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: 391 Neb. Admin. Code (NAC) § 3-006.10 Staff and Volunteer Orientation and Training 3-006.10A Orientation: When new staff or volunteers are employed, those individuals must be provided with orientation prior to their having direct responsibility for the care of children. The orientation must include: 1. Job duties and responsibilities; 2. Infection control practices including proper hand washing techniques, personal hygiene, and disposal of infectious material; 3. Information on abuse, neglect and sexual abuse of children and the state’s reporting requirements; 4. Child care center regulations; 5. Evacuation plans in the event of fire; 6. Safety plans in the event of a tornado; 7. Emergency preparedness in the event of a natural or man made disaster; and 8. The center’s method of interacting with children and discipline policies. 391 Neb. Admin. Code (NAC) § 3-006.10A Orientation: When new staff or volunteers are employed, those individuals must be provided with orientation prior to their having direct responsibility for the care of children. The orientation must include: 2. Infection control practices including proper hand washing techniques, personal hygiene, and disposal of infectious material; 391 Neb. Admin. Code (NAC) § 3-006.16 Communicable Diseases: The Department will provide the center with information about communicable diseases to assist the center in carrying out its responsibilities. 391 Neb. Admin. Code (NAC) § 3-006.16A Notification to Parents: The licensee/director must notify parents of all enrolled children of any case of any reportable communicable disease on the same day the licensee is informed of or observes the illness, unless otherwise directed by the health authority. The health authority is the local health department for the area. Proper notification includes: 1. Notification to parents of children in attendance; 2. Notification to parents of enrolled children who are not in attendance on that day; and 3. Posting notice of the outbreak in a conspicuous place. 391 Neb. Admin. Code (NAC) § 3-006.16B Confidentiality: Names of ill children must not be released to anyone except health authorities, unless parents have given their permission. 391 Neb. Admin. Code (NAC) § 3-006.16C Health Authority: The center must follow all directives given to the licensee by the health authority in the event of a communicable disease outbreak. 391 Neb. Admin. Code (NAC) § 3-006.17 Children Excluded Due to Illness: The center must have a written policy that identifies the circumstances under which children would be excluded from child care due to illness. To assist in writing the policy, the Department will provide the licensee with materials that include recommendations on: 1. Exclusion based on specific conditions such as fever, diarrhea, vomiting, etc.; and 2. Exclusion based on specific contagious and infectious diseases such as chickenpox, measles, mumps, etc. The licensee must enforce the center’s exclusion policy and make it available to the Department and to the parents of enrolled children. 391 Neb. Admin. Code (NAC) § 3-006.22B Beds, Cribs, and Sleeping Surfaces: The licensee must ensure that sleeping surfaces appropriate to the child's age and level of development are available for each child in care. 2. The only acceptable sleeping surfaces for children age 12 months and under are cribs and playpens. When used, cribs and playpens must meet the following standards: d. Cribs and playpens must be kept clean, in good repair, and not have any surface covered by lead-based paint. 3. Cribs, playpens, cots, and mats must be separated by at least three feet of space. 4. Cribs, playpens, cots, and mats must be disinfected daily or marked for individual use and disinfected weekly or more often when needed. 391 Neb. Admin. Code (NAC) § 3-006.23B Diapering and Toileting 1. The licensee must ensure that diapering procedures are established and followed by center staff. The procedures must include: a. Wet and/or soiled diapers are changed immediately; b. Diapers are checked on a frequent and regular basis; c. Individual washcloths or disposable towelettes are used; d. Wet and soiled diapers are properly stored and disposed; e. Diaper-changing surfaces are cleaned after each use by sanitizing the surface or changing the diaper pad or disposable sheeting and are disinfected daily; and f. Proper hand washing is done after each diaper change. 2. The licensee must ensure that toilet training is conducted in a manner agreed upon with the parent. The licensee must also ensure that: a. Potty chairs are not used or stored in eating or play areas; and b. Proper hand washing by the provider and the child is done each time a child is helped with toileting 391 Neb. Admin. Code (NAC) § 3-006.31 Environmental Services: The licensee must ensure that child care is provided in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 3-006.31A Housekeeping and Maintenance: The licensee must ensure that the necessary housekeeping and maintenance are provided to protect the health and safety of children in care. The center and grounds must be kept clean, safe, and in good repair. 2. Rooms, walls, floors, and ceilings must be kept clean, dry, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 3. Heating, ventilation, and lighting in all rooms used for child care must be adequate to protect the health of children. 