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: The provider shall report to the local health department if any child in the facility is suspected of having a reportable disease. In the event of an outbreak of communicable disease in the facility, caregivers shall implement control measures recommended by a local state health authority as required by the department. Each child shall be observed for contagious diseases and for other signs of illness on arrival and throughout the day. The parent(s) or his/her designee shall be contacted when signs of illness are observed. Unless determined otherwise by the parent(s) or provider, a child with no more than one of the following symptoms may remain in care: a child with a temperature of up to one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; after an illness has been evaluated by a physician, medication has been prescribed and any period of contagion has passed as determined by a licensed physician; when it has been determined that a child has a common cold unless the director and the parent(s) agree that isolation precautions should be taken; when a child has vomited once with no further vomiting episodes, other symptoms, or both; or when a child has experienced loose stools only one time with no further problems or symptoms. If children exhibit any of the following symptoms, they must be sent home: diarrhea￿more than one abnormally loose stool. If a child has one loose stool, s/he shall be observed for additional loose stools or other symptoms; severe coughing￿if the child gets red or blue in the face or makes high-pitched croupy or whooping sounds after coughing; difficult or rapid breathing (especially important in infants under six months; yellowish skin or eyes; Pinkeye￿tears, redness of eyelid lining, irritation, followed by swelling or discharge of pus; unusual spots or rashes; sore throat or trouble swallowing; an infected skin patch(es)￿crusty, bright yellow, dry or gummy areas of the skin; unusually dark, tea-colored urine; grey or white stool; fever over one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; headache and stiff neck; vomiting more than once; and severe itching of the body or scalp, or scratching of the scalp. These may be symptoms of lice or scabies. The ill child shall be kept isolated from the other children until the parent(s) arrives. No child shall be permitted to enroll in or attend any day care facility caring for ten or more children unless the child has been immunized adequately against vaccine- preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day, and year of administration. In the event of an outbreak or suspected outbreak of a vaccine-preventable disease in the facility, the administrator of the facility shall follow the control measures instituted by the local health authority or the department, or both the local health authority and the department. Staff or volunteers shall not work when ill if the health or well- being of children is endangered. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The provider shall report to the local health department if any child in the facility is suspected of having a reportable disease. In the event of an outbreak of communicable disease in the facility, caregivers shall implement control measures recommended by a local state health authority as required by the department. Each child shall be observed for contagious diseases and for other signs of illness on arrival and throughout the day. The parent(s) or his/her designee shall be contacted when signs of illness are observed. Unless determined otherwise by the parent(s) or provider, a child with no more than one of the following symptoms may remain in care: a child with a temperature of up to one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; after an illness has been evaluated by a physician, medication has been prescribed and any period of contagion has passed as determined by a licensed physician; when it has been determined that a child has a common cold unless the director and the parent(s) agree that isolation precautions should be taken; when a child has vomited once with no further vomiting episodes, other symptoms, or both; or when a child has experienced loose stools only one time with no further problems or symptoms. If children exhibit any of the following symptoms, they must be sent home: diarrhea￿more than one abnormally loose stool. If a child has one loose stool, s/he shall be observed for additional loose stools or other symptoms; severe coughing￿if the child gets red or blue in the face or makes high- pitched croupy or whooping sounds after coughing; difficult or rapid breathing (especially important in infants under six months; yellowish skin or eyes; Pinkeye￿tears, redness of eyelid lining, irritation, followed by swelling or discharge of pus; unusual spots or rashes; sore throat or trouble swallowing; an infected skin patch(es)￿crusty, bright yellow, dry or gummy areas of the skin; unusually dark, tea-colored urine; grey or white stool; fever over one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; headache and stiff neck; vomiting more than once; and severe itching of the body or scalp, or scratching of the scalp. These may be symptoms of lice or scabies. The ill child shall be kept isolated from the other children until the parent(s) arrives. No child shall be permitted to enroll in or attend any day care facility caring for ten or more children unless the child has been immunized adequately against vaccine-preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day, and year of administration. In the event of an outbreak or suspected outbreak of a vaccine- preventable disease in the facility, the administrator of the facility shall follow the control measures instituted by the local health authority or the department, or both the local health authority and the department. No individual shall work when ill if the health or well-being of children is endangered. 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: Requirements for religious organizations and nursery schools (LE): The director or other caregiver shall report to the local health department when any child in a facility is suspected of having a reportable communicable disease. In the event of an unusual outbreak of a reportable communicable disease, caregivers shall implement control measures recommended by the department or local health department. Caregivers shall use proper handwashing techniques with soap and warm, running water after toileting, after assisting a child with toileting, after diapering a child, and at other times as needed. Good hygiene practices shall be followed during food preparation. These practices include, but are not limited to, washing hands properly after smoking, eating, drinking, using the restroom, after touching raw food products and before preparing and serving food. Hands shall be dried with single-service towels. Caregivers shall teach and see that children wash their hands at appropriate times: before eating, after toileting and as needed when hands are soiled. Caregivers shall not work when ill and likely to transmit an illness that might endanger the health or well-being of children. This may include symptoms such as fever, coughing, upper respiratory infection, vomiting or diarrhea. Each child shall be observed for contagious diseases and other signs of illness on arrival and throughout each day. A parent or guardian shall be contacted when signs of illness are observed. When a child exhibits any of the symptoms described below, the parent(s) shall be contacted and the child shall be sent home. Parental contact shall be recorded and filed in the child’s records. Symptoms that require parental contact and sending a child home are: more than one abnormally loose stool; red or blue in the face or makes high-pitched croupy or whooping sounds after coughing; difficult or rapid breathing￿especially important in infants under six months of age; yellowish skin or eyes; tears, redness of eyelid lining or irritation, followed by swelling or discharge of pus; unusual spots or rashes; sore throat or swallowing difficulty; an infected skin patch￿crusty, bright yellow, dry or gummy areas of the skin; unusually dark, tea- colored urine; gray or white stool; fever over one hundred one degrees Fahrenheit (101°F) by mouth or one hundred degrees Fahrenheit (100°F) under the arm; headache and stiff neck; vomiting more than once; a child is in the contagious period of a disease; or severe itching of the body or scalp or scratching of the scalp which may be symptoms of lice or scabies. An ill child shall be kept isolated from the other children and a caregiver shall be in close proximity to the child until a parent arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that indicate a need for assistance. A parent of each child shall be notified when any reportable communicable disease occurs in the facility. Child care facilities shall meet immunization requirements. Requirements for other license exempt child care centers: Staff in facilities receiving subsidy are required to be in compliance with the standard on the Prevention and Control of Infectious Diseases including immunizations. Good hygiene, proper sanitation, and consistently following universal health precautions in early childhood setting is essential for reducing health risks to children and adults by limiting the spread of infectious germs. All are designed to promote wellness and prevent and control infectious diseases. Using appropriate sanitation measures and universal precautions protect the health and safety of everyone. Requirements for staff to have medical examinations, immunization requirements for children, restrictions for children and staff to be present when ill, and diapering and handwashing requirements, proper handling of food, water play, using toilet or assisting a child in the use of a toilet. Standard requires that providers have a set and routine cleaning, sanitizing and disinfecting process using soap and water, bleach/water solution, dishwasher and washing machine. Knowledge of signs and symptoms of illness, decision making if child should remain or be excluded from the child care setting and when to notify parent/guardian that child has signs or showing symptoms of illness. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Staff in facilities receiving subsidy are required to be in compliance with the standard on the Prevention and Control of Infectious Diseases including immunizations. Good hygiene, proper sanitation, and consistently following universal health precautions in early childhood setting is essential for reducing health risks to children and adults by limiting the spread of infectious germs. All are designed to promote wellness and prevent and control infectious diseases. Using appropriate sanitation measures and universal precautions protect the health and safety of everyone. Requirements for staff to have medical examinations, immunization requirements for children, restrictions for children and staff to be present when ill, and diapering and handwashing requirements, proper handling of food, water play, using toilet or assisting a child in the use of a toilet. Standard requires that providers have a set and routine cleaning, sanitizing and disinfecting process using soap and water, bleach/water solution, dishwasher and washing machine. Knowledge of signs and symptoms of illness, decision making if child should remain or be excluded from the child care setting and when to notify parent/guardian that child has signs or showing symptoms of illness. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Staff in facilities receiving subsidy are required to be in compliance with the standard on the Prevention and Control of Infectious Diseases including immunizations. Good hygiene, proper sanitation, and consistently following universal health precautions in early childhood setting is essential for reducing health risks to children and adults by limiting the spread of infectious germs. All are designed to promote wellness and prevent and control infectious diseases. Using appropriate sanitation measures and universal precautions protect the health and safety of everyone. Requirements for staff to have medical examinations, immunization requirements for children, restrictions for children and staff to be present when ill, and diapering and handwashing requirements, proper handling of food, water play, using toilet or assisting a child in the use of a toilet. Standard requires that providers have a set and routine cleaning, sanitizing and disinfecting process using soap and water, bleach/water solution, dishwasher and washing machine. Knowledge of signs and symptoms of illness, decision making if child should remain or be excluded from the child care setting and when to notify parent/guardian that child has signs or showing symptoms of illness. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Requirements for licensed afterschool programs: The provider shall report to the local health department if any child in the facility is suspected of having a reportable disease. In the event of an outbreak of communicable disease in the facility, caregivers shall implement control measures recommended by a local state health authority as required by the department. Each child shall be observed for contagious diseases and for other signs of illness on arrival and throughout the day. The parent(s) or his/her designee shall be contacted when signs of illness are observed. Unless determined otherwise by the parent(s) or provider, a child with no more than one of the following symptoms may remain in care: a child with a temperature of up to one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; after an illness has been evaluated by a physician, medication has been prescribed and any period of contagion has passed as determined by a licensed physician; when it has been determined that a child has a common cold unless the director and the parent(s) agree that isolation precautions should be taken; when a child has vomited once with no further vomiting episodes, other symptoms, or both; or when a child has experienced loose stools only one time with no further problems or symptoms. If children exhibit any of the following symptoms, they must be sent home: diarrhea￿more than one abnormally loose stool. If a child has one loose stool, s/he shall be observed for additional loose stools or other symptoms; severe coughing￿if the child gets red or blue in the face or makes high-pitched croupy or whooping sounds after coughing; difficult or rapid breathing (especially important in infants under six months; yellowish skin or eyes; Pinkeye￿tears, redness of eyelid lining, irritation, followed by swelling or discharge of pus; unusual spots or rashes; sore throat or trouble swallowing; an infected skin patch(es)￿crusty, bright yellow, dry or gummy areas of the skin; unusually dark, tea-colored urine; grey or white stool; fever over one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; headache and stiff neck; vomiting more than once; and severe itching of the body or scalp, or scratching of the scalp. These may be symptoms of lice or scabies. Requirements for other exempt out-of- school programs: Staff in facilities receiving subsidy are required to be in compliance with the standard on the Prevention and Control of Infectious Diseases including immunizations. Good hygiene, proper sanitation, and consistently following universal health precautions in early childhood setting is essential for reducing health risks to children and adults by limiting the spread of infectious germs. All are designed to promote wellness and prevent and control infectious diseases. Using appropriate sanitation measures and universal precautions protect the health and safety of everyone. Requirements for staff to have medical examinations, immunization requirements for children, restrictions for children and staff to be present when ill, and diapering and handwashing requirements, proper handling of food, water play, using toilet or assisting a child in the use of a toilet. Standard requires that providers have a set and routine cleaning, sanitizing and disinfecting process using soap and water, bleach/water solution, dishwasher and washing machine. Knowledge of signs and symptoms of illness, decision making if child should remain or be excluded from the child care setting and when to notify parent/guardian that child has signs or showing symptoms of illness. 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: Completion by the parent(s) of the following written information shall be on file before the child is accepted for care: Information indicating that the child has completed age- appropriate immunizations, is in the process of completing immunizations, or is exempt from immunization requirements. No child shall be permitted to enroll in or attend any day care facility caring for ten or more children unless the child has been immunized adequately against vaccine-preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month day and year of administration. A child who has not completed all immunizations appropriate for his/her age may enroll, if satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/ Missouri Department of Health recommended schedule; or the parent(s) or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following: a medical exemption by which the child shall be exempted from immunization requirements upon certification by a licensed physician that the immunization would seriously endanger the child’s health or life; or a parent or guardian exemption, by which a child shall be exempted from immunization requirements if one parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age-appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Completion by the parent(s) of the following written information shall be on file before the child is accepted for care: Information indicating that the child has completed age-appropriate immunizations, is in the process of completing immunizations, or is exempt from immunization requirements. No child shall be permitted to enroll in or attend any day care facility caring for ten or more children unless the child has been immunized adequately against vaccine- preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month day and year of administration. A child who has not completed all immunizations appropriate for his/her age may enroll, if satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/ Missouri Department of Health recommended schedule; or the parent(s) or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following: a medical exemption by which the child shall be exempted from immunization requirements upon certification by a licensed physician that the immunization would seriously endanger the child’s health or life; or a parent or guardian exemption, by which a child shall be exempted from immunization requirements if one parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age- appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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: Requirements for religious organizations and nursery schools (LE): Child care facilities shall meet immunization requirements for children. The Contract for Child Care Subsidy Services Terms and Conditions state that the provider shall maintain accurate records. The following records shall contain the following information for each child served under this contract: record of completed immunizations. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age- appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that the provider shall maintain accurate records. The following records shall contain the following information for each child served under this contract: record of completed immunizations. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age-appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that the provider shall maintain accurate records. The following records shall contain the following information for each child served under this contract: record of completed immunizations. The Lead Agency received a Preliminary Notice of Possible Non- Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age-appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Requirements for licensed afterschool programs: Completion by the parent(s) of the following written information shall be on file before the child is accepted for care: Information indicating that the child has completed age-appropriate immunizations, is in the process of completing immunizations, or is exempt from immunization requirements. No child shall be permitted to enroll in or attend any day care facility caring for ten or more children unless the child has been immunized adequately against vaccine- preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month day and year of administration. A child who has not completed all immunizations appropriate for his/her age may enroll, if satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/ Missouri Department of Health recommended schedule; or the parent(s) or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following: a medical exemption by which the child shall be exempted from immunization requirements upon certification by a licensed physician that the immunization would seriously endanger the child’s health or life; or a parent or guardian exemption, by which a child shall be exempted from immunization requirements if one parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. Requirements for all other exempt out-of-school programs: The Contract for Child Care Subsidy Services Terms and Conditions state that the provider shall maintain accurate records. The following records shall contain the following information for each child served under this contract: record of completed immunizations. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating the Lead Agency does not currently have age- appropriate immunization requirements for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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: Every three years, the child care provider, group child care home provider, child care staff members, and volunteers in a group child care home or child care center licensed to provide care for infants less than one year of age shall successfully complete department- approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations. The child care provider, group child care home provider, child care staff members, and volunteers shall complete safe sleep training within thirty days of employment or volunteering at the facility. The provider’s infant safe sleep policy shall comply with section 210.223, RSMo, and shall include, but not be limited to the following safe sleep practices: the policy shall list the licensee’s expectations regarding how and when caregivers are to be trained on safe sleep; a requirement that children less than one year of age be placed on their backs to sleep; a requirement that the facility shall receive a written statement from the infant’s licensed health care provider stating that the infant requires alternative sleep positions or special sleeping arrangements that differ from those set forth in these rules prior to allowing the infant to be placed in a sleep position that is not on his or her back; and supervision of infants during nap/sleep times, to include: positioning of staff; lighting in the nap room; physical checks of the child to ensure he or she is not overheated or in distress; and prohibitions against the use of any equipment such as a sound machine that may interfere with the caregiver’s ability to see or hear a child who may be distressed; and the following requirements for safe sleep environments: the policy shall state that cribs and playpens must have a firm mattress and tight fitting sheets, be free of loose bedding, bumper pads, pillows, and soft toys; shall require infants’ heads be uncovered during nap/ sleep times; shall prohibit covering cribs or playpens with blankets or bedding; shall prohibit smoking in the child care home during the hours children are in care; and shall require giving the parent(s) or guardian(s) of each infant in care a copy of the provider’s safe sleep policy upon the child’s enrollment. A supervised nap period that meets the child’s individual needs shall meet the following requirements: a child under twelve months of age shall be placed on his/her back to sleep; an infant’s head and face shall remain uncovered during sleep; infants unable to roll from their stomachs to their backs and from their backs to their stomachs shall be placed on their backs when found face down. When infants can easily turn from their stomachs to their backs and from their backs to their stomachs, they shall be initially placed on their backs, but shall be allowed to adopt whatever positions they prefer for sleep; an infant shall not be overdressed when sleeping to avoid overheating. Infants should be dressed appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment; when, in the opinion of the infant’s licensed health care provider, an infant requires alternative sleep positions or special sleeping arrangements that differ from those set forth in this rule, the provider shall have on file at the facility written instructions, signed by the infant’s licensed health care provider, detailing the alternative sleep positions or special sleeping arrangements for such infant. The caregiver(s) shall put the infant to sleep in accordance with such written instructions; pacifiers, if used, shall not be hung around the infant’s neck. Pacifier mechanisms or pacifiers that attach to infant clothing shall not be used with sleeping infants. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Every three years the provider, assistant(s), and volunteers in a family child care home licensed to provide care for infants less than one year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations. The provider, assistant(s), and volunteers in a family child care home shall complete the safe sleep training prior to licensure. The provider and any assistant hired or volunteering at the facility after initial licensure shall complete the safe sleep training within thirty days of employment or volunteering at the facility. The provider’s infant safe sleep policy shall comply with section 210.223, RSMo, and shall include, but not be limited to the following safe sleep practices: the policy shall list the licensee’s expectations regarding how and when caregivers are to be trained on safe sleep; a requirement that children less than one year of age be placed on their backs to sleep; a requirement that the facility shall receive a written statement from the infant’s licensed health care provider stating that the infant requires alternative sleep positions or special sleeping arrangements that differ from those set forth in these rules prior to allowing the infant to be placed in a sleep position that is not on his or her back; and supervision of infants during nap/sleep times, to include: positioning of staff; lighting in the nap room; physical checks of the child to ensure he or she is not overheated or in distress; and prohibitions against the use of any equipment such as a sound machine that may interfere with the caregiver’s ability to see or hear a child who may be distressed; and the following requirements for safe sleep environments: the policy shall state that cribs and playpens must have a firm mattress and tight fitting sheets, be free of loose bedding, bumper pads, pillows, and soft toys; shall require infants’ heads be uncovered during nap/ sleep times; shall prohibit covering cribs or playpens with blankets or bedding; shall prohibit smoking in the child care home during the hours children are in care; and shall require giving the parent(s) or guardian(s) of each infant in care a copy of the provider’s safe sleep policy upon the child’s enrollment. A supervised nap period that meets the child’s individual needs shall meet the following requirements: a child under twelve months of age shall be placed on his/her back to sleep; an infant’s head and face shall remain uncovered during sleep; infants unable to roll from their stomachs to their backs and from their backs to their stomachs shall be placed on their backs when found face down. When infants can easily turn from their stomachs to their backs and from their backs to their stomachs, they shall be initially placed on their backs, but shall be allowed to adopt whatever positions they prefer for sleep; an infant shall not be overdressed when sleeping to avoid overheating. Infants should be dressed appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment; when, in the opinion of the infant’s licensed health care provider, an infant requires alternative sleep positions or special sleeping arrangements that differ from those set forth in this rule, the provider shall have on file at the facility written instructions, signed by the infant’s licensed health care provider, detailing the alternative sleep positions or special sleeping arrangements for such infant. The caregiver(s) shall put the infant to sleep in accordance with such written instructions; pacifiers, if used, shall not be hung around the infant’s neck. Pacifier mechanisms or pacifiers that attach to infant clothing shall not be used with sleeping infants. 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: Staff in facilities receiving subsidy are required to be in compliance with the standard on the prevention of sudden infant and death syndrome and use of safe-sleep practices. All licensed, license-exempt and registered child care providers are required to complete a training on safe sleep and SIDS at time of hire. Prevention of sudden infant death syndrome and use of safe sleep practices, as a caregiver, it is important to ensure an infant’s sleep environment is a safe one. All caregivers should follow safe sleep practices as recommended by the American Academy of Pediatrics (AAP) to reduce the risk of sudden infant death syndrome (SIDS) or suffocation death and other infant deaths that could occur when an infant is in a crib or asleep. Training requirements for caregivers include appropriate sleeping areas (cribs, pack and play), bedding, sleep wear, items in cribs, and sleeping on back. Through training, the objective is for staff to recognize that safe sleep practices are used to reduce risk for SIDS or suffocation death while infants are napping or sleeping. The techniques trained and to be used include: place the baby on his or her back to sleep alone, for naps and night time; place the baby in a safety-approved crib with a firm surface and fitted sheet; do not use an infant seat, swing, or any other type of furniture/equipment that is not a safety approved crib; remove all soft objects, toys, blankets, bumper pads, and pillows from the sleep area; dress the baby in a sleeper or sleep sack instead of using a blanket or other covering; directly observe the infant by sight and sound at all times. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The child care provider is required to be in compliance with the standard on the prevention of sudden infant and death syndrome and use of safe-sleep practices and must complete a training on safe sleep and SIDS at time of hire. Prevention of sudden infant death syndrome and use of safe sleep practices, as a caregiver, it is important to ensure an infant’s sleep environment is a safe one. All caregivers should follow safe sleep practices as recommended by the American Academy of Pediatrics (AAP) to reduce the risk of sudden infant death syndrome (SIDS) or suffocation death and other infant deaths that could occur when an infant is in a crib or asleep. Training requirements for caregivers include appropriate sleeping areas (cribs, pack and play), bedding, sleep wear, items in cribs, and sleeping on back. Through training, the objective is for staff to recognize that safe sleep practices are used to reduce risk for SIDS or suffocation death while infants are napping or sleeping. The techniques trained and to be used include: place the baby on his or her back to sleep alone, for naps and night time; place the baby in a safety-approved crib with a firm surface and fitted sheet; do not use an infant seat, swing, or any other type of furniture/equipment that is not a safety approved crib; remove all soft objects, toys, blankets, bumper pads, and pillows from the sleep area; dress the baby in a sleeper or sleep sack instead of using a blanket or other covering; directly observe the infant by sight and sound at all times. The provider is required to complete the DESE provided CCDF Health & Safety Training which contains a component on infant safe sleep prior to being approval of a contract to receive subsidy. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The child care provider is required to be in compliance with the standard on the prevention of sudden infant and death syndrome and use of safe-sleep practices and must complete a training on safe sleep and SIDS at time of hire. Prevention of sudden infant death syndrome and use of safe sleep practices, as a caregiver, it is important to ensure an infant’s sleep environment is a safe one. All caregivers should follow safe sleep practices as recommended by the American Academy of Pediatrics (AAP) to reduce the risk of sudden infant death syndrome (SIDS) or suffocation death and other infant deaths that could occur when an infant is in a crib or asleep. Training requirements for caregivers include appropriate sleeping areas (cribs, pack and play), bedding, sleep wear, items in cribs, and sleeping on back. Through training, the objective is for staff to recognize that safe sleep practices are used to reduce risk for SIDS or suffocation death while infants are napping or sleeping. The techniques trained and to be used include: place the baby on his or her back to sleep alone, for naps and night time; place the baby in a safety-approved crib with a firm surface and fitted sheet; do not use an infant seat, swing, or any other type of furniture/equipment that is not a safety approved crib; remove all soft objects, toys, blankets, bumper pads, and pillows from the sleep area; dress the baby in a sleeper or sleep sack instead of using a blanket or other covering; directly observe the infant by sight and sound at all times. The provider is required to complete the DESE provided CCDF Health & Safety Training which contains a component on infant safe sleep prior to being approval of a contract to receive subsidy. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: There is no safe sleep standard for out of school programs as these programs provide care to school age children only. 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: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. Prescription medication shall be in the original container and labeled with the child’s name, instructions for administration, including the times and amounts for dosages and the physician’s name. This may include sample medication provided by a physician. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. All medication shall be stored out of reach of children or in a locked container. Medication shall be returned to storage immediately after use. Medication needing refrigeration shall be kept in the refrigerator in a container separate from food. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. The date and time(s) of administration, the name of the individual giving the medication and the quantity of any medication given shall be recorded promptly after administration. This information shall be filed in the child’s record after the medication is no longer necessary. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. Prescription medication shall be in the original container and labeled with the child’s name, instructions for administration, including the times and amounts for dosages and the physician’s name. This may include sample medication provided by a physician. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. All medication shall be stored out of reach of children or in a locked container. Medication shall be returned to storage immediately after use. Medication needing refrigeration shall be kept in the refrigerator in a container separate from food. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. The date and time(s) of administration, the name of the individual giving the medication and the quantity of any medication given shall be recorded promptly after administration. This information shall be filed in the child’s record after the medication is no longer 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: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. A record will be maintained as to the time and the amount of any medication given or applied. The medication shall be in the original container, stored according to the instructions, and must have the original pharmacy label indicating the physician’s name, child’s name, instructions, and name and strength of the medication and shall be given in accordance with those instructions. Medications will be kept out of the reach of children. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. A record will be maintained as to the time and the amount of any medication given or applied. The medication shall be in the original container, stored according to the instructions, and must have the original pharmacy label indicating the physician’s name, child’s name, instructions, and name and strength of the medication and shall be given in accordance with those instructions. Medications will be kept out of the reach of children. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. A record will be maintained as to the time and the amount of any medication given or applied. The medication shall be in the original container, stored according to the instructions, and must have the original pharmacy label indicating the physician’s name, child’s name, instructions, and name and strength of the medication and shall be given in accordance with those instructions. Medications will be kept out of the reach of children. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. Prescription medication shall be in the original container and labeled with the child’s name, instructions for administration, including the times and amounts for dosages and the physician’s name. This may include sample medication provided by a physician. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. All medication shall be stored out of reach of children or in a locked container. Medication shall be returned to storage immediately after use. Medication needing refrigeration shall be kept in the refrigerator in a container separate from food. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. The date and time(s) of administration, the name of the individual giving the medication and the quantity of any medication given shall be recorded promptly after administration. This information shall be filed in the child’s record after the medication is no longer necessary. Requirements for all other exempt out-of-school programs: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. A record will be maintained as to the time and the amount of any medication given or applied. The medication shall be in the original container, stored according to the instructions, and must have the original pharmacy label indicating the physician’s name, child’s name, instructions, and name and strength of the medication and shall be given in accordance with those instructions. Medications will be kept out of the reach of children. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. 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: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. 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 Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Requirements for licensed afterschool programs: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. Requirements for all other exempt out-of-school programs: The Provider Policy Manual for Contracted Subsidy Providers states: When a parent/guardian requests the child care provider to administer medication, the following shall apply: Medication, including prescription drugs or individual special medical procedures, will be given or applied only with prior written permission from the parent/guardian. Instructions from a parent/guardian which contradict the instructions of the physician (for prescription drugs) or the instructions on the label (for over-the-counter drugs) will not be honored. Medications will be returned to the parent/guardian when it is expired or no longer needed. No medication prescribed to one child will ever be administered to another child at any time. 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: The provider, within 30 days following the admission of each infant, toddler, or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The department’s form includes a section for the physician to provide instructions for specialized care which includes allergies, special diets, diabetes, etc. During monitoring inspections, Compliance Inspectors review medical examination reports and enrollment forms. If the doctor or parent has indicated that the child has an allergy, the provider is required to have a special needs plan on file for that child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The provider, within 30 days following the admission of each infant, toddler, or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The department’s form includes a section for the physician to provide instructions for specialized care which includes allergies, special diets, diabetes, etc. 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 Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of chokking emergencies and have the knowledge of handling an incident through First Aid and CPR training. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed afterschool programs, the medical examination report form and the health history report for school-age children shall be supplied by the department or the facility may use its own form if it contains all the information on the department’s form. This report requires the parent to list any allergies or special medical conditions. For other exempt afterschool programs, the Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. 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: Caregivers shall have knowledge of the needs of children and shall be sensitive to the capabilities, interests, and problems of children in care. Caregivers shall be capable of handling emergencies promptly and intelligently. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers shall have knowledge of the needs of children and shall be sensitive to the capabilities, interests, and problems of children in care. Caregivers shall be capable of handling emergencies promptly and intelligently. 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 Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed afterschool programs: Caregivers shall have knowledge of the needs of children and shall be sensitive to the capabilities, interests, and problems of children in care. Caregivers shall be capable of handling emergencies promptly and intelligently. For other exempt afterschool programs, The Contract for Child Care Subsidy Services Terms and Conditions requires that providers follow the Health and Safety Standards which states that child care providers and staff need to be aware of the common types and symptoms of an allergic reaction, ways to prevent allergic reactions, and the steps to take to handle an allergy emergency. Child care providers should have on file documentation on each child in care that has a history of or known allergy, including food allergies. The child care provider should be aware of steps to take to avoid the allergens, specific symptoms that would indicate the need for treatment, and what treatment is necessary in the event of an allergic reaction. The child care provider must notify the parent/guardian when a child shows signs or symptoms of an allergic reaction. In addition to allergic reactions, staff should be aware of choking emergencies and have the knowledge of handling an incident through First Aid and CPR training. 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: The premises shall be safe and suitable for the care of children. The premises shall conform to the fire and safety requirements of the State Fire Marshal or his/her designee. Children shall have no access to areas not approved for child care. Stairways in approved child care space shall be well lighted and free of obstructions. Stairways in approved child care space having more than three steps shall have a handrail the children can reach. Porches, decks, stairwells or other areas in approved child care space having a drop-off of more than 24 inches from which children might fall and be injured shall have an approved railing or approved barrier. The railing or barrier shall be constructed to prevent the child from crawling or falling through or becoming entrapped. Approved safety gates at stairways and doors shall be provided and used as needed. Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children. Heaters, floor furnaces, radiators, hot water heaters or other equipment which pose a threat to children shall meet the requirements of Fire Safety. All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children. Ammunition, guns, hunting knives, bows and arrows or other weapons shall be stored in a locked cabinet or locked closet. A fenced outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. For facilities initially licensed after the effective date of these rules or for the installation of new fences in existing facilities, the fence shall be at least 42 inches high. An outdoor play area used exclusively for school-age children shall not be required to have a fence. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped. The play area shall be safe for children’s activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage. The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact-absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material. The provider shall be responsible for the type, depth and fall-zone area of resilient material necessary for the protection of children. Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed. Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The premises shall be safe and suitable for the care of children. The premises shall conform to the fire and safety requirements of the State Fire Marshal or his/her designee. Children shall have no access to areas not approved for child care. Stairways in approved child care space shall be well lighted and free of obstructions. Stairways in approved child care space having more than three steps shall have a handrail the children can reach. Porches, decks, stairwells or other areas in approved child care space having a drop-off of more than 24 inches from which children might fall and be injured shall have an approved railing or approved barrier. The railing or barrier shall be constructed to prevent the child from crawling or falling through, or becoming entrapped. Approved safety gates at stairways and doors shall be provided and used as needed. Heaters, floor furnaces, radiators, hot water heaters or other equipment which poses a threat to children shall meet the requirements of Fire Safety. All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children. Ammunition, guns, hunting knives, bows and arrows or other weapons shall be stored in a locked cabinet or locked closet. An outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. It shall be fenced when necessary for the protection of children from traffic, water or other hazards. For family day care homes initially licensed after the effective date of these rules, or for the installation of new fences in existing facilities, the fence shall be at least 42 inches high. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped. The play area shall be safe for children’s activities, well maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage. The fall- zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact-absorbing materials which effectively cushions the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material. Grass may be an approved resilient material, but if grass becomes worn or sparse, the area must be covered with another approved resilient material. Swimming and wading pools used by children shall be constructed, maintained, and used in a manner which safeguards the lives and health of children. Swimming and wading pools shall have a water filtration system. The water in swimming and wading pools shall be treated, cleaned, and maintained in accordance with health practices and rules as determined by the local or state health authority, or both. Swimming and wading pools shall be fenced to prevent access by children. For family day care homes initially licensed after the effective date of these rules, the fence shall be at least 42 inches high and shall have a locked gate. Above-the- ground pools may use a 42-inch fence around the top of the pool with barricades of the steps to the pool deck. Children using swimming or wading pools shall be instructed in water safety and supervised by an adult at all times. An adult with a current lifeguard training certificate, including infant/child cardiopulmonary resuscitation (CPR) training, shall be on duty when a swimming or wading pool containing a depth of 48 inches or more of water is being used. An adult who has completed a course in basic water safety, which includes infant/child CPR, shall be on duty when a swimming or wading pool containing less than 48 inches of water is being used. 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: Requirements for religious organizations and nursery schools (LE): The premises of all facilities shall be safe and suitable for the care of children. Children shall have no access to areas not approved for child care. Porches, decks, stairwells or other areas in approved child care space shall have protective handrails and guardrails if there is a drop-off of more than 24 inches from which children might fall and be injured. Guardrails shall be at least 36 inches high, and shall have bars placed at intervals of no more than 3 1/2 inches, or have protective material to prevent a 3 1/2 inch sphere from passing through the bars. Approved safety gates at stairways and doors shall be provided as needed. Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials. Ammunition, guns, hunting knives, bows and arrows, or other weapons shall not be on the premises unless stored in a locked cabinet or closet. An outdoor play area available on or adjoining the child care property. Facilities with a capacity of more than 10 children shall have a fenced play area. Play areas in facilities with a capacity of 10 or fewer children shall be fenced when necessary for the protection of children from traffic, water or other hazards. Fences shall be at least 42 inches high. Openings in fences shall be no greater than three and 3 ½ inches. The play area shall be safe for children’s activities. It shall be well-maintained and free of hazards such as poisonous plants, broken glass, barbed wire, open wells, rocks and other debris, and shall have good drainage. These general fire safety requirements shall be followed at all facilities: At least one portable, operable flashlight shall be accessible to staff; All flammable materials shall be stored properly and accessible only to authorized persons. These requirements for exits and doors shall be followed at all facilities: Each floor occupied by children shall have no less than two exits remote from each other. Exit doors shall swing in the direction of exit travel and shall lead directly, or through an enclosed fire-resistant stairway, to the outside. This includes basement areas. For other exempt programs, The Contract for Child Care Subsidy Services Terms and Conditions requires that the physical space where child care is provided must ensure that hazardous materials are inaccessible to children and weapons and ammunition must be stored in locked cabinets inaccessible to children. The provider shall install and maintain operable smoke detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in the corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the smoke detector(s) shall provide an alarm. When the provider uses equipment or appliances that pose a potential carbon monoxide risk, including homes with attached garages, the provider shall install and maintain operable carbon monoxide detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in a corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the carbon monoxide detector(s) shall provide an alarm. The provider shall have a working fire extinguisher at the child care facility. The child care facility’s indoor space shall be safe and suitable for the care of children. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that the physical space where child care is provided must ensure that hazardous materials are inaccessible to children and weapons and ammunition must be stored in locked cabinets inaccessible to children. The provider shall install and maintain operable smoke detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in the corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the smoke detector(s) shall provide an alarm. When the provider uses equipment or appliances that pose a potential carbon monoxide risk, including homes with attached garages, the provider shall install and maintain operable carbon monoxide detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in a corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the carbon monoxide detector(s) shall provide an alarm. The provider shall have a working fire extinguisher at the child care facility. The child care facility’s indoor space shall be safe and suitable for the care of children. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions requires that the physical space where child care is provided must ensure that hazardous materials are inaccessible to children and weapons and ammunition must be stored in locked cabinets inaccessible to children. The provider shall install and maintain operable smoke detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in the corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the smoke detector(s) shall provide an alarm. When the provider uses equipment or appliances that pose a potential carbon monoxide risk, including homes with attached garages, the provider shall install and maintain operable carbon monoxide detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in a corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the carbon monoxide detector(s) shall provide an alarm. The provider shall have a working fire extinguisher at the child care facility. The child care facility’s indoor space shall be safe and suitable for the care of children. Subsidy rules require: The outdoor play area must meet the following criteria: it must be an area safe, maintained, and no hazards; the outdoor area must either be continuously fenced to ensure that the children cannot leave and others cannot enter the premises without supervision; or, if not fenced, child care provider must have a division approved, supervision plan for when children are in outdoor play area. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For exempt afterschool programs, the Contract for Child Care Subsidy Services Terms and Conditions requires that the physical space where child care is provided must ensure that hazardous materials are inaccessible to children and weapons and ammunition must be stored in locked cabinets inaccessible to children. The provider shall install and maintain operable smoke detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in the corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the smoke detector(s) shall provide an alarm. When the provider uses equipment or appliances that pose a potential carbon monoxide risk, including homes with attached garages, the provider shall install and maintain operable carbon monoxide detector(s) in accordance with the manufacturer’s instructions on the ceiling or wall at a point centrally located in a corridor or other area giving access to rooms used for providing child care services. The provider shall ensure that when activated, the carbon monoxide detector(s) shall provide an alarm. The provider shall have a working fire extinguisher at the child care facility. The child care facility’s indoor space shall be safe and suitable for the care of children. Per a new statute passed in 2024, licensed afterschool programs caring for school age children only will not be required to receive a fire safety inspection or have the physical premises inspected. 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: Swimming and wading pools used by children shall be constructed, maintained, and used in a manner which safeguards the lives and health of children. Swimming and wading pools shall have a water filtration system. The water in swimming and wading pools shall be treated, cleaned, and maintained in accordance with health practices and rules as determined by the local or state health authority, or both. Swimming and wading pools shall be fenced to prevent access by children. For facilities initially licensed after the effective date of these rules, the fence shall be at least 42 inches high and shall have a locked gate. Above-the-ground pools may use a 42-inch fence around the top of the pool with barricades of the steps to the pool deck. Children using swimming or wading pools shall be instructed in water safety and supervised by an adult at all times. An adult with a current lifeguard training certificate, including infant/child cardiopulmonary resuscitation (CPR) training, shall be on duty at all times when a swimming or wading pool containing a depth of 48 inches or more of water is being used. An adult who has completed a course in basic water safety, which includes infant/child CPR, shall be on duty when a swimming or wading pool containing less than 48 inches of water is being used. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Swimming and wading pools used by children shall be constructed, maintained, and used in a manner which safeguards the lives and health of children. Swimming and wading pools shall have a water filtration system. The water in swimming and wading pools shall be treated, cleaned, and maintained in accordance with health practices and rules as determined by the local or state health authority, or both. Swimming and wading pools shall be fenced to prevent access by children. For family day care homes initially licensed after the effective date of these rules, the fence shall be at least 42 inches high and shall have a locked gate. Above-the- ground pools may use a 42-inch fence around the top of the pool with barricades of the steps to the pool deck. Children using swimming or wading pools shall be instructed in water safety and supervised by an adult at all times. An adult with a current lifeguard training certificate, including infant/child cardiopulmonary resuscitation (CPR) training, shall be on duty when a swimming or wading pool containing a depth of 48 inches or more of water is being used. An adult who has completed a course in basic water safety, which includes infant/child CPR, shall be on duty when a swimming or wading pool containing less than 48 inches of water is being used. 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: Requirements for religious organizations and nursery schools (LE): Swimming and wading pools used by children that are constructed, maintained, and used in a manner that protects the health and safety of children. Swimming and wading pools shall be enclosed by a fence at least 42 inches high with a locked gate. Swimming and wading pools shall have a water filtration system. The water shall be treated, cleaned, and maintained in a manner approved by a state or local health authority. For other exempt centers, the Contract for Child Care Subsidy Services Terms and Conditions state that the child care provider and staff/volunteers should frequently inspect the outdoor setting to inspect for water hazards such as pools, drains, streams, and standing water. Pools and open water areas shall not be accessible to children without adult supervision. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that the child care provider and staff/volunteers should frequently inspect the outdoor setting to inspect for water hazards such as pools, drains, streams, and standing water. Pools and open water areas shall not be accessible to children without adult supervision. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that the child care provider and staff/volunteers should frequently inspect the outdoor setting to inspect for water hazards such as pools, drains, streams, and standing water. Pools and open water areas shall not be accessible to children without adult supervision. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For exempt out-of-school programs, the Contract for Child Care Subsidy Services Terms and Conditions state that the child care provider and staff/volunteers should frequently inspect the outdoor setting to inspect for water hazards such as pools, drains, streams, and standing water. Pools and open water areas shall not be accessible to children without adult supervision. Per a new statute passed in 2024, licensed afterschool programs caring for school age children only will not be required to receive a fire safety inspection or have the physical premises inspected. 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: A fenced outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. ii. All CCDF-eligible licensed family child care homes. Provide the standard: An outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. It shall be fenced when necessary for the protection of children from traffic, water or other 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: Requirements for religious organizations and nursery schools (LE): An outdoor play area available on or adjoining the child care property. Facilities with a capacity of more than 10 children shall have a fenced play area. Play areas in facilities with a capacity of 10 or fewer children shall be fenced when necessary for the protection of children from traffic, water or other hazards. The Contract for Child Care Subsidy Services Terms and Conditions require that the provider ensure that children have adequate supervision when outside or in areas near roadways. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The outdoor area must either be continuously fenced to ensure that the children cannot leave and others cannot enter the premises without supervision; or, if not fenced, child care provider must have a division approved, supervision plan for when children are in outdoor play area. The Contract for Child Care Subsidy Services Terms and Conditions require that the provider ensure that children have adequate supervision when outside or in areas near roadways. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions require that the provider ensure that children have adequate supervision when outside or in areas near roadways. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions require that the provider ensure that children have adequate supervision when outside or in areas near roadways. Per a new statute passed in 2024, licensed afterschool programs caring for school age children only will not be required to receive a fire safety inspection or have the physical premises inspected. 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: For children of all ages in care, physical punishment including, but not limited to, spanking, slapping, shaking, biting, or pulling hair shall be prohibited. ii. All CCDF-eligible licensed family child care homes. Provide the standard: For children of all ages in care, physical punishment including, but not limited to, spanking, slapping, shaking, biting, or pulling hair shall be prohibited. 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 Contract for Child Care Subsidy Services Terms and Conditions require all staff have knowledge of shaken baby syndrome. In addition, to knowledge of signs and symptoms of abusive head trauma. Shaken baby syndrome is on the leading causes of child abuse deaths in the United States and it is preventable. Child care staff must be knowledgeable on how to prevent, identify, and respond to shaken baby syndrome. Knowledge of possible reasons for shaken baby syndrome, have skills in and knowledge for coping with crying and the factors that contribute to an infant being vulnerable to abusive head trauma. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions require all staff have knowledge of shaken baby syndrome. In addition, to knowledge of signs and symptoms of abusive head trauma. Shaken baby syndrome is on the leading causes of child abuse deaths in the United States and it is preventable. Child care staff must be knowledgeable on how to prevent, identify, and respond to shaken baby syndrome. Knowledge of possible reasons for shaken baby syndrome, have skills in and knowledge for coping with crying and the factors that contribute to an infant being vulnerable to abusive head trauma. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions require all staff have knowledge of shaken baby syndrome. In addition, to knowledge of signs and symptoms of abusive head trauma. Shaken baby syndrome is on the leading causes of child abuse deaths in the United States and it is preventable. Child care staff must be knowledgeable on how to prevent, identify, and respond to shaken baby syndrome. Knowledge of possible reasons for shaken baby syndrome, have skills in and knowledge for coping with crying and the factors that contribute to an infant being vulnerable to abusive head trauma. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions require all staff have knowledge of shaken baby syndrome. In addition, to knowledge of signs and symptoms of abusive head trauma. Shaken baby syndrome is on the leading causes of child abuse deaths in the United States and it is preventable. Child care staff must be knowledgeable on how to prevent, identify, and respond to shaken baby syndrome. Knowledge of possible reasons for shaken baby syndrome, have skills in and knowledge for coping with crying and the factors that contribute to an infant being vulnerable to abusive head trauma. 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 staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/ OnlineCanReporting/default.aspx. Children shall not be subjected to child abuse/neglect as defined by section 210.110, RSMo. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All child care providers and assistants shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/OnlineCanReporting/default. aspx. Children shall not be subjected to child abuse/neglect as defined by section 210.110, RSMo 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 Contract for Child Care Subsidy Services Terms and Conditions state that by law in Missouri, child care providers are mandated reporters of child abuse and neglect. Every staff person should understand their role as a mandated reporter, be aware of common physical and emotional signs of and symptoms of child maltreatment, and know how to report abuse and neglect v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that by law in Missouri, child care providers are mandated reporters of child abuse and neglect. Every staff person should understand their role as a mandated reporter, be aware of common physical and emotional signs of and symptoms of child maltreatment, and know how to report abuse and neglect. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that by law in Missouri, child care providers are mandated reporters of child abuse and neglect. Every staff person should understand their role as a mandated reporter, be aware of common physical and emotional signs of and symptoms of child maltreatment, and know how to report abuse and neglect. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed afterschool programs, all staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/ OnlineCanReporting/default.aspx. Children shall not be subjected to child abuse/neglect as defined by section 210.110, RSMo. For other exempt out-of- school programs, The Contract for Child Care Subsidy Services Terms and Conditions state that by law in Missouri, child care providers are mandated reporters of child abuse and neglect. Every staff person should understand their role as a mandated reporter, be aware of common physical and emotional signs of and symptoms of child maltreatment, and know how to report abuse and neglect. 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. [ ] 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: On February 14, 2024, the Lead Agency was issued a Preliminary Notice of Possible Non-Compliances indicating that they do not have procedures for continuity of operations for Group Child Care Homes/Child Care Centers and Family Child Care Homes. The Lead Agency needs additional time to meet this requirement. The current disaster plan was written prior to the pandemic and the Lead Agency is working on a process to re-write its disaster plan to include continuity of operations. 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: Areas used by children shall be free of animal excrement. The facility shall be clean at all times and free of dirt, insects, spiders, rodents or other pests. The water and milk supply, and the method of dispensing, shall be approved by local or state health authorities, or both. Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces. All furniture and equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used. All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Areas used by children shall be free of animal excrement. The home shall be clean at all times and free of dirt, insects, spiders, rodents or other pests. The water and milk supply, and the method of dispensing, shall be approved by local or state health authorities, or both. Water supply and sewage disposal systems shall conform to state or local requirements, or both. Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces. All furniture and equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used. All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used. 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: Requirements for religious organizations and nursery schools (LE): Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials. For other exempt centers, the Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood- borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. 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: Wet or soiled diapers shall be placed in an airtight disposal container located in the diaper change area. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Wet or soiled diapers shall be placed in an airtight disposal container located in the diaper change area. 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: Requirements for religious organizations and nursery schools (LE): Wet or soiled disposable diapers shall be placed in an airtight disposal container located in the diaper change area and discarded daily. For other exempt centers, the Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood-borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that a healthy and safe environment includes proper handling and storage of hazardous materials. Additionally, caregivers need to protect themselves against possible exposure to environmental risks and blood- borne pathogens that may cause disease. Child care provider and staff/volunteers must ensure that all toxic substances are stored in the original labeled containers and inaccessible to children. Child caregivers should use the following standards precautions, developed by the Centers for Disease Control and Prevention (CDC), to handle potential exposure to blood and other potentially infectious fluids: handwashing, use of disposable gloves , respiratory hygiene and cough etiquette, safe handling of potentially contaminated surfaces, proper disposal of hazardous materials, including bodily fluids. 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 provider shall be responsible for the care, safety, and supervision of children on field trips or at any time they transport children away from the facility. Written parental consent shall be on file at the facility for field trips and transportation. Parents shall be informed when field trips are planned. The driver of any vehicle used to transport children shall be no less than 18 years of age and shall have a valid driver’s license as required by Missouri law. All vehicles used to transport children shall be licensed in accordance with Missouri law. Children shall not be transported in campers, trailers or in the back of trucks. All children shall be seated in a permanent seat and restrained by seat belts or child restraint devices as required by Missouri law. Identifying information regarding the name of the provider, the names of the children and the names, addresses and telephone numbers of each child’s parent(s) shall be carried in the vehicle. Staff/child ratios shall be maintained at any time the provider transports children away from the facility. Children shall be required to remain seated while the vehicle is in motion. Doors shall be locked when the vehicle is moving. Order shall be maintained in the vehicle at all times. Children shall not be left unattended in a vehicle at any time. Children shall enter and leave the vehicle from the curbside unless the vehicle is in a protected area or driveway. Children shall be assisted, when necessary, while entering or leaving the vehicle. Children shall be released only to the parent(s) or individual(s) authorized by the parent(s). The operator of the vehicle shall wait until the child is in the custody of the parent(s) or individual(s) authorized by the parent(s) to receive the child. Head counts shall be taken before leaving the facility, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the facility. When children leave the vehicle, the vehicle shall be inspected to ensure that no children are left on or under seats. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The provider shall be responsible for the care, safety and supervision of children on field trips or at any time they transport children away from the family day care home. Written parental consent shall be on file at the home for field trips and transportation. Parents shall be informed when field trips are planned. The driver of any vehicle used to transport children shall be no less than 18 years of age and shall have a valid driver’s license as required by Missouri law. All vehicles used to transport children shall be licensed in accordance with Missouri law. Children shall not be transported in campers, trailers or in the back of trucks. All children shall be seated in a permanent seat and restrained by seat belts or child restraint devices as required by Missouri law. Identifying information regarding the name of the provider, the names of the children and the names, addresses and telephone numbers of each child’s parent(s) shall be carried in the vehicle. Staff/child ratios shall be maintained at any time the provider transports children away from the home. Children shall be required to remain seated while the vehicle is in motion. Doors shall be locked when the vehicle is moving. Order shall be maintained in the vehicle at all times. Children shall not be left unattended in a vehicle at any time. Children shall enter and leave the vehicle from the curbside unless the vehicle is in a protected area or driveway. Children shall be assisted, when necessary, while entering or leaving the vehicle. Children shall be released only to the parent(s) or individual(s) authorized by the parent(s). The operator of the vehicle shall wait until the child is in the custody of the parent(s) or individual(s) authorized by the parent(s) to receive the child. Head counts shall be taken before leaving the home, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the home. When children leave the vehicle, the vehicle shall be inspected to ensure that no children are left on or under seats. 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 Contract for Child Care Subsidy Services Terms and Conditions state that Child care providers and staff/volunteers should be knowledgeable about safe transportation guidelines and best practices to keep children supervised and safe in and around vehicles. Child care providers and staff/volunteers must ensure that when children are driven in a motor vehicle that all children are restrained in a developmentally appropriate and properly installed care safety seat, booster seat, seat belt, or harness that is suited to the child’s weight and age in accordance with state and federal laws and regulations. Child care providers and staff/volunteers must ensure that children are never left alone or unattended in or around vehicles and that they are continuously supervised and that a face-to-name count is conducted before leaving the program, upon arrival at a destination, before departing to return to the program, and once in the building upon return. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that Child care providers and staff/volunteers should be knowledgeable about safe transportation guidelines and best practices to keep children supervised and safe in and around vehicles. Child care providers and staff/volunteers must ensure that when children are driven in a motor vehicle that all children are restrained in a developmentally appropriate and properly installed care safety seat, booster seat, seat belt, or harness that is suited to the child’s weight and age in accordance with state and federal laws and regulations. Child care providers and staff/volunteers must ensure that children are never left alone or unattended in or around vehicles and that they are continuously supervised and that a face-to-name count is conducted before leaving the program, upon arrival at a destination, before departing to return to the program, and once in the building upon return. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state that Child care providers and staff/volunteers should be knowledgeable about safe transportation guidelines and best practices to keep children supervised and safe in and around vehicles. Child care providers and staff/volunteers must ensure that when children are driven in a motor vehicle that all children are restrained in a developmentally appropriate and properly installed care safety seat, booster seat, seat belt, or harness that is suited to the child’s weight and age in accordance with state and federal laws and regulations. Child care providers and staff/volunteers must ensure that children are never left alone or unattended in or around vehicles and that they are continuously supervised and that a face-to-name count is conducted before leaving the program, upon arrival at a destination, before departing to return to the program, and once in the building upon return. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed out-of-school programs, the following apply: The provider shall be responsible for the care, safety, and supervision of children on field trips or at any time they transport children away from the facility. Written parental consent shall be on file at the facility for field trips and transportation. Parents shall be informed when field trips are planned. The driver of any vehicle used to transport children shall be no less than 18 years of age and shall have a valid driver’s license as required by Missouri law. All vehicles used to transport children shall be licensed in accordance with Missouri law. Children shall not be transported in campers, trailers or in the back of trucks. All children shall be seated in a permanent seat and restrained by seat belts or child restraint devices as required by Missouri law. Identifying information regarding the name of the provider, the names of the children and the names, addresses and telephone numbers of each child’s parent(s) shall be carried in the vehicle. Staff/child ratios shall be maintained at any time the provider transports children away from the facility. Children shall be required to remain seated while the vehicle is in motion. Doors shall be locked when the vehicle is moving. Order shall be maintained in the vehicle at all times. Children shall not be left unattended in a vehicle at any time. Children shall enter and leave the vehicle from the curbside unless the vehicle is in a protected area or driveway. Children shall be assisted, when necessary, while entering or leaving the vehicle. Children shall be released only to the parent(s) or individual(s) authorized by the parent(s). The operator of the vehicle shall wait until the child is in the custody of the parent(s) or individual(s) authorized by the parent(s) to receive the child. Head counts shall be taken before leaving the facility, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the facility. When children leave the vehicle, the vehicle shall be inspected to ensure that no children are left on or under seats. For other exempt out-of-school programs, the following apply: The Contract for Child Care Subsidy Services Terms and Conditions state that Child care providers and staff/volunteers should be knowledgeable about safe transportation guidelines and best practices to keep children supervised and safe in and around vehicles. Child care providers and staff/volunteers must ensure that when children are driven in a motor vehicle that all children are restrained in a developmentally appropriate and properly installed care safety seat, booster seat, seat belt, or harness that is suited to the child’s weight and age in accordance with state and federal laws and regulations. Child care providers and staff/volunteers must ensure that children are never left alone or unattended in or around vehicles and that they are continuously supervised and that a face-to-name count is conducted before leaving the program, upon arrival at a destination, before departing to return to the program, and once in the building upon return. 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: The licensee shall have documentation on file at the facility of current certification in age- appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one caregiver at the facility for every 20 children in the licensed capacity. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. 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 Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age- appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed child care centers, the following shall apply: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one caregiver at the facility for every 20 children in the licensed capacity. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. For other exempt out-of-school programs, the following apply: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age- Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. 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: The licensee shall have documentation on file at the facility of current certification in age- appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one caregiver at the facility for every 20 children in the licensed capacity. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. 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 Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age- appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age-Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed child care centers, the following shall apply: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one caregiver at the facility for every 20 children in the licensed capacity. At least one caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification and be approved by the department. For other exempt out-of-school programs, the following apply: The Contract for Child Care Subsidy Services Terms and Conditions contain requirements relating to Training at Initial Application for Contract. The following trainings are required for all staff members and persons involved in direct care and included in staff child ratio (i.e., volunteers) Age- Appropriate Cardiopulmonary Resuscitation (CPR)/First Aid Certification ￿ to be completed through a nationally recognized organization within 90 days of employment and before a staff member or volunteer can provide unsupervised direct care to children. Age-appropriate means the training and certification shall cover the ages of all children cared for by the provider. The provider shall maintain a record of current certification in age-appropriate CPR and first aid. The training shall be certified by a nationally recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include a skills assessment, and be approved by DESE OOC. The provider, all child care staff members, and volunteers shall maintain a record of current certification in age-appropriate CPR and First Aid. The Lead Agency has an accepted CPR/First Aid Model that addresses both pediatric and adult CPR. 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: All staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/ OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ ii. All CCDF-eligible licensed family child care homes. Provide the standard: All child care providers and assistants shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/OnlineCanReporting/default. aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ 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 Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392- 3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed out-of-school programs, the following shall apply: All staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/ OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ For other exempt out-of-school programs, the following shall apply: The Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. Missouri state statute 210.110 defines ￿abuse￿ as ￿any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody, and control, except that discipline including spanking, administered in a reasonable manner, shall not be construed to be abuse.￿ This same statute defines ￿neglect￿ as ￿failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being.￿ 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: All child care providers and assistants shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/OnlineCanReporting/default. aspx. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All child care providers and assistants shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/OnlineCanReporting/default. aspx. 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 Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392- 3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Contract for Child Care Subsidy Services Terms and Conditions state The provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: For licensed out-of-school programs, the following shall apply: All staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll-free number 1-800-392-3738 or online at https://apps.dss.mo.gov/ OnlineCanReporting/default.aspx. For all other exempt out-of-school programs, the following shall apply: The Contract for Child Care Subsidy Services Terms and Conditions state that the provider, all child care staff members, and volunteers shall be familiar with Section 210.115, RSMo, the child abuse and neglect reporting law. The provider, all child care staff members, and volunteers shall make a report of any suspected child abuse or neglect to the Children’s Division at the toll free number 1-800-392-3738 or online at: https://apps.dss.mo.gov/OnlineCanReporting/default.aspx. c. Confirm if child care providers must comply with the Lead Agency’s procedures for reporting child abuse and neglect as required by the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a(b)(2)(B)(i): [x] Yes, confirmed. [ ] No. If no, describe: 5.3.12 Additional optional standards In addition to the required health and safety standards, does the Lead Agency require providers to comply with the following optional standards? [x] Yes. [ ] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: Licensed child care centers, group child care homes, and family child care programs are required to provide nutritious meals to children. ii. Access to physical activity. Describe: Licensed child care centers, group child care homes, and family child care programs are required to provide outdoor space for children’s play as well as an hour of outdoor time each day (weather permitting). iii. Caring for children with special needs. Describe: N/A iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A