and environmental codes, be in good repair, free of health and safety hazards including infestation by insects and rodents; have operable and safe utilities for lighting and heating; hot and cold running water; working, accessible toilet; operable refrigerator, stove, and telephone. In addition, providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards including bodies of water, vehicular traffic and other potentially hazardous items. 13A.16.05.01 Child Care Center and 13A.17.05.01 Letter of Compliance Building Safety: An operator shall provide a building for a center that is: (1) Maintained in good repair; (2) Free from health and safety hazards as identified by the office; and (3) Clean and free from infestation of insects and rodents. 13A.15.05.12C, D & E Child Care Center and Letter of Compliance 13A.17.05.12C, D & E Outdoor Activity Area C. Usable play space may include only the area and the activity equipment approved for use by children in care. D. The activity area shall be free from potential hazards to child health or safety. E. All outdoor activity equipment shall be safe, in good repair, clean, and nontoxic. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: 13A.15.05.12C, D & E Child Care Center and Letter of Compliance 13A.17.05.12C, D & E Outdoor Activity Area: C. Usable play space may include only the area and the activity equipment approved for use by children in care. D. The activity area shall be free from potential hazards to child health or safety. E. All outdoor activity equipment shall be safe, in good repair, clean, and nontoxic.F. Any pool on the premises of the facility shall be made inaccessible to children in care and have security features, including but not limited to a: (1) Fence that surrounds the pool at least 4 feet in height; (2) Self-closing and self-latching mechanism on the gate, door, or access to the pool; (3) Lock that is operable and secured; and (4) Sensor or alarm in the pool and on the access door. Child Care Center 13A.16.06.05 and Letter of Compliance 13A.18.08.05: Supervision During Water Activities A. An operator shall have prior written approval from a child's parent for the child's participation in a water activity. B. If a wading or swimming area is 4 feet or less in depth, each child engaged in a water activity shall receive continuous supervision by a staff member. C. If the water exceeds 4 feet in depth, there shall be a lifeguard present who: (1) Holds a current certificate of approval for lifeguarding from the American Red Cross, YMCA, or other organization acceptable to the office or the local health department; (2) Is present at waterside during the swimming activity; and (3) Is not included in the required staff/child ratio. D. Except during a swimming lesson conducted by a certified water safety organization, such as the American Red Cross, that is acceptable to the office or the local health department, whenever water is over the chest of a child who cannot swim, the child shall receive one-to-one supervision by a staff member who is in the water with the child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 13A.15.05.05 Family Child Care and 13A.18.05.12 Large Family Child Care: Outdoor Activity Area: .05 Outdoor Activity Area. A. There shall be ample, accessible space for outdoor activity that is free from conditions that may be dangerous to the health or safety of children in care. B. If required by the office, the outdoor activity area shall be enclosed to protect children in care from accessible hazards such as a heavily trafficked area, a body of water, or environmental hazards. C. Any pool on the premises of the facility shall be made inaccessible to children in care and have security features, including but not limited to a: (1) Fence that surrounds the pool at least 4 feet in height; (2) Self- closing and self-latching mechanism on the gate, door, or access to the pool; (3) Lock that is operable and secured; and (4) Sensor or alarm in the pool and on the access door. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements for identification of and protection from bodies of water for license- exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all identification and protection from bodies of water regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. In the meantime, licensed-exempt providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards, including bodies of water. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 13A.15.05.12C, D & E Child Care Center and Letter of Compliance 13A.17.05.12C, D & E Outdoor Activity Area: C. Usable play space may include only the area and the activity equipment approved for use by children in care. D. The activity area shall be free from potential hazards to child health or safety. E. All outdoor activity equipment shall be safe, in good repair, clean, and nontoxic.F. Any pool on the premises of the facility shall be made inaccessible to children in care and have security features, including but not limited to a: (1) Fence that surrounds the pool at least 4 feet in height; (2) Self- closing and self-latching mechanism on the gate, door, or access to the pool; (3) Lock that is operable and secured; and (4) Sensor or alarm in the pool and on the access door. Child Care Center 13A.16.06.05 and Letter of Compliance 13A.18.08.05: Supervision During Water Activities A. An operator shall have prior written approval from a child's parent for the child's participation in a water activity. B. If a wading or swimming area is 4 feet or less in depth, each child engaged in a water activity shall receive continuous supervision by a staff member. C. If the water exceeds 4 feet in depth, there shall be a lifeguard present who: (1) Holds a current certificate of approval for lifeguarding from the American Red Cross, YMCA, or other organization acceptable to the office or the local health department; (2) Is present at waterside during the swimming activity; and (3) Is not included in the required staff/child ratio. D. Except during a swimming lesson conducted by a certified water safety organization, such as the American Red Cross, that is acceptable to the office or the local health department, whenever water is over the chest of a child who cannot swim, the child shall receive one-to-one supervision by a staff member who is in the water with the child. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements for the identification of and protection from vehicular traffic for licensed providers. MSDE will need additional time to meet this requirement. The Licensing Branch is currently drafting regulations and will send the proposed amendments to the ACF for review and approval, before starting the regulation promulgation process. June 2025 is MSDEs anticipated date of compliance. ii. All CCDF-eligible licensed family child care homes. Provide the standard: MSDE does not have requirements for the identification of and protection from vehicular traffic for licensed providers. MSDE will need additional time to meet this requirement. The Licensing Branch is currently drafting regulations and will send the proposed amendments to the ACF for review and approval, before starting the regulation promulgation process. June 2025 is MSDEs anticipated date of compliance. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements for the identification of and protection from vehicular traffic hazards for license-exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all identification and protection from vehicular traffic regulations for licensed providers, once licensing receives approval of the proposed amendments they are drafting for the ACFs review. June 2025 is MSDEs anticipated date of compliance. In the meantime, licensed-exempt providers are required to use child safety latches and equipment to ensure the indoor and outdoor child care space is free from all hazards, including vehicular traffic. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements for the identification of and protection from vehicular traffic for licensed providers. MSDE will need additional time to meet this requirement. The Licensing Branch is currently drafting regulations and will send the proposed amendments to the ACF for review and approval, before starting the regulation promulgation process. June 2025 is MSDEs anticipated date of compliance. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center 13.16.07.01 and Letter of Compliance 13A.17.07.01: Prohibition of Abuse, Neglect and Injurious Treatment .01 Prohibition of Abuse, Neglect, and Injurious Treatment. An operator, employee, substitute, volunteer, individual residing on the premises of the center, or other individual connected with the center may not subject a child to abuse, neglect, mental injury, or injurious treatment. Child Care Center 13A.16.17.03 and Letter of Compliance13A.17.07.03: Child Discipline A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The operator, employee, substitute, or volunteer may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The operator shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the center; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the center. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.07.01: Prohibition of Abuse, Neglect and Injurious Treatment .01 Prohibition of Abuse, Neglect, and Injurious Treatment. A child in care may not be subjected to abuse, neglect, mental injury, or injurious treatment as defined in COMAR 13A.15.01.02B. 13A.15.07.03: Applicability to Residents .03 Applicability to Residents. The requirement set forth in Regulation .01 of this chapter also applies to a resident of the family child care home. 13A.15.07.04: Child Discipline Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this subtitle. B. The provider or substitute may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. Large Family Child Care: 15A.18.07.01: Prohibition of Abuse, Neglect and Injurious Treatment A provider, employee, substitute, volunteer, individual residing on the premises of the child care home, or other individual connected with the home may not subject a child to abuse, neglect, mental injury, or injurious treatment. 13A.18.07.03: Child Discipline A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The provider, an employee, substitute, volunteer, or other individual connected to the child care home may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The provider shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the child care home; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the child care home. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements that address the prevention of shaken baby syndrome and abusive head trauma for license-exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate prevention of shaken baby syndrome and abusive head trauma regulations from the regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. In the meantime, licensed-exempt providers take an annual mandatory Health & Safety training that addresses topics that include information about shaken baby syndrome and signs and symptoms of head trauma. Licensed-exempt providers are required to monitor children for signs of abuse, neglect, and/or maltreatment and report suspected incidences to the child protective service agency. There are no variations based on the ages of children in care. [Scholarship] Informal Child Care (License-exempt): The informal child care provider submits application documentation required for approval. This type of care addresses all children in care ages 0-13, and up to age 19 years for children with special needs. The Health & Safety and Child Care Provider Agreement contains the standards for the health and safety of children in informal child care requiring both the parent and the provider to initial each standard and to sign agreement acknowledgement. ￿Directions: Read each standard carefully. The parent and the provider must initial each item to document that the standard has been reviewed and is met. All standards must be met to authorize informal child care. … (Required. EACH item must be initialed by parent and provider.)￿ 12. A child in care is not subjected to mistreatment, including any deliberate act that hurts a child physically or emotionally, such as: … 28. Prevention of shaken baby syndrome, abusive head trauma, and child maltreatment. Both parent and provider must also sign attesting: ￿Acknowledgement: I have reviewed each standard and acknowledge by my initials that each has been met to ensure the health and safety of each child in care. Further, I have read the Statement of Understanding and attest that I understand my rights and responsibilities.