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: Center Ages 0 to 12 years and Preschool Ages 2- 6 years: Verification that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document citing that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs; and the program shall have written plans to respond to illness and emergencies. Programs must require a supervised temporary isolation area designated for a child who is too ill to remain in the program or who has an infectious or contagious disease, with the following procedures being followed when those signs of symptoms are observed: (a) parents are notified immediately and asked to pick up their child; and (b) first aid is provided, and medical care is sought as necessary. Establish and implement practices in accordance with guidance obtained through consultation with local or state department of health authorities implemented regarding the exclusion and return of children with infectious or communicable conditions. The program may obtain this guidance directly or through current published materials regarding exclusion and return to the program. The provider shall ensure that the program bathroom sinks, toilets, tables, chairs, and floors are cleaned daily. The provider shall also ensure pillows and mattresses have clean coverings; sheets and pillowcases are changed as often as necessary for cleanliness and hygiene, at least weekly; if beds, cots, mats, or cribs are used by different children, sheets and pillowcases are laundered before use by other children; cots, mats, and cribs are cleaned as often as necessary for cleanliness and hygiene, at least weekly, and after each use if used by different children; cots, mats, and cribs are single occupancy; each bed, cot, or mat has sufficient blankets available; aisles between beds, cots, mats, cribs, and portable cribs are a minimum space of two feet and are kept free of all obstructions while beds, cots, mats, cribs, and portable cribs are occupied; separate storage is provided for personal blankets or coverings; and mattresses and sheets are properly fitted. The provider shall ensure that the program’s building, grounds, and equipment are located, cleaned, and maintained to protect the health and safety of children. The program shall ensure that all toys and equipment are kept clean and in sanitary condition. Books and other toys are not readily cleanable must be sanitized as much as possible without damaging the integrity or educational value of the item. Staff members and children shall wash their hands, according to recommendations by the federal centers for disease control and prevention, before preparing or serving meals, after diapering, after using toilet facilities, and after any other procedure that may involve contact with bodily fluids. Hand soap and sanitary hand-drying equipment, single-use cloth towels or paper towels must be available at each sink. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Child Care Ages 0 to 12 years old: Children shall have received all immunizations appropriate for the child's age, as prescribed by the public health division of the department, unless the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Group Child Care Ages 0 to 12 years: Verification that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department, or have on file a document citing that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs; and the group child care must have written plans to respond to illness and emergencies, including burns, serious injury, and ingestion of poison. Staff members and children shall wash their hands, according to recommendations by the federal centers for disease control and prevention, before preparing or serving meals, after diapering, after using toilet facilities, and after any other procedure that may involve contact with bodily fluids. Hand soap and sanitary hand-drying equipment, single-use or individually designated cloth towels, or paper towels must be available at each sink. Pillows and mattresses have clean coverings. Sheets and pillowcases are changed as often as necessary for cleanliness and hygiene, at least weekly. If beds, cots, mats, or cribs are used by different children, sheets and pillowcases are laundered before use by other children. Cots, mats, and cribs are cleaned as often as necessary for cleanliness and hygiene, at least weekly, and after each use if used by different children. The provider shall ensure that parents of enrollees are advised of these plans. The group child care must have written plans to respond to illness and emergencies, including burns, serious injury, and ingestion of poison. The provider shall ensure that parents of enrollees are advised of these plans. Require a supervised temporary isolation area designated for a child who is too ill to remain in the group child care or who has an infectious or contagious disease, with the following procedures being followed when those signs or symptoms are observed: (a) parents are notified immediately and asked to pick up their child; and (b) first aid is provided, and medical care is sought, as necessary. Notify parents, legal custodians, or guardians of a child's exposure to a presumed or confirmed reportable infectious disease. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration Ages 0 to 12 years: Shall verify that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document stating that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Notify parents, legal custodians, or guardians of a child's exposure to a presumed or confirmed reportable infectious disease. The provider shall operate according to the recommendations by the federal centers for disease control and prevention, including washing hands, before preparing or serving meals, after diapering, after using toilet facilities, and after any other procedure that may involve contact with bodily fluids. Hand soap and single-use or individually designated cloth towels or paper towels must be available at each sink. Clean towels must be provided at least daily. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child's home, the provider shall provide for a safe and sanitary environment while children are in care. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: School-Age Ages 5 to 12 years: Shall verify that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document stating that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Staff members and children shall wash their hands, according to recommendations by the federal centers for disease control and prevention, before preparing or serving meals, after using toilet facilities, and after any other procedure that may involve contact with bodily fluids. Hand soap and paper towels, sanitary hand-drying equipment, or single-use or individually designated cloth towels must be available at each sink. Require a supervised, temporary isolation area be designated for a child who is too ill to remain in the school-age child care program, or who has an infectious or contagious disease, with the following procedures being followed when those signs or symptoms are observed: (a) parents are notified immediately and asked to pick up their child; and (b) first aid is provided, and medical care sought, as necessary. Establish and implement practices in accordance with guidance obtained through consultation with local health unit authorities or authorities from the public health division of the department regarding the exclusion and return of children with infectious or communicable conditions. The operator may obtain this guidance directly or through current published material regarding exclusion and return to the school-age child care program. Notify parents, legal custodians, or guardians of a child's exposure to a presumed or confirmed reportable infectious disease. 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: Center Ages 0 to 12 years and Preschool 2- 6 years: Verification that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document stating that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Any child admitted to an early childhood facility and not adhering to the recommended schedule shall provide proof of immunization or a certificate of immunization within thirty calendar days of enrollment or be excluded from the early childhood facility. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group Ages 0 to 12 years: Children shall have received all immunizations appropriate for the child's age, as prescribed by the public health division of the department, unless the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Any child admitted to an early childhood facility and not adhering to the recommended schedule shall provide proof of immunization or a certificate of immunization within thirty calendar days of enrollment or be excluded from the early childhood facility. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration 0 to 12 years old: Shall verify that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document stating that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Any child admitted to an early childhood facility and not adhering to the recommended schedule shall provide proof of immunization or a certificate of immunization within thirty calendar days of enrollment or be excluded from the early childhood facility. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency does not have a standard for immunization requirements when care is provided in a child’s home. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: Shall verify that the child has received all immunizations appropriate for the child's age, as prescribed by the public health division of the department or have on file a document stating that the child is medically exempt or exempt from immunizations based on religious, philosophical, or moral beliefs. Any child admitted to an early childhood facility and not adhering to the recommended schedule shall provide proof of immunization or a certificate of immunization within thirty calendar days of enrollment or be excluded from the early childhood facility. 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: Ages 0-12 years: Certify annual completion of a minimum of thirteen hours of department- approved training related to child care, including one hour on safe sleep prior to the director providing care to infants. The supervisor shall certify completion of one hour of department-approved safe sleep training before providing care to infants. Completion of one hour of department-approved safe sleep prior to the staff member providing care to infants. Sleeping: (1) The operator shall ensure that infants are placed on their back initially when sleeping to lower the risk of sudden infant death syndrome, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. The infant's face must remain uncovered when sleeping. (2) The operator shall ensure that infants sleep in a crib with a firm mattress or in a portable crib with the manufacturer's pad that meets consumer product safety commission standards. (3) The operator shall ensure that if an infant falls asleep while not in a crib, the infant must be moved immediately to a crib or portable crib, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. (4) Water beds, adult beds, sofas, pillows, soft mattresses, and other soft surfaces are prohibited as infant sleeping surfaces. (5) The operator shall ensure that all items are removed from and that no toys or objects are hung over or attached to the crib or portable crib when an infant is sleeping or preparing to sleep. With written parental permission, the provider may place one individual infant blanket or sleep sack, a pacifier, and a security item that does not pose a risk of suffocation to the infant in the crib or portable crib while the infant is sleeping or preparing to sleep. (6) The operator shall ensure that a staff member responsible for caring for or teaching children checks on sleeping infants regularly and that a monitor is in the room with the infants unless a staff member is in the room with the infants while the infants are sleeping. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group Ages 0 to 12 years: A Provider shall certify completion of one hour of department-approved safe sleep training prior to provider providing care to infants and annually thereafter. Sleeping: (1) The provider shall ensure that infants are placed on their back initially when sleeping to lower the risk of sudden infant death syndrome, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. The infant's face must remain uncovered when sleeping. (2) The provider shall ensure that infants sleep in a crib with a firm mattress or in a portable crib with the manufacturer's pad that meets consumer product safety commission standards. (3) The provider shall ensure that if an infant falls asleep while not in a crib or portable crib, the infant must be moved immediately to a crib or portable crib, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. (4) Water beds, adult beds, sofas, pillows, soft mattresses, and other soft surfaces are prohibited as infant sleeping surfaces. (5) The provider shall ensure that all items are removed from and that no toys or objects are hung over or attached to the crib or portable crib when an infant is sleeping or preparing to sleep. With written parental permission, the provider may place one individual infant blanket or sleep sack, a pacifier, and a security item that does not pose a risk of suffocation to the infant in the crib or portable crib while the infant is sleeping or preparing to sleep. (6) A staff member shall check on sleeping infants regularly and have a monitor in the room with the sleeping infant unless a staff member is in the room with the infants while the infants are sleeping. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: Shall complete a minimum of three hours of department-approved training annually, including one hour on safe sleep prior to provider providing care to infants. Shall ensure that the emergency designee completes required department approved training annually, including one hour on safe sleep prior to emergency designee providing care to infants. Sleeping: (a) The provider shall ensure that infants are placed on their back initially when sleeping to lower the risk of sudden infant death syndrome, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. The infant's face must remain uncovered when sleeping. (b) The provider shall ensure that infants sleep in a crib with a firm mattress or in a portable crib with the manufacturer's pad that meets consumer product safety commission standards. (c) The provider shall ensure that if an infant falls asleep while not in a crib or portable crib, the infant must be moved immediately to a crib or portable crib, unless the infant's parent has provided a note from the infant's medical provider specifying otherwise. (d) Water beds, adult beds, sofas, pillows, soft mattresses, and other soft surfaces are prohibited as infant sleeping surfaces. (e) The provider shall ensure that all items are removed from and that no toys or objects are hung over or attached to the crib or portable crib when an infant is sleeping or preparing to sleep. With written parental permission, the provider may place one individual infant blanket or sleep sack, a pacifier, and a security item that does not pose a risk of suffocation to the infant in the crib or portable crib while the infant is sleeping or preparing to sleep. (f) The provider shall ensure that mattresses and sheets are properly fitted. The provider shall ensure that sheets and mattress pads are changed whenever they become soiled or wet, when cribs are used by different infants, or at least weekly. (g) The provider shall check on sleeping infants regularly and have a monitor in the room with sleeping infants unless the provider or an emergency designee is in the room with the infants while the infants are sleeping. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to 12 years: Shall complete one hour of department-approved training annually on safe sleep prior to in-home provider having unsupervised access to infants and one hour on mandated reporter of suspected child abuse or neglect. Shall provide proper care, supervision, and protection for children in the applicant's care. Supervision means the provider being within sight or hearing range of an infant, toddler, or preschooler at all times so the provider is capable of intervening to protect the health and safety of the child. For the school-age child, it means a provider being available for assistance and care so that the child's health and safety are protected. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A 5.3.3 Administration of medication, consistent with standards for parental consent health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the administration of medication for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Center Ages 0 to 12 years and Preschool ages 2 to 6 years: (a) Medication prescribed by a medical provider must be accompanied by the medical provider's written instructions as to dosage and storage, and labeled with the child's name and date; (b) Medication must be stored in an area inaccessible to children, and medication stored in a refrigerator must be stored collectively in a spillproof container; (c) The operator shall keep a written record of the administration of medication, including over- the-counter medication, for each child. Records must include the date and time of each administration, the dosage, the name of the staff member administering the medication, and the name of the child; and (d) The operator shall include completed medication records in the child's record. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: (a) Medication prescribed by a medical provider must be accompanied by the medical provider's written instructions as to dosage and storage and labeled with the child's name and date; (b) The provider shall store medications in an area inaccessible to children; (c) Medications stored in a refrigerator must be stored collectively in a spillproof container; and (d) The provider shall keep a written record of the administration of medication, including over-the-counter medication, for each child. Records must include the date and time of each administration, the dosage, the name of the staff member administering the medication, and the name of the child. Completed medication records must be included in the child's record. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: (a) Medication prescribed by a medical provider must be accompanied by the medical provider's written instructions as to dosage and storage and labeled with the child's name and date; (b) The provider shall store medications in an area inaccessible to children; (c) Medications stored in a refrigerator must be stored collectively in a spill-proof container; and (d) The provider shall keep a written record of the administration of medication, including over-the-counter medication, for each child. Records must include the date and time of each administration, the dosage, the name of the staff member administering the medication, and the name of the child. Completed medication records must be included in the child's record. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When a child with special needs is being cared for, the in-home provider shall consult with the child's parents, and, with the parent's permission, the child's source of professional health care, or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The in-home provider shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: (a) Medication prescribed by a medical provider must be accompanied by the medical provider's written instructions as to its dosage and storage and labeled with the child's name and date; and (b) The program shall keep a written record of the administration of medication, including over-the-counter medication, for each child. Records must include the date and time of each administration, the dosage, the name of the staff member administering the medication, and the name of the child. The program shall include completed medication records in the child's record. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: Require written permission to dispense medication and proper instructions for the administration of medication obtained from the parent of a child in the child care center who requires medication. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: If children in care require medication, the provider shall secure written permission and follow proper instructions as to the administration of medication. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x]Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: Shall secure written permission and follow proper instructions as to the administration of medication. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When a child with special needs is being cared for, the in-home provider shall consult with the child's parents, and, with the parent's permission, the child's source of professional health care, or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The in-home provider shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: Require written permission to dispense medication and require proper instructions for the administration of medication be obtained from the parent of a child in the school-age child care program who requires medication. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: A provider shall make appropriate accommodations, as required by the Americans with Disabilities Act, to meet the needs of children with special needs. The provider shall receive documentation of the child's special needs from the parent upon the child's enrollment. When a child with special needs is admitted, the director or supervisor shall consult with the child's parents, and, with the parent's permission, the child's source of professional health care, or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The operator shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. A current health assessment or a health assessment statement completed by the parent, obtained at the time of initial enrollment of the child which must indicate any special precautions for diet, medication, or activity. This assessment must be completed annually. The operator shall ensure staff members responsible for caring for or teaching children receive proper instructions as to the nature of the child's special needs and potential for growth and development. The Lead Agency is in the process of developing standards to address the prevention of emergencies due to food and allergic reaction for children not identified as special needs; this work will be completed after October 1, 2024. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: A provider shall make appropriate accommodations, as required by the Americans with Disabilities Act, to meet the needs of children with special needs. The provider shall receive documentation of the child's special needs by the parent upon the child's enrollment. When children with special needs are being cared for, the provider shall consult with the child's parents, and with the parent's permission, the child's source of professional health care or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The provider shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description of the special needs, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. The provider shall ensure staff members responsible for caring for or teaching children receive proper instructions as to the nature of the child's special needs and potential for growth and development. The Lead Agency is in the process of developing standards to address the prevention of emergencies due to food and allergic reaction for children not identified as special needs; this work will be completed after October 1, 2024. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: A provider shall make appropriate provisions, as required by the Americans with Disabilities Act, to meet the needs of children with special needs. The provider shall receive documentation of the child's special needs by the parent upon the child's enrollment. When a child with special needs is admitted, the provider shall consult with the child's parents, and with the parent's permission, the child's source of professional health care or, when appropriate, other health and professional consultants, to gain an understanding of the child's individual needs. The provider shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. The provider shall ensure that emergency designees responsible for caring for or teaching children receive proper instructions as to the nature of the child's disability and potential for growth and development. The Lead Agency is in the process of developing standards to address the prevention of emergencies due to food and allergic reaction for children not identified as special needs; this work will be completed after October 1, 2024. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: In-home provider ages 0 to 12 years: shall make appropriate accommodations, as required by the Americans with Disabilities Act, to meet the needs of children with special needs. The in-home provider must receive documentation of the child's special needs by the parent upon the child's enrollment. When a child with special needs is being cared for, the in-home provider shall consult with the child's parents, and, with the parent's permission, the child's source of professional health care, or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The in-home provider shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description, definition of the diagnosis, and general information for emergency and required care such as usual medications and procedures. In-home providers shall receive proper instructions as to the nature of the child's special needs and potential for growth and development. The Lead Agency is in the process of developing standards to address the prevention of emergencies due to food and allergic reaction for children not identified as special needs; this work will be completed after October 1, 2024. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: The operator shall consider information provided by the children's parents as to the children's eating habits, food preferences, or special needs in creating the feeding schedules and in tailoring menus. An operator shall make appropriate accommodations, as required by the Americans with Disabilities Act, to meet the needs of a child with special needs. The operator shall receive documentation of the child's special needs from the parent upon the child's enrollment. When a child with special needs is admitted, the director or supervisor shall consult with the child's parents, and with the parent's permission, the child's source of professional health care, or, when appropriate, other health and professional consultants to gain an understanding of the child's individual needs. The operator shall receive a written health care plan from the child's medical provider or parent with information related to the child's special needs, such as a description of the special needs, definition of the diagnosis, and general information for emergency and required care such as usual medication and procedures. The operator shall ensure staff members responsible for caring for or teaching children receive proper instructions as to the nature of the child's special needs and potential for growth and development. The Lead Agency is in the process of developing standards to address the prevention of emergencies due to food and allergic reaction for children not identified as special needs; this work will be completed after October 1, 2024. 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: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements for the response to emergencies due to food and allergic reactions for all six CCDF- eligible provider types.￿ The Lead Agency will need additional time to meet the requirement to ensure policies include the response to emergencies due to food and allergic reactions. Current policies: Center ages 0 to 12 years and Preschool ages 2-6 years: Establish emergency response procedures; Identify a source of emergency health services readily available to the child care center, including: (a) A prearranged plan for emergency medical care in which parents of enrollees are advised of the arrangement; and (b) Provisions for emergency transportation, specifically that when a child is to be brought to another place for emergency care, an adult staff member responsible for caring for or teaching children shall remain with the child until medical personnel assume responsibility for the child's care and until the parent is notified. Require information be provided to parents, as needed, concerning child health and social services available in the community; and require that the child care center inform parents in writing of any first aid administered to their child within twenty-four hours of the incident, immediately notify parents of any injury which requires emergency care beyond first aid, and require each injury report to be made a part of the child's record. ii. All CCDF-eligible licensed family child care homes. Provide the standard: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements for the response to emergencies due to food and allergic reactions for all six CCDF-eligible provider types.￿ The Lead Agency will need additional time to meet the requirement to ensure policies include the response to emergencies due to food and allergic reactions. Current policies: Family ages 0 to 12 years: The provider shall have a statement on file, signed by the child's parents, authorizing emergency medical care for each child. The provider shall have plans to response to illness and emergencies, including evacuation in case of fire, serious injury, and ingestion of poison. Group Ages 0-12 years: The group child care must have written plans to respond to illness and emergencies, including burns, serious injury, and ingestion of poison. The provider shall ensure that parents of enrollees are advised of these plans. Plans must: Establish emergency response procedures; Provide accessible posting of emergency response procedures and require training for all staff members concerning those emergency procedures; Provide a working telephone line immediately accessible to staff members with a list of emergency telephone numbers conspicuously posted; Require a plan for responding to minor illnesses and minor accidents when children are in the care of the group child care; Parents are notified immediately and asked to pick up their child; First aid is provided, and medical care is sought, as necessary; Identify a source of emergency health services available to the group child care, including: (a) A prearranged plan for emergency medical care in which the parent of each enrolled child is advised of the arrangement; and (b) Provisions for emergency transportation, specifically that when a child is to be brought to another place for emergency care, an adult staff member responsible for caring for or teaching children shall remain with the child until medical personnel assume responsibility for the child's care and until the parent or emergency contact is notified. iii. All CCDF-eligible licensed in-home care. Provide the standard:: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements for the response to emergencies due to food and allergic reactions for all six CCDF-eligible provider types.￿ The Lead Agency will need additional time to meet the requirement to ensure policies include the response to emergencies due to food and allergic reactions. Current policies: Self-Declaration ages 0 to 12 years: Shall report to the department within twenty-four hours: (a) A death or serious accident or illness requiring hospitalization of a child while in the care of the self-declaration provider or attributable to care received by the self-declaration provider; and (b) An injury to any child which occurs while the child is in the care of the self- declaration provider, and which requires medical treatment. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements for the response to emergencies due to food and allergic reactions for all six CCDF-eligible provider types.￿ The Lead Agency will need additional time to meet the requirement to write policies which include the response to emergencies due to food and allergic reactions. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements for the response to emergencies due to food and allergic reactions for all six CCDF-eligible provider types.￿ The Lead Agency will need additional time to meet the requirement to ensure policies include the response to emergencies due to food and allergic reactions. Current policies: Ages 5 to 12 years: Parents are notified immediately and asked to pick up their child; First aid is provided, and medical care sought, as necessary; Notify parents, legal custodians, or guardians of a child's exposure to a presumed or confirmed reportable infectious disease; Identify a source of emergency health services readily available to the school-age child care program, including: (a) A prearranged plan for emergency medical care in which parents of enrolled children are advised of the arrangement; and (b) Provisions for emergency transportation, specifically when a child is to be brought to another place for emergency care, an adult staff member responsible for caring for or teaching children shall remain with the child until medical personnel assume responsibility for the child's care and until the parent is notified; and Require information be provided to parents, as needed, concerning child health and social services available in the community. 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: Center ages 0 to 12 years and Preschool ages 2- 6 years: The child care shall ensure that the child care building, grounds, and equipment are located, cleaned, and maintained to protect the health and safety of children. Routine maintenance and cleaning procedures must be established to protect the health of the children and the staff members. The child care shall ensure that the child care ground areas are free from accumulations of refuse, standing water, unprotected wells, debris, flammable material, and other health and safety hazards. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family ages 0 to 12 years: The family child care must be clean and maintained to protect the health and safety of children. The family child care and outdoor play area must be free of clutter, accumulation of refuse, standing water, unprotected wells, debris, and other health and safety hazards. Garbage must be regularly removed. Group ages 0 to 12 years: The provider shall ensure that the group child care building, grounds, and equipment are located, cleaned, and maintained to protect the health and safety of children. Routine maintenance and cleaning procedures must be established to protect the health of the children and the staff members. The provider shall ensure that the group child care ground areas are free from accumulations of refuse, standing water, unprotected wells, debris, flammable material, and other health and safety hazards. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: The provider shall ensure that the residence, grounds, and equipment are located, cleaned, and maintained to protect the health and safety of children. The provider shall establish routine cleaning procedures to protect the health of the children. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to 12 years: Shall provide for a safe and sanitary environment while children are in care. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: The operator shall ensure that the school-age child care program's building, grounds, and equipment are located, cleaned, and maintained to protect the health and safety of children. The operator shall establish routine maintenance and cleaning procedures to protect the health of the children and the staff members. The operator shall ensure that the school-age child care program ground areas are free from accumulations of refuse, standing water, unprotected wells, debris, flammable material, and other health and safety hazards. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: An operator shall have policies that ensure the health and safety of children in care while participating in aquatic activities, including types of aquatic activities the preschool may participate in, staff-to-child ratios appropriate to the ages and swimming ability of children participating in aquatic activities, and additional safety precautions to be taken. The operator may not permit any child to participate in an aquatic activity without written parental permission, which includes parent disclosure of the child's swimming ability. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: The child care shall have policies that ensure the health and safety of children in care while participating in aquatic activities, including types of aquatic activities the child care may participate in, staff-to-child ratios appropriate to the ages and swimming ability of children participating in aquatic activities, and additional safety precautions to be taken. The provider may not permit any child to participate in an aquatic activity without written parental permission, which includes parent disclosure of the child's swimming ability. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: The provider shall have policies that ensure the health and safety of children in care while participating in aquatic activities, including types of aquatic activities the self- declaration program may participate in, staff-to-child ratios appropriate to the ages and swimming ability of the children participating in aquatic activities, and additional safety precautions to be taken. The provider may not permit any child to participate in an aquatic activity without written parental permission, which includes parent disclosure of the child's swimming ability. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child’s home, the Lead Agency does not have a regulation for this standard. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: The operator shall have policies which ensure the health and safety of children in care while participating in aquatic activities, including types of aquatic activities the program may participate in, staff-to-child ratios appropriate to the ages and swimming ability of children participating in aquatic activities, and additional safety precautions to be taken. The operator may not permit any child to participate in an aquatic activity without written parental permission, which includes parent disclosure of the child's swimming ability. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: The program shall ensure that exterior play areas in close proximity to busy streets and other unsafe areas are contained or fenced or have natural barriers to restrict children from those unsafe areas. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: The provider shall ensure that exterior play areas in close proximity to busy streets and other unsafe areas are contained or fenced or have natural barriers to restrict children from those unsafe areas. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0-12 years: Shall provide proper care and protection for children in the provider's care. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to 12 years: Shall provide for a safe and sanitary environment while children are in care. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5-12 years: The operator shall ensure that exterior play areas in close proximity to busy streets and other unsafe areas are contained or fenced or have natural barriers to restrict children from those unsafe areas. Outdoor play areas must be inspected daily for hazards and necessary maintenance. 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: Center ages 0 to 12 years: Discipline-Punishment Prohibited: A staff member or any other adult in or at the child care may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat any infant or child in their care. The operator shall ensure that infants are not shaken or jostled. Preschool 2- 6 years old: A staff member, or household member, or any other adult in or at the preschool may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family ages 0 to 12 years: A staff member, household member, or any other adult in the family child care may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. The provider shall ensure that infants are not shaken or jostled. Group Ages 0 to 12 years old: A staff member, household member, or any other adult in or at the group child care may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. The provider shall ensure that infants are not shaken or jostled. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration Ages 0 to 12 years: A child may not be kicked, punched, spanked, shaken, pinched, bitten, roughly handled, struck, mechanically restrained, or physically maltreated by the provider, emergency designee, household member, or any other adult in the residence. The provider shall ensure that infants are not shaken or jostled. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to 12 years: An in-home provider may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: A staff member, household member, or any other adult at the school-age child care program may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. 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: Center Ages 0 to 12 years: Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury, or neglect, or abuse, to any child is grounds for license denial or revocation: The child care center must have a written policy regarding the discipline of children. The operator shall provide the policy to, and discuss the policy with, the staff members responsible for caring for or teaching children before the child care center begins operation or before staff members begin working with children. Discipline must be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. Authority to discipline may not be delegated to children nor may discipline be administered by children. Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well-ventilated room within sight or hearing range of an adult staff member responsible for caring for or teaching children. A staff member may not isolate a child in a locked room or closet. A child may not be punished for lapses in toilet training. A staff member may not use verbal abuse or make derogatory remarks about a child, or a child's family, race, or religion when addressing the child or in the presence of a child. A staff member may not use profane, threatening, unduly loud, or abusive language in the presence of a child. A staff member may not force-feed a child or coerce a child to eat, unless medically prescribed and administered under a medical provider's care. A staff member may not use deprivation of meals or snacks as a form of discipline or punishment. A staff member or any other adult in or at the child care center may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. A staff member may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in a child's mouth to deter the child from biting other children. A staff member may not withhold active play from a child as a form of discipline or punishment, beyond a brief period of separation. Preschool Ages 2 -6 years: Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury, neglect, or abuse to any child is grounds for license denial or revocation: 1. The preschool must have a written policy regarding the discipline of children. The operator shall provide the policy to, and discuss the policy with, staff members responsible for caring for or teaching children before the preschool begins operation or before staff members begin working with children. 2. Discipline must be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. 3. Authority to discipline may not be delegated to children nor may discipline be administered by children. 4. Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well-ventilated room within sight or hearing range of a staff member responsible for caring for or teaching children. A staff member may not isolate a child in a locked room or closet. 5. A child may not be punished for lapses in toilet training. 6. A staff member may not use verbal abuse or make derogatory remarks about a child, or a child's family, race, or religion when addressing the child or in the presence of other children. 7. A staff member may not use profane, threatening, unduly loud, or abusive language in the presence of a child. 8. A staff member may not force-feed a child or coerce a child to eat unless medically prescribed and administered under a medical provider's care. 9. A staff member may not use deprivation of meals or snacks as a form of discipline or punishment. 18 10. A staff member, or household member, or any other adult in or at the preschool may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. 11. A staff member may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in the mouth of a child to deter the child from biting other children. 12. A staff member may not withhold active play as a form of discipline or punishment, beyond a brief period of separation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family Ages 0 to 12 years: Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury, or neglect or abuse, to any child is grounds for denial or revocation of a provider's license. 1. Discipline must be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. 2. Authority to discipline may not be delegated to or be administered by children. 3. Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well-ventilated room within sight or hearing range of a staff member responsible for caring for or teaching children. A child may not be isolated in a locked room or closet. 4. A child may not be punished for lapses in toilet training. 5. A staff member may not use verbal abuse or make derogatory remarks about the child, the child's family, race, or religion when addressing a child or when in the presence of a child. A staff member may not use profane, threatening, unduly loud, or abusive language in the presence of a child. 6. A staff member may not force-feed a child or coerce a child to eat, unless medically prescribed and administered under a medical provider's care. 7. A staff member may not use deprivation of snacks or meals as a form of discipline or punishment. 8. A staff member, household member, or any other adult in the family child care may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. 9. A staff member may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in the mouth of a child to deter the child from biting other children. 10. A staff member may not withhold active play from a child as a form of discipline or punishment, beyond a brief period of separation. Group Ages 0 to 12 years: Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury, neglect, or abuse to any child is grounds for denial or revocation. 1. The group child care must have a written policy regarding the discipline of children. The provider shall provide the policy to, and discuss the policy with, staff members before the group child care begins operation or before staff members begin working with children. 2. Discipline must be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. 3. Authority to discipline may not be delegated to children nor may discipline be administered by children. 4. Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well-ventilated room within sight or hearing range of a staff member responsible for caring for or teaching children. A staff member may not isolate a child in a locked room or closet. 5. A child may not be punished for lapses in toilet training. 6. A staff member may not use verbal abuse or make derogatory remarks about the child, the child's family, race, or religion when addressing a child or in the presence of a child. 7. A staff member may not use profane, threatening, unduly loud, or abusive language in the presence of a child. 8. A staff member may not force-feed a child or coerce a child to eat unless medically prescribed and administered under a medical provider's care. 9. A staff member may not use deprivation of meals or snacks as a form of discipline or punishment. 10. A staff member, household member, or any other adult in or at the group child care may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. 11. A staff member may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in the mouth of a child to deter the child from biting other children. 12. A staff member may not withhold active play from a child as a form of discipline or punishment, beyond a brief period of separation. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self Declaration Ages 0 to 12 years: The provider shall ensure that discipline will be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint such as holding. A child may not be subjected to physical harm or humiliation. Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury or neglect or abuse to any child is grounds for denial or revocation of a self- declaration document. (1) A child may not be kicked, punched, spanked, shaken, pinched, bitten, roughly handled, struck, mechanically restrained, or physically maltreated by the provider, emergency designee, household member, or any other adult in the residence. (2) Authority to discipline may not be delegated to or be administered by children. (3) Separation, when used as discipline, must be appropriate to the child's development and circumstances, and the child must be in a safe, lighted, well-ventilated room within sight or hearing range of an adult. A child may not be isolated in a locked room or closet. (4) A child may not be punished for lapses in toilet training. (5) A provider may not use verbal abuse or make derogatory remarks about the child, or the child's family, race, or religion when addressing a child or in the presence of a child. (6) A provider may not use profane, threatening, unduly loud, or abusive language in the presence of a child. (7) A provider may not force-feed a child or coerce a child to eat unless medically prescribed and administered under a medical provider's care. (8) A provider may not use deprivation of snacks or meals as a form of discipline or punishment. (9) A provider may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in a child's mouth to deter the child from biting other children. (10) A provider may not withhold active play from a child as a form of discipline or punishment, beyond a brief period of separation. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to12 years: Shall ensure that discipline is constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. Disregard of any of the following disciplinary rules or any disciplinary measure resulting in physical or emotional injury, or neglect or abuse, to any child is grounds for denial or revocation of an in-home registration. (1) Authority to discipline may not be delegated to children nor may discipline be administered by children. (2) Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well- ventilated room within sight or hearing range of the in-home provider. An in- home provider may not isolate a child in a locked room or closet. (3) A child may not be punished for lapses in toilet training. (4) An in-home provider may not use verbal abuse or make derogatory remarks about a child, or a child's family, race, or religion when addressing the child or in the presence of a child. (5) An in-home provider may not use profane, threatening, unduly loud, or abusive language in the presence of a child. (6) An in-home provider may not force-feed a child or coerce a child to eat, unless medically prescribed and administered under a medical provider's care. (7) An in-home provider may not use deprivation of meals or snacks as a form of discipline or punishment. (8) An in-home provider may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. (9) An in-home provider may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in a child's mouth to deter the child from biting other children. (10) An in-home provider may not withhold active play from a child as a form of discipline or punishment, beyond a brief period of separation. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: Disregard of any of the following disciplinary rules or disciplinary measure resulting in physical or emotional injury, neglect, or abuse to any child is grounds for license denial or revocation. 1. The school-age child care program must have a written policy regarding the discipline of children. The operator shall provide the policy to, and discuss the policy with, the staff members before the school-age child care program begins operation or before staff members begin working with children. 2. Discipline must be constructive or educational in nature and may include diversion, separation from the problem situation, talking with the child about the situation, praising appropriate behavior, or gentle physical restraint, such as holding. A child may not be subjected to physical harm, fear, or humiliation. 3. Authority to discipline may not be delegated to children nor may discipline be administered by children. 4. Separation, when used as discipline, must be appropriate to the child's development and circumstances. The child must be in a safe, lighted, well-ventilated room within sight or hearing range of a staff member responsible for caring for or teaching children. A staff member may not isolate a child in a locked room or closet. 5. A child may not be punished for lapses in toilet training. 6. A staff member may not use verbal abuse or make derogatory remarks about a child, or a child's family, race, or religion when addressing a child or in the presence of a child. 7. A staff member may not use profane, threatening, unduly loud, or abusive language in the presence of a child. 8. A staff member may not force-feed a child or coerce a child to eat, unless medically prescribed and administered under a medical provider's care. 9. A staff member may not use deprivation of meals or snacks as a form of discipline or punishment. 10. A staff member, household member, or any other adult at the school-age child care program may not kick, punch, spank, shake, pinch, bite, roughly handle, strike, mechanically restrain, or physically maltreat a child. 11. A staff member may not force a child to ingest substances that would cause pain or discomfort, for example, placing soap in a child's mouth to deter the child from biting other children. 12. A staff member may not withhold active play from children as a means of discipline or punishment, beyond a brief period of separation. 5.3.7 Emergency preparedness and response planning standard Identify by checking below that the emergency preparedness and response planning due to natural disasters and human-caused events standard includes procedures in the following areas: i. [x] Evacuation ii. [x] Relocation iii. [x] Shelter-in-place iv. [x] Lock down v. Staff emergency preparedness [x] Training [x] Practice drills vi. Volunteer emergency preparedness [x] Training [x] Practice drills vii. [x] Communication with families viii. [x] Reunification with families ix. [x] Continuity of operations x. Accommodation of [x] Infants [x] Toddlers [x] Children with disabilities [x] Children with chronic medical conditions xi. If any of the above are not checked, describe: 5.3.8 Handling and storage of hazardous materials and the appropriate disposal of biocontaminants health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the handling and storage of hazardous materials for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Center ages 0 to 12 years and Preschool ages 2-6 years: The program shall ensure that potential hazards, such as noncovered electrical outlets, guns, household cleaning chemicals, uninsulated wires, medicines and poisonous plants are not accessible to children. The program shall keep guns and ammunition in locked storage, each separate from the other, or shall use trigger locks. The program shall ensure other weapons and dangerous sporting equipment, such as bow and arrows are not accessible to children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: The provider shall ensure that potential hazards, such as guns, household cleaning chemicals, uninsulated wires, medicines, noncovered electrical outlets, and poisonous plants are not accessible to children. The provider shall keep guns and ammunition in locked storage, each separate from the other, or shall use trigger locks. The provider shall ensure other weapons and dangerous sporting equipment, such as bows and arrows, are not accessible to children. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: Potential hazards, such as guns, household cleaning chemicals, uninsulated wires, medicines, noncovered electrical outlets, poisonous plants, and open stairways must not be accessible to children. Guns and ammunition must be kept in separate locked storage, or trigger locks must be used. Other weapons and dangerous sporting equipment, such as bows and arrows, must not be accessible to children. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child’s home, the Lead Agency does not have a regulation for this standard. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: The operator shall ensure that potential hazards, such as guns, household cleaning chemicals, uninsulated wires, medicines, poisonous plants, and open stairways are not accessible to children. The operator shall keep guns and ammunition in locked storage, each separate from the other, or shall use trigger locks. The operator shall ensure other weapons and dangerous sporting equipment, such as bows and arrows, are not accessible to children. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: The operator shall ensure that the garbage stored outside is kept away from areas used by children and is kept in containers with lids. Open burning is not permitted. The operator shall keep indoor garbage in covered containers. The provider may allow paper waste to be kept in open waste containers. The operator shall ensure that potential hazards, such as noncovered electrical outlets, guns, household cleaning chemicals, uninsulated wires, medicines, and poisonous plants are not accessible to children. The operator shall ensure that soiled linens are placed in closed containers or hampers during storage and transportation. The provider shall ensure that soiled or wet diapers are stored in a sanitary, covered container, separate from other garbage and waste until removed from the child care center. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: The provider shall ensure that the garbage stored outside is kept away from areas used by children and is kept in containers with lids. Open burning is not permitted. The operator shall keep indoor garbage in covered containers. The provider may allow paper waste to be kept in open waste containers. The provider shall ensure that potential hazards, such as noncovered electrical outlets, guns, household cleaning chemicals, uninsulated wires, medicines, and poisonous plants are not accessible to children. The operator shall ensure that soiled linens are placed in closed containers or hampers during storage and transportation. The provider shall ensure that soiled or wet diapers are stored in a sanitary, covered container, separate from other garbage and waste until removed from the program. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: The provider shall ensure that soiled or wet diapers are stored in a sanitary, covered container separate from other garbage and waste until removed from the child care. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child’s home, the Lead Agency does not have a regulation for this standard. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: After the completion of Cycle 2 monitoring in April 2024, the Lead Agency received a preliminary notice of non-compliance for this requirement on July 3, 2024. The notice stated: ￿The Monitoring Team did not find evidence that the Lead Agency has requirements in place for Licensed School-Age Programs for the appropriate disposal of biocontaminants.￿ The Lead Agency will need additional time to meet the requirement to ensure policies include standards, appropriate to the provider setting and age of children, that address the disposal of bio contaminants. Current policies: The operator shall ensure that garbage stored outside is kept away from areas used by children and is kept in containers with lids. Open burning is not permitted. The operator shall keep indoor garbage in covered containers. The operator may allow paper waste to be kept in open waste containers. 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: Center ages 0 to 12 years: The operator shall establish a written policy governing the transportation of children to and from the child care center, if the child care center provides transportation. This policy must specify who is to provide transportation and how parental permission is to be obtained for activities which occur outside the child care center. If the child care center provides transportation, the operator shall inform the parents of any insurance coverage on the vehicles. Any vehicle used for transporting children must be in safe operating condition and in compliance with state and local laws. When transportation is provided by a child care center, children must be protected by adequate staff member supervision, safety precautions, and liability insurance. Staffing requirements must be maintained to assure the safety of children while being transported. A child may not be left unattended in a vehicle. Children must be instructed in safe transportation conduct as appropriate to their age and stage of development. The driver must be eighteen years of age or older and shall comply with all relevant federal, state, and local laws, including child restraint system laws. Preschool ages 2 to 6 years: Prior to licensing, the operator shall establish a written policy governing the transportation of children to and from the preschool if the preschool provides transportation. This policy must specify who is to provide transportation and how parental permission is to be obtained for activities which occur outside the preschool. If the preschool provides transportation, the operator shall inform the parents of any insurance coverage on the vehicles. Any vehicle used for transporting children must be in safe operating condition and in compliance with state and local laws. When transportation is provided by a preschool, children must be protected by adequate staff member supervision, safety precautions, and liability insurance. Staffing requirements must be maintained to assure the safety of children while being transported. A child may not be left unattended in a vehicle. Children must be instructed in safe transportation conduct as appropriate to their age and stage of development. The driver must be eighteen years of age or older and must comply with all relevant federal, state, and local laws, including child restraint system laws. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family ages 0 to 12 years: Prior to licensure, the provider shall establish a written policy governing the transportation of children to and from the family child care if the family child care provides transportation. This policy must specify who is to provide transportation and how parental permission is to be obtained for activities which occur outside the family child care. If the family child care provides transportation, the provider shall inform the parents of any insurance coverage on the vehicles. Any vehicle used for transporting children must be in safe operating condition and in compliance with state and local laws. When transportation is provided by a family child care, children must be protected by adequate staff supervision, safety precautions, and liability insurance. Staffing requirements must be maintained to assure the safety of children while being transported. A child may not be left unattended in a vehicle. Children must be instructed in safe transportation conduct appropriate to their age and stage of development. Group ages 0 to 12 years: Prior to licensure, the provider shall establish a written policy governing the transportation of children to and from the group child care, if the group child care provides transportation. This policy must specify who is to provide transportation and how parental permission is to be obtained for activities which occur outside the group child care. If the group child care provides transportation, the provider shall inform the parents of any insurance coverage on the vehicles. Any vehicle used for transporting children must be in safe operating condition and in compliance with state and local laws. When transportation is provided by a group child care, children must be protected by adequate staff supervision, safety precautions, and liability insurance. Staffing requirements must be maintained to assure the safety of children while being transported. A child may not be left unattended in a vehicle. Children must be instructed in safe transportation conduct as appropriate to their age and stage of development. The driver must be eighteen years of age or older and must comply with all relevant federal, state, and local laws, including child restraint system laws. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0-12 years: When transportation is provided by a provider, children must be protected by adequate supervision, safety precautions, and liability insurance. Drivers must be eighteen years of age or older and must comply with all relevant federal, state, and local laws, including child restraint laws. A child must not be left unattended in a vehicle. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child’s home, the Lead Agency does not have a regulation for this standard. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: The operator shall establish a written policy governing the transportation of children to and from the school-age child care program if the school-age child care program provides transportation. This policy must specify who is to provide transportation and how parental permission is to be obtained for activities which occur outside the school- age child care program. If the school-age child care program provides transportation, the operator shall inform the parents of any insurance coverage on the vehicles. Any vehicle used for transporting children must be in safe operating condition and in compliance with state and local laws. When transportation is provided by a school-age child care program, children must be protected by adequate staff member supervision, safety precautions, and liability insurance. Staffing requirements must be maintained to assure the safety of the children while being transported. A child may not be left unattended in a vehicle. Children must be instructed in safe transportation conduct as appropriate to their age and stage of development. The driver must be at least eighteen years of age and shall comply with all relevant federal, state, and local laws, including child restraint system laws. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: All Staff members shall be currently certified within ninety days of employment and prior to staff member having unsupervised access to children under care, in pediatric first aid by a program approved by the department. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0-12 years: Be currently certified within ninety days of employment and prior to staff member having unsupervised access to children in care, in pediatric first aid by a program approved by the department. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: The provider shall be currently certified in pediatric first aid by a program approved by the department. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: When care is provided in a child’s home, the Lead Agency does not have a regulation for this standard. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: All staff members shall be currently certified within ninety days of employment and prior to staff member having unsupervised access to children under care, in pediatric first aid by a program approved by the department. 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: Center ages 0 to 12 years and Preschool ages 2-6 years: Shall be currently certified within ninety days of employment and prior to staff member having unsupervised access to children under care, in infant and pediatric cardiopulmonary resuscitation and the use of an automated external defibrillator by the American heart association, American red cross, or other similar cardiopulmonary resuscitation and automated external defibrillator training programs that are approved by the department. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0-12 years: Each staff member who provides care shall be currently certified within ninety days of employment and prior to staff member having unsupervised access to children under care, in infant and pediatric cardiopulmonary 6 resuscitation and the use of an automated external defibrillator by the American heart association, American red cross, or other similar cardiopulmonary resuscitation and automated external defibrillator training programs that are approved by the department. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0-12 years: The provider shall be currently certified in infant and pediatric cardiopulmonary resuscitation and the use of an automated external defibrillator by the American heart association, the American red cross, or other similar cardiopulmonary resuscitation and automated external defibrillator training programs that are approved by the department. The provider shall ensure the emergency designee is currently certified in infant and pediatric cardiopulmonary resuscitation and the use of an automated external defibrillator by the American heart association, American red cross, or other similar cardiopulmonary resuscitation and automated external defibrillator training programs that are approved by the department. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency currently does not have a standard for this requirement and will need additional time to come into compliance. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: All staff members shall be currently certified within ninety days of employment and prior to staff member having unsupervised access to children under care, in infant and pediatric cardiopulmonary resuscitation and the use of an automated external defibrillator by the American heart association, American red cross, or other similar cardiopulmonary resuscitation and automated external defibrillator training programs that are approved by the department. 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: Center Ages 0 to age 12 and Preschool ages 2-6 years: Certify annual completion of the required minimum number of hours of department-approved training related to child care, including one hour on safe sleep prior to caring for infants and one hour on mandated reporter of suspected child abuse or neglect. By completing the required North Dakota Mandated Reporter the provider will learn about the North Dakota child abuse and neglect law, specifically: Who is a mandated reporter of suspected child abuse and neglect; What needs to be reported; How to recognize the signs of child abuse and neglect; Definitions and examples of child maltreatment, child safety and dangers (present and impending); How, where, and when to report; What happens after a report is filed; and, Actions for assisting children and families when the identified concerns fall outside the child abuse and neglect law. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group 0 to 12 years: Providers and Staff certify completion of the required minimum number of hours of department-approved training related to child care annually, including one hour on mandated reporter of suspected child abuse or neglect. By completing the required North Dakota Mandated Reporter the provider will learn about the North Dakota child abuse and neglect law, specifically: Who is a mandated reporter of suspected child abuse and neglect; What needs to be reported; How to recognize the signs of child abuse and neglect; Definitions and examples of child maltreatment, child safety and dangers (present and impending); How, where, and when to report; What happens after a report is filed; and, Actions for assisting children and families when the identified concerns fall outside the child abuse and neglect law. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0 to 12 years: Shall complete a minimum of three hours of department-approved training annually, including one hour on safe sleep prior to provider providing care to infants and one hour on mandated reporter of suspected child abuse or neglect. By completing the required North Dakota Mandated Reporter the provider will learn about the North Dakota child abuse and neglect law, specifically: Who is a mandated reporter of suspected child abuse and neglect; What needs to be reported; How to recognize the signs of child abuse and neglect; Definitions and examples of child maltreatment, child safety and dangers (present and impending); How, where, and when to report; What happens after a report is filed; and, Actions for assisting children and families when the identified concerns fall outside the child abuse and neglect law. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Ages 0 to 12 years: Shall complete one hour of department-approved training annually on safe sleep prior to in-home provider having unsupervised access to infants and one hour on mandated reporter of suspected child abuse or neglect. By completing the required North Dakota Mandated Reporter the provider will learn about the North Dakota child abuse and neglect law, specifically: Who is a mandated reporter of suspected child abuse and neglect; What needs to be reported; How to recognize the signs of child abuse and neglect; Definitions and examples of child maltreatment, child safety and dangers (present and impending); How, where, and when to report; What happens after a report is filed; and, Actions for assisting children and families when the identified concerns fall outside the child abuse and neglect law. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years: Certify annual completion of the required minimum number of hours of department-approved training related to child care, including one hour on mandated reporter of suspected child abuse or neglect. By completing the required North Dakota Mandated Reporter the provider will learn about the North Dakota child abuse and neglect law, specifically: Who is a mandated reporter of suspected child abuse and neglect; What needs to be reported; How to recognize the signs of child abuse and neglect; Definitions and examples of child maltreatment, child safety and dangers (present and impending); How, where, and when to report; What happens after a report is filed; and, Actions for assisting children and families when the identified concerns fall outside the child abuse and neglect law. 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: Center Ages 0 to 12 years: The operator is responsible for compliance with the requirements set forth in this chapter and North Dakota Century Code chapter 50-11.1. The provider must have policies that include the process for a parent or staff member to report a complaint, a suspected licensing violation, and suspected child abuse or neglect. The provider must report immediately, as a mandatory reporter, suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. Preschool Ages 2-6 years: Policies shall include the process for a parent or staff member to report a complaint, a suspected licensing violation, and suspected child abuse or neglect. The provider must report immediately, as a mandatory reporter, any suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Family and Group ages 0 to 12 years: The provider, as a mandatory reporter, shall report any suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. The provider of a group child care is responsible for compliance with requirements set forth in the standards and North Dakota Century Code chapter 50-11.1. The provider must have policies must include the process for a parent or staff member to report a complaint, a suspected licensing violation, and suspected child abuse or neglect. Provider must report, as a mandatory reporter, any suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: N/A v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Self-Declaration ages 0-12 years: Shall report immediately, as a mandated reporter, suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Shall report immediately, as a mandated reporter, suspected child abuse or neglect as required by North Dakota Century Code section 50-25.1-03. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Ages 5 to 12 years old: The operator of a school-age child care program is responsible for compliance with the requirements set forth in this chapter and North Dakota Century Code chapter 50- 11.1. The provider must have policies that include the process for a parent or staff member to report a complaint, a suspected licensing violation, and suspected child abuse or neglect. The provider shall report immediately, as a mandated reporter, any suspected child abuse or neglect as required by North Dakota Century Code chapter 50-25.1. 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: When a provider is responsible for providing food to children, the food supplied must meet UDSA standards and must be properly prepared, sufficient in amount and varied. Food must be served at the appropriate hours. Children in care for more than 3 hours shall receive either a snack or meal, whichever is appropriate. Food that is prepared, and served or stored at the program must be treated in a safe and sanitary manner with safe and sanitary equipment. Specific training is not required. ii. Access to physical activity. Describe: Each operator shall provide adequate indoor and outdoor space for the daily activities of all children within the licensed capacity of the child care. Operators who provide 75 square feet of separate indoor recreation space per child for the largest class or group are exempt from outdoor space requirement. iii. Caring for children with special needs. Describe: An operator shall make appropriate accommodations, as required by the Americans with Disabilities Act, to meet the need of children with special needs. The child care center shall receive documentation of the child 's special needs from the parent upon the child's enrollment. Specific training is not required. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A