4. The licensee must equip and maintain the premises to prevent the entrance, harborage, or breeding of rodents, flies and all other insects and vermin. All doors opening to the outside must be self-closing. (except sliding doors) and all windows used for ventilation must be screened. The center must have effective screening of all openings to the outside when flies or other flying insects are present. 5. All garbage and rubbish must be disposed of in a manner that minimizes odor and the transmission of infectious diseases, and prevents the attraction of rodents, flies, and all other insects and vermin. This includes: a. Using containers, both indoor and outdoor, for garbage and rubbish that are watertight, have tight fitting covers, and are fly and rodent-proof; b. Keeping all garbage and rubbish containers clean; and c. Not burning garbage on the premises. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.09 Communicable Diseases: The Department will provide the program with information about communicable diseases to assist the program in carrying out its responsibilities. 391 Neb. Admin. Code (NAC) § 1-006.09A Notification to Parents: The licensee must notify parents of all enrolled children of any case of any reportable communicable disease on the same day the licensee is informed of or observes the illness, unless otherwise directed by the health authority. The health authority is the local health department for the area. Proper notification includes: 1. Notification to parents of children in attendance; 2. Notification to parents of enrolled children who are not in attendance on that day; and 3. Posting notice of the outbreak in a conspicuous place. 391 Neb. Admin. Code (NAC) § 1-006.09B Confidentiality: Names of ill children must not be released to anyone except health authorities, unless parents have given their permission. 391 Neb. Admin. Code (NAC) § 1-006.09C Health Authority: The licensee must follow all directives given to the licensee by the health authority in the event of a communicable disease outbreak. 391 Neb. Admin. Code (NAC) § 1-006.10 Children Excluded Due to Illness: The licensee must have a written policy that identifies the circumstances under which children would be excluded from child care due to illness. To assist in writing the policy, the Department will provide the licensee with materials that include recommendations on: 1. Exclusion based on specific conditions such as fever, diarrhea, vomiting, etc.; and 2. Exclusion based on specific contagious and infectious diseases such as chickenpox, measles, mumps, etc. The licensee must enforce the program’s exclusion policy and make it available to the Department and to the parents of enrolled children. 391 Neb. Admin. Code (NAC) § 1-006.15B Beds, Cribs, and Sleeping Surfaces: Appropriate sleeping surfaces must be available for each child in care. 2. The only acceptable sleeping surfaces for children age 12 months and under are cribs and playpens. When used, cribs and playpens must meet the following standards: d. Cribs and playpens must be clean, in good repair, and not have any surface covered by lead-based paint. 391 Neb. Admin. Code (NAC) § 1-006.16A Diapering and Toileting 1. The licensee must ensure that diapering procedures are established and followed by staff. The procedures must require that: a. Wet and/or soiled diapers are changed immediately; b. Diapers are checked on a frequent and regular basis; c. Individual washcloths or disposable towelettes are used; d. Wet and soiled diapers are properly stored and disposed; e. Diaper-changing surfaces are cleaned after each use by sanitizing the surface or changing the diaper pad or disposable sheeting; and f. Proper hand washing is done after each diaper change. 2. The licensee must ensure that toilet training is conducted in a manner agreed upon by the primary provider and the parent. The licensee must also ensure that: a. Potty chairs are not used or stored in eating or play areas; and b. Proper hand washing by the provider and the child is done each time a child is helped with toileting. 391 Neb. Admin. Code (NAC) § 1-006.24 Environmental Services: The licensee must provide child care in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 1-006.24A Housekeeping and Maintenance: The licensee must provide the necessary housekeeping and maintenance to protect the health and safety of children in care. The child care home and grounds must be kept clean, safe, and in good repair. 2. Rooms, walls, floors, and ceilings must be kept clean, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 3. Heating, ventilation, and lighting in all rooms used for child care must be adequate to protect the health of children. 4. The licensee must equip and maintain the premises to prevent the entrance, harborage, or breeding of rodents, flies, and all other insects and vermin. All doors opening to the outside must be self-closing (except sliding doors) and all windows used for ventilation must be screened. 5. All garbage and rubbish must be disposed of in a manner that prevents the attraction of rodents, flies, and all other insects and vermin. The licensee must dispose of garbage so as to minimize odor and the transmission of infectious diseases. 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (A) Prevention and control of infectious diseases, including immunizations: (i) Infection control practices; 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets the control of infectious diseases to include proper vaccinations for household pets susceptible to rabies. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements: Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 1. Prevention and control of infectious diseases (including immunization) a. Infection control practices; vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (A) Prevention and control of infectious diseases, including immunizations: (i) Infection control practices; 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets the control of infectious diseases to include proper vaccinations for household pets susceptible to rabies. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements: Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 1. Prevention and control of infectious diseases (including immunization) a. Infection control practices; vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.09 Staff and Volunteer Orientation and Training 391 Neb. Admin. Code (NAC) § 4-006.09A Orientation: When new staff or volunteers are employed, those individuals must be provided with orientation prior to their having direct responsibility for the care of children. The orientation must include: 2. Infection control practices including proper hand washing techniques, personal hygiene, and disposal of infectious material; 391 Neb. Admin. Code (NAC) § 4-006.15 Communicable Diseases: The Department will provide the center with information about communicable diseases to assist the center in carrying out its responsibilities. 391 Neb. Admin. Code (NAC) § 4-006.15A Notification to Parents: The licensee/director must notify parents of all enrolled children of any case of any reportable communicable disease on the same day the licensee is informed of or observes the illness, unless otherwise directed by the health authority. The health authority is the local health department for the area. Proper notification includes: 1. Notification to parents of children in attendance; 2. Notification to parents of enrolled children who are not in attendance on that day; and 3. Posting notice of the outbreak in a conspicuous place. 391 Neb. Admin. Code (NAC) § 4-006.15B Confidentiality: Names of ill children must not be released to anyone except health authorities, unless parents have given their permission. 391 Neb. Admin. Code (NAC) § 4-006.15C Health Authority: The center must follow all directives given to the licensee by the health authority in the event of a communicable disease outbreak. 391 Neb. Admin. Code (NAC) § 4-006.16 Children Excluded Due to Illness: The center must have a written policy that identifies the circumstances under which children would be excluded from child care due to illness. To assist in writing the policy, the Department will provide the licensee with materials that will include recommendations on: 1. Exclusion based on specific conditions such as fever, diarrhea, vomiting, etc.; and 2. Exclusion based on specific contagious and infectious diseases such as chickenpox, measles, mumps, etc. The center must enforce its own exclusion policy and make it available to the Department and to the parents of enrolled children. 391 Neb. Admin. Code (NAC) § 4-006.21B Sleeping Surfaces: When children nap or sleep at the center, the licensee must ensure that appropriate sleeping surfaces are available for each child in care. 391 Neb. Admin. Code (NAC) § 4-006.28 Environmental Services: The licensee must ensure that child care is provided in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 4-006.28A Housekeeping and Maintenance: The licensee must ensure that the necessary housekeeping and maintenance are provided to protect the health and safety of children in care. The center and grounds must be kept clean, safe, and in good repair. 2. Rooms, walls, floors, and ceilings must be kept clean, dry, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 3. Heating, ventilation, and lighting in all rooms used for child care must be adequate to protect the health of children. 4. The licensee must equip and maintain the premises to prevent the entrance, harborage, or breeding of rodents, flies and all other insects and vermin. All doors opening to the outside must be self-closing (except sliding doors) and all windows used for ventilation must be screened. The center must have effective screening of all openings to the outside when flies or other flying insects are present. 5. All garbage and rubbish must be disposed of in a manner that minimizes odor and the transmission of infectious diseases, and prevents the attraction of rodents, flies, and all other insects and vermin. This includes: a. Using containers, both indoor and outdoor, for garbage and rubbish that are watertight, have tight fitting covers, and are fly and rodent proof; b. Keeping all garbage and rubbish containers clean; and c. Not burning garbage on the premises. 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: 391 Neb. Admin. Code (NAC) § 3-006.18 Immunizations: Within 30 days of a child’s enrollment, the licensee/director must obtain a copy of the child’s immunization record. Immunization records must be available for review upon request by the Department and updated each time the child receives additional immunizations. Each child’s immunization record must include: 1. Documentation of age- appropriate immunization; 2. Certification by a physician, advanced practice registered nurse, or physician assistant that immunization is not appropriate for a stated medical reason; or 3. A written statement that the parent or guardian does not wish to have the child immunized and the reasons for that decision. 391 Neb. Admin. Code (NAC) § 3-006.18A Immunization Report: The licensee must comply with all state statutes and regulations regarding immunization status of all enrolled children. This includes annual reporting to the Department. The Department will provide the program with materials to assist the program in carrying out its responsibilities. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Immunization records must include: 1. Documentation of appropriate immunization; 2. Certification by a physician, advanced practice registered nurse, or physician’s assistant that immunization is not appropriate for a stated medical reason; or 3. A written statement that the parent or guardian does not wish to have the child immunized and the reason for that decision. iii. All CCDF-eligible licensed in-home care. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.11 Immunizations: Within 30 days of a child’s enrollment, the licensee must obtain a copy of each enrolled child’s immunization record. Immunization records must be available for review upon request by the Department and updated each time the child receives additional immunizations. Each child’s immunization record must include: 1. Documentation of age- appropriate immunization; 2. Certification by a physician, advanced practice registered nurse, or physician assistant that immunization is not appropriate for a stated medical reason; or 3. A written statement that the parent or guardian does not wish to have the child immunized and the reasons for that decision. 391 Neb. Admin. Code (NAC) § 1-006.11A Immunization Report: The licensee must comply with all state statutes and regulations regarding immunization status of all enrolled children. This includes annual reporting to the Department. The Department will provide materials to assist the program in carrying out its responsibilities. [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004 PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (ii) Each child’s immunization record must include: (1) Documentation of age-appropriate immunization; (2) Certification by a physician, advanced practice registered nurse, or physician assistant that immunization is not appropriate for a stated medical reason; or (3) A written statement that the parent or guardian does not wish to have the child immunized and the reasons for that decision. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements: Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 1. Prevention and control of infectious diseases (including immunization) b. Each child’s immunization record must include one of the following: Documentation of age-appropriate immunizations; Certification by a physician, advanced practice registered nurse or physician’s assistant that immunization is not appropriate for a stated medical reason; or, A written statement that the parent or guardian does not wish to have the child immunized and the reason for that decision. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004 PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (ii) Each child’s immunization record must include: (1) Documentation of age-appropriate immunization; (2) Certification by a physician, advanced practice registered nurse, or physician assistant that immunization is not appropriate for a stated medical reason; or (3) A written statement that the parent or guardian does not wish to have the child immunized and the reasons for that decision. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements: Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 1. Prevention and control of infectious diseases (including immunization) b. Each child’s immunization record must include one of the following: Documentation of age-appropriate immunizations; Certification by a physician, advanced practice registered nurse or physician’s assistant that immunization is not appropriate for a stated medical reason; or, A written statement that the parent or guardian does not wish to have the child immunized and the reason for that decision. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.17 Immunizations: If a school-age-only center is located on the premises of a school and the staff have access to the school’s child immunization records, copies of immunization records are not required. For all other centers, within 30 days of a child’s enrollment, the licensee/director must obtain a copy of the child’s immunization record. Immunization records must be available for review upon request by the Department and updated each time the child receives additional immunizations. Each child’s immunization record must include: 1. Documentation of age-appropriate immunization; 2. Certification by a physician, advanced practice registered nurse, or physician assistant that immunization is not appropriate for a stated medical reason; or 3. A written statement that the parent or guardian does not wish to have the child immunized and the reasons for that decision. 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: State Statute § 71- 1917.01. Blankets; prohibited in cribs. Blankets shall not be used in cribs in any child care facility State Statute § 43-2606. Providers of child care and school-age-care programs; training requirements; use of Nebraska Early Childhood Professional Record System. (