￿ Parent’s Statement of Understanding: 32. I understand that the Department of Human Services local department of social services’ Child Protective Services unit will investigate any complaint of mistreatment, neglect, or abuse that occurs while my child is in care. Informal Provider’s Statement of Understanding 44. I understand that the Department of Human Services local department of social services’ Child Protective Services unit will investigate any complaint of mistreatment, neglect, or abuse that occurs while a child is in care. Providers are also required to meet the standard of completing certificates in Basic Health and Safety Training, without which they cannot be approved. Review of standards takes place during care location inspections. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13.16.07.01 and Letter of Compliance 13A.17.07.01: Prohibition of Abuse, Neglect and Injurious Treatment .01 Prohibition of Abuse, Neglect, and Injurious Treatment. An operator, employee, substitute, volunteer, individual residing on the premises of the center, or other individual connected with the center may not subject a child to abuse, neglect, mental injury, or injurious treatment. Child Care Center 13A.16.17.03 and Letter of Compliance13A.17.07.03: Child Discipline A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The operator, employee, substitute, or volunteer may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The operator shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the center; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the center. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: All providers are required to complete the Basic Health and Safety training which includes information about the indicators of abuse and neglect. Providers are required to monitor children for signs of abuse, neglect and/or maltreatment and report suspected incidences to the child protective service agency. Additionally, providers must submit and maintain an age appropriate discipline policy for the children they plan to serve in child care. 13.16.07.01 Child Care Center and 13A.17.07.01 Letter of Compliance: Prohibition of Abuse, Neglect and Injurious Treatment: .01 Prohibition of Abuse, Neglect, and Injurious Treatment. An operator, employee, substitute, volunteer, individual residing on the premises of the center, or other individual connected with the center may not subject a child to abuse, neglect, mental injury, or injurious treatment. 15A.16.17.02 Child Care Center and 13A.18.07.02 Letter of Compliance Abuse/Neglect Reporting: A. An operator, staff member, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department or to a law enforcement agency, as required under Maryland law; (2) Neglected, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department as required under Maryland law. B. When a child has been subjected to injurious treatment, it shall be reported to the office. C. An operator shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect; (2) Instruct staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and(3) Post, near each telephone in the facility, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. An operator may not require a staff member, employee, substitute, or volunteer to report through the operator or director, rather than directly to the local department or a law enforcement agency, when the staff member has reason to believe that a child has been abused or neglected. 15A.16.17.03 Child Care Center and 13A.18.07.03 Letter of Compliance Child Discipline: A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The operator, employee, substitute, or volunteer may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The operator shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the center; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the center. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All providers are required to complete the Basic Health and Safety training which includes information about the indicators of abuse and neglect. Providers are required to monitor children for signs of abuse, neglect and/or maltreatment and report suspected incidences to the child protective service agency. Additionally, providers must submit and maintain an age appropriate discipline policy for the children they plan to serve in child care. Family Child Care: 13A.15.07.01 Prohibition of Abuse, Neglect and Injurious Treatment: .01 Prohibition of Abuse, Neglect, and Injurious Treatment. A child in care may not be subjected to abuse, neglect, mental injury, or injurious treatment as defined in COMAR 13A.15.01.02B. 13A.15.07.02 Abuse/Neglect Reporting An individual who is responsible for providing care to a child: A. Shall monitor the child for signs and symptoms of child abuse or neglect; and B. If the individual has reason to believe that a child in care has been: (1) Abused, shall report that belief directly to the protective services unit of the local department of social services or to a law enforcement agency, as required under Maryland law; or (2) Neglected, shall report that belief directly to the protective services unit of the local department of social services as required under Maryland law. 13A.15.07.03 Applicability to Residents .03 Applicability to Residents. The requirement set forth in Regulation .01 of this chapter also applies to a resident of the family child care home. 13A.15.07.04 Child Discipline Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this subtitle. B. The provider or substitute may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. Large Family Child Care: 15A.18.07.01 Prohibition of Abuse, Neglect and Injurious Treatment A provider, employee, substitute, volunteer, individual residing on the premises of the child care home, or other individual connected with the home may not subject a child to abuse, neglect, mental injury, or injurious treatment. 13A.18.07.02 Abuse/Neglect Reporting A. A provider, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, inside or outside of the child care home, shall report that belief directly to the protective services unit of the local department or to a law enforcement agency, as required under Maryland law; or (2) Neglected, inside or outside of the child care home, shall report that belief directly to the protective services unit of the local department as required under Maryland law. B. If a child has been subjected to injurious treatment, it shall be reported to the office. C. A provider shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect; (2) Instruct the staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and (3) Post, near each telephone in the child care home, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. A provider may not require an employee, substitute, or volunteer to report through the provider, rather than directly to the local department or a law enforcement agency, when the employee, substitute, or volunteer has reason to believe that a child has been abused or neglected. 13A.18.07.03 Child Discipline A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The provider, an employee, substitute, volunteer, or other individual connected to the child care home may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The provider shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the child care home; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the child care home. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Licensed- exempt providers take an annual mandatory Health & Safety training course on maltreatment. Providers are required to monitor children for signs of abuse, neglect, and/or maltreatment and report suspected incidents to the child protective service agency. There are no variations based on the ages of children in care. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All providers are required to complete the Basic Health and Safety training which includes information about the indicators of abuse and neglect. Providers are required to monitor children for signs of abuse, neglect and/or maltreatment and report suspected incidences to the child protective service agency. Additionally, providers must submit and maintain an age appropriate discipline policy for the children they plan to serve in child care. 13.16.07.01 Child Care Center and 13A.17.07.01 Letter of Compliance: Prohibition of Abuse, Neglect and Injurious Treatment: .01 Prohibition of Abuse, Neglect, and Injurious Treatment. An operator, employee, substitute, volunteer, individual residing on the premises of the center, or other individual connected with the center may not subject a child to abuse, neglect, mental injury, or injurious treatment. 15A.16.17.02 Child Care Center and 13A.18.07.02 Letter of Compliance Abuse/Neglect Reporting: A. An operator, staff member, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department or to a law enforcement agency, as required under Maryland law; (2) Neglected, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department as required under Maryland law. B. When a child has been subjected to injurious treatment, it shall be reported to the office. C. An operator shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect; (2) Instruct staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and(3) Post, near each telephone in the facility, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. An operator may not require a staff member, employee, substitute, or volunteer to report through the operator or director, rather than directly to the local department or a law enforcement agency, when the staff member has reason to believe that a child has been abused or neglected. 15A.16.17.03 Child Care Center and 13A.18.07.03 Letter of Compliance Child Discipline: A. Child discipline shall be: (1) Appropriate to the age, maturity, and physical condition of the child; and (2) Consistent with the requirements of this chapter. B. The operator, employee, substitute, or volunteer may not: (1) Force a child to eat or drink; (2) Punish a child for refusing to eat or drink; (3) Withhold food or beverages as punishment; or (4) Spank, hit, shake, or use any other means of physical discipline. C. The operator shall: (1) Prepare a written child discipline policy that states the: (a) Discipline methods used at the center; and (b) The circumstances under which the child discipline methods may be applied; (2) Make the child discipline policy available to: (a) The parent of each child in care; (b) A parent who is considering whether to enroll their children; and (c) The office; and (3) Ensure that the child discipline policy is followed by each employee, substitute, volunteer, and other individual connected with the center. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: The Basic Health and Safety training module for regarding the safe handling and storage of hazardous materials includes bio-contaminates. Providers must ensure the building/home is free from health and safety hazards and ensure that all potentially hazardous items are stored in an approved manner, as specified in the regulations. Child Care Center 13A.16.10.04, Letter of Compliance 13A.17.10.04 and Large Family Child Care 13A.18.10.04 Potentially Hazardous Items: A. An operator shall store all potentially harmful items, including but not limited to the items described in §§B￿E of this regulation, in locations which are inaccessible to children in care. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The Basic Health and Safety training module for regarding the safe handling and storage of hazardous materials includes bio-contaminates. Providers must ensure the building/home is free from health and safety hazards and ensure that all potentially hazardous items are stored in an approved manner, as specified in the regulations. Family Child Care 13A.15.10.02 Potentially Hazardous Items: The provider shall properly store, and keep inaccessible to the children in care, all potentially harmful items, including, but not limited to, knives, sharp tools, firearms, matches, alcohol, tobacco, cannabis, cannabis edibles, and smoking and vaping paraphernalia and byproducts, petroleum, flammable products, cleaning agents, and poisonous products. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements that address the handling and storage of hazardous materials for license-exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all handling and storage of hazardous materials regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Basic Health and Safety training module for regarding the safe handling and storage of hazardous materials includes bio-contaminates. Providers must ensure the building/home is free from health and safety hazards and ensure that all potentially hazardous items are stored in an approved manner, as specified in the regulations. Child Care Center 13A.16.10.04, Letter of Compliance 13A.17.10.04 and Large Family Child Care 13A.18.10.04 Potentially Hazardous Items: A. An operator shall store all potentially harmful items, including but not limited to the items described in §§B￿E of this regulation, in locations which are inaccessible to children in care. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center 13A.16.05.11 and Letter of Compliance 13A.17.05.11 Cleanliness and Sanitation G. Biocontaminants and biohazards shall be disposed of in a clean and sanitary manner. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care 13A.15.05.03G Cleanliness and Sanitation G. Biocontaminants and biohazards shall be disposed of in a clean and sanitary manner. Large Family Child Care 13A.18.05.11 Cleanliness and Sanitation G. Biocontaminants and biohazards shall be disposed of in a clean and sanitary manner. 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 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: MSDE does not have requirements that address the disposal of bio contaminants for license- exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate disposal of bio contaminants regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center 13A.16.05.11 and Letter of Compliance 13A.17.05.11 Cleanliness and Sanitation G. Biocontaminants and biohazards shall be disposed of in a clean and sanitary manner. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: The Basic Health and Safety training module regarding transportation safety includes information including the state requirements for the appropriate height weight requirements for car seats and seat belt use and supervision while transporting children. In Family child care, when transporting child care children, the provider must follow Maryland law: Each child is separately secured in a car safety seat or belt and it is appropriate for their height and weight. In center care, unless being transported in a school bus or motor coach, children must be in a car seat or seat belt appropriate for their height and weight. Vehicles used to transport children must comply with applicable state and federal requirements. Child Care Center 13A.16.08.01 and Letter of Compliance 13A.17.08.01 E Individualized Attention and Care: E. A child is allowed to travel to or from school or a school transportation site without adult supervision only if: (1) The child is in the first or a higher grade; and (2) The child's parent and the operator agree in writing that the child can travel safely without adult supervision. Child Care Center 13A.16.08.06 and Letter of Compliance 13A.17.08.06 Supervision During Transportation: When child transportation is conducted to or from: A. The center by the center operator, there shall be at least one adult, who has successfully passed federal and State criminal background checks and a review of child and adult abuse and neglect records pursuant to COMAR 13A.16.07.06D, other than the driver present in the vehicle if: (1) More than eight preschoolers are being transported as a group; or (2) At least one child is being transported and the driver of the vehicle is not: (a) A center employee; or (b) The parent of a child in care who is authorized by the operator to assist in transporting children in care; or B. An off-site activity by an independent contractor or a local school district and at least one child in care is being transported, the center operator shall ensure that there is at least one adult other than the driver present in the vehicle. Child Care Center 13A.16.10.06 and Letter of Compliance 13A.17.10.05 Transportation: A. Unless being transported in a licensed school bus or contract motor coach, each child who is transported in a vehicle while in care shall be separately secured in a child car seat or seat belt which is appropriate for the child's age and weight, as specified by Maryland law. B. A vehicle used to transport a child in care shall comply with all applicable State and federal safety requirements. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The Basic Health and Safety training module regarding transportation safety includes information including the state requirements for the appropriate height weight requirements for car seats and seat belt use and supervision while transporting children. In Family child care, when transporting child care children, the provider must follow Maryland law: Each child is separately secured in a car safety seat or belt and it is appropriate for their height and weight. In center care, unless being transported in a school bus or motor coach, children must be in a car seat or seat belt appropriate for their height and weight. Vehicles used to transport children must comply with applicable state and federal requirements. Family Child Care 13A.15.03.04B(3) Child Records: B. Before the provider or substitute permits a child to: (3) Be transported in a vehicle by the provider or substitute, the provider shall obtain written permission from the child's parent to transport the child; 13A.15.10.05 Transportation Safety: If children are transported in a vehicle while in care, the provider or substitute shall ensure that, as specified by Maryland law: A. Each child in care is separately secured in a child car seat or seat belt; and B. Each child car seat or seat belt is appropriate for the age and weight of the child using it. 13A.15.08.02D Off-Site Supervision: A child in care may not travel to or from school or a school transportation site without adult supervision unless the child is in the first or a higher grade. Large Family Child Care: 13A.18.08.01 E Individualized Attention and Care E. A child is allowed to travel to or from school or a school transportation site without adult supervision only if: (1) The child is in the first or a higher grade; and (2) The child's parent and the operator agree in writing that the child can travel safely without adult supervision. Large Family Child Care 13A.18.08.06 Supervision During Transportation: When child transportation is conducted to or from: A. The center by the center operator, there shall be at least one adult, who has successfully passed federal and State criminal background checks and a review of child and adult abuse and neglect records pursuant to COMAR 13A.16.07.06D, other than the driver present in the vehicle if: (1) More than eight preschoolers are being transported as a group; or (2) At least one child is being transported and the driver of the vehicle is not: (a) A center employee; or (b) The parent of a child in care who is authorized by the operator to assist in transporting children in care; or B. An off-site activity by an independent contractor or a local school district and at least one child in care is being transported, the center operator shall ensure that there is at least one adult other than the driver present in the vehicle. 13A.18.10.06 Transportation: A. Unless being transported in a licensed school bus or contract motor coach, each child who is transported in a vehicle while in care shall be separately secured in a child car seat or seat belt which is appropriate for the child's age and weight, as specified by Maryland law. B. A vehicle used to transport a child in care shall comply with all applicable State and federal safety requirements. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Per ACF Preliminary Notice of Possible Non-Compliance, 01/2023: MSDE does not have requirements for appropriate precautions in transporting children for license- exempt Informal Care providers. MSDE will need additional time to meet this requirement. The Scholarship Branch will duplicate all the supervision during transportation and transportation safety regulations for licensed providers. As a result of the regulation promulgation process, June 2025 is MSDEs anticipated date of compliance. In the meantime, license-exempt providers must follow Maryland law, which states the following: Each child should be separately secured in a car safety seat or belt, and it is appropriate for their height and weight. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Basic Health and Safety training module regarding transportation safety includes information including the state requirements for the appropriate height weight requirements for car seats and seat belt use and supervision while transporting children. In Family child care, when transporting child care children, the provider must follow Maryland law: Each child is separately secured in a car safety seat or belt and it is appropriate for their height and weight. In center care, unless being transported in a school bus or motor coach, children must be in a car seat or seat belt appropriate for their height and weight. Vehicles used to transport children must comply with applicable state and federal requirements. Child Care Center 13A.16.08.01 and Letter of Compliance 13A.17.08.01 E Individualized Attention and Care: E. A child is allowed to travel to or from school or a school transportation site without adult supervision only if: (1) The child is in the first or a higher grade; and (2) The child's parent and the operator agree in writing that the child can travel safely without adult supervision. Child Care Center 13A.16.08.06 and Letter of Compliance 13A.17.08.06 Supervision During Transportation: When child transportation is conducted to or from: A. The center by the center operator, there shall be at least one adult, who has successfully passed federal and State criminal background checks and a review of child and adult abuse and neglect records pursuant to COMAR 13A.16.07.06D, other than the driver present in the vehicle if: (1) More than eight preschoolers are being transported as a group; or (2) At least one child is being transported and the driver of the vehicle is not: (a) A center employee; or (b) The parent of a child in care who is authorized by the operator to assist in transporting children in care; or B. An off-site activity by an independent contractor or a local school district and at least one child in care is being transported, the center operator shall ensure that there is at least one adult other than the driver present in the vehicle. Child Care Center 13A.16.10.06 and Letter of Compliance 13A.17.10.05 Transportation: A. Unless being transported in a licensed school bus or contract motor coach, each child who is transported in a vehicle while in care shall be separately secured in a child car seat or seat belt which is appropriate for the child's age and weight, as specified by Maryland law. B. A vehicle used to transport a child in care shall comply with all applicable State and federal safety requirements. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center: 13A.16.10.02 A. At all times, including during an off-site activity, at least one child care teacher or the director shall be present who holds a current certificate indicating successful completion of approved: (1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved;. B. A center with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified at §A of this regulation. C. Whenever a child in care is being transported under center auspices to or from the center, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. D. §C of this regulation does not apply if the driver of the vehicle is a parent of a child in care who is designated by the center operator to assist in transporting children in care. Letter of Compliance: 13A.17.10.02 First Aid and CPR At all times, including during an off-site activity, at least one individual who is responsible for supervision of children shall be present who holds a current certificate indicating successful completion of approved: Basic first aid training through the American Red Cross, or a program with equivalent standards; and B. A facility with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified in §A of this regulation. C. Whenever a child in care is being transported under child care facility auspices to or from the facility, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.06.02A & D Training Requirements A. Preservice Training. An individual who applies for an initial registration shall: (1) Hold a current certificate indicating successful completion of training in approved: (a) Basic first-aid through the American Red Cross, or a program with equivalent standards; D. Current certification in approved basic first aid and CPR training as specified in §A(1)(a) and (b) of this regulation shall be maintained at all times by: (1) The provider; and (2) If applicable, the additional adult. Large Family Child Care: 13A.18.10.02 First Aid and CPR A. At all times, including during an off-site activity, at least one family child care teacher or the provider shall be present who holds a current certificate indicating successful completion of approved:(1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the child care home is approved; and (2) Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the child care home is approved. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Licensed- Exempt Providers must provide proof of successfully completing requirements for Adult/Infant CPR/AED and First Aid. (a) Basic first-aid class which covers the required Health & Safety training through our approved the Maryland State department of Education local trainers' courses; and (b) Cardiopulmonary resuscitation (CPR) through the American Heart Association, or a program with equivalent standards. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center: 13A.16.10.02 A. At all times, including during an off-site activity, at least one child care teacher or the director shall be present who holds a current certificate indicating successful completion of approved: (1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved;. B. A center with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified at §A of this regulation. C. Whenever a child in care is being transported under center auspices to or from the center, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. D. §C of this regulation does not apply if the driver of the vehicle is a parent of a child in care who is designated by the center operator to assist in transporting children in care. Letter of Compliance: 13A.17.10.02 First Aid and CPR At all times, including during an off-site activity, at least one individual who is responsible for supervision of children shall be present who holds a current certificate indicating successful completion of approved: Basic first aid training through the American Red Cross, or a program with equivalent standards; and B. A facility with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified in §A of this regulation. C. Whenever a child in care is being transported under child care facility auspices to or from the facility, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: Child Care Center: 13A.16.10.02 A. At all times, including during an off-site activity, at least one child care teacher or the director shall be present who holds a current certificate indicating successful completion of approved: (1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved; and (2) Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved. B. A center with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified at §A of this regulation. C. Whenever a child in care is being transported under center auspices to or from the center, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. D. §C of this regulation does not apply if the driver of the vehicle is a parent of a child in care who is designated by the center operator to assist in transporting children in care. Letter of Compliance: 13A.17.10.02 A. At all times, including during an off-site activity, at least one individual who is responsible for supervision of children shall be present who holds a current certificate indicating successful completion of approved: Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the facility is approved. B. A facility with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified in §A of this regulation. C. Whenever a child in care is being transported under child care facility auspices to or from the facility, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.06.02A & D Training Requirements A. Preservice Training. An individual who applies for an initial registration shall: (1) Hold a current certificate indicating successful completion of training in approved: (b) Cardiopulmonary resuscitation (CPR) through the American Heart Association, or a program with equivalent standards, appropriate for each age group approved for care in the home; D. Current certification in approved basic first aid and CPR training as specified in §A(1)(a) and (b) of this regulation shall be maintained at all times by: (1) The provider; and (2) If applicable, the additional adult. Large Family Child Care: 13A.18.10.02 A. At all times, including during an off-site activity, at least one family child care teacher or the provider shall be present who holds a current certificate indicating successful completion of approved: (1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the child care home is approved; and (2) Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the child care home is approved. B. Whenever a child in care is present, there shall be at least one staff member, or the provider, present who is currently certified in approved first aid and CPR as specified at §A of this regulation. C. Whenever a child in care is being transported under child care home auspices to or from the child care home, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Licensed- Exempt Providers must provide proof of successfully completing requirements for Adult/Infant CPR/AED and First Aid. (a) Basic first-aid class which covers the required Health & Safety training through our approved the Maryland State department of Education local trainers' courses; and (b) Cardiopulmonary resuscitation (CPR) through the American Heart Association, or a program with equivalent standards. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Child Care Center: 13A.16.10.02 A. At all times, including during an off-site activity, at least one child care teacher or the director shall be present who holds a current certificate indicating successful completion of approved: (1) Basic first aid training through the American Red Cross, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved; and (2) Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the center is approved. B. A center with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified at §A of this regulation. C. Whenever a child in care is being transported under center auspices to or from the center, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. D. §C of this regulation does not apply if the driver of the vehicle is a parent of a child in care who is designated by the center operator to assist in transporting children in care. Letter of Compliance: 13A.17.10.02 A. At all times, including during an off-site activity, at least one individual who is responsible for supervision of children shall be present who holds a current certificate indicating successful completion of approved: Cardiopulmonary resuscitation (CPR) training through the American Heart Association, or a program with equivalent standards, which is appropriate to all child age groups for which the facility is approved. B. A facility with an approved capacity of more than 20 children shall have in attendance, in a ratio of at least one staff member for every 20 children present, staff members who are currently certified in approved first aid and CPR as specified in §A of this regulation. C. Whenever a child in care is being transported under child care facility auspices to or from the facility, there shall be at least one adult present in the vehicle who is currently certified in approved CPR and first aid. This requirement may be met by the driver of the vehicle if the driver is an employee of the center. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: 13A.16.17.02 Child Care Center and 13A.18.07.02 Letter of Compliance: Abuse/Neglect Reporting: C. An operator shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care 13A.15.07.02: Abuse/Neglect Reporting: An individual who is responsible for providing care to a child: A. Shall monitor the child for signs and symptoms of child abuse or neglect. Large Family Child Care 13A.18.07.02: Abuse/Neglect Reporting C. A provider shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt providers sign an agreement annually stating they would report any case of abuse or neglect directly to the Child Protective Unit at the Local Department of Social Services or to a law enforcement agency, as required under Maryland law; because children in care should not be subjected to abuse, neglect, mental injury, or injurious treatment. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 13A.16.17.02 Child Care Center and 13A.18.07.02 Letter of Compliance: Abuse/Neglect Reporting: C. An operator shall: (1) Instruct the staff to monitor all children daily for signs and symptoms of child abuse and neglect. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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: 13A.16.17.02 Child Care Center and 13A.18.07.02: Letter of Compliance Abuse/Neglect Reporting: A. An operator, staff member, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department or to a law enforcement agency, as required under Maryland law; (2) Neglected, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department as required under Maryland law. B. When a child has been subjected to injurious treatment, it shall be reported to the office. C. An operator shall: (2) Instruct staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and(3) Post, near each telephone in the facility, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. An operator may not require a staff member, employee, substitute, or volunteer to report through the operator or director, rather than directly to the local department or a law enforcement agency, when the staff member has reason to believe that a child has been abused or neglected. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care: 13A.15.07.02 Abuse/Neglect Reporting An individual who is responsible for providing care to a child: B. If the individual has reason to believe that a child in care has been: (1) Abused, shall report that belief directly to the protective services unit of the local department of social services or to a law enforcement agency, as required under Maryland law; or (2) Neglected, shall report that belief directly to the protective services unit of the local department of social services as required under Maryland law. Large Family Child Care: 13A.18.07.02 Abuse/Neglect Reporting A. A provider, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, inside or outside of the child care home, shall report that belief directly to the protective services unit of the local department or to a law enforcement agency, as required under Maryland law; or (2) Neglected, inside or outside of the child care home, shall report that belief directly to the protective services unit of the local department as required under Maryland law. B. If a child has been subjected to injurious treatment, it shall be reported to the office. C (2) Instruct the staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and (3) Post, near each telephone in the child care home, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. A provider may not require an employee, substitute, or volunteer to report through the provider, rather than directly to the local department or a law enforcement agency, when the employee, substitute, or volunteer has reason to believe that a child has been abused or neglected. iii. All CCDF-eligible licensed in-home care. Provide the standard: N/A [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: N/A vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt providers must report suspected child abuse and neglect directly to child protective services and or law enforcement as required by Maryland Law. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 13A.16.17.02 Child Care Center and 13A.18.07.02: Letter of Compliance Abuse/Neglect Reporting: A. An operator, staff member, employee, substitute, or volunteer who has reason to believe that a child has been: (1) Abused, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department or to a law enforcement agency, as required under Maryland law; (2) Neglected, in a facility or outside of the facility, shall report that belief directly to the Child Protective Services unit of the local department as required under Maryland law. B. When a child has been subjected to injurious treatment, it shall be reported to the office. C. An operator shall: (2) Instruct staff about their legal obligations to report suspected child abuse or neglect directly to the local department or the appropriate law enforcement agency; and(3) Post, near each telephone in the facility, the telephone numbers of the Child Protective Services unit of the local department and the appropriate law enforcement agency. D. An operator may not require a staff member, employee, substitute, or volunteer to report through the operator or director, rather than directly to the local department or a law enforcement agency, when the staff member has reason to believe that a child has been abused or neglected. Summer Camps are regulated by the Maryland Department of Health and are not eligible for CCDF funds. 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? [ ] Yes. [x] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: ii. Access to physical activity. Describe: iii. Caring for children with special needs. Describe: iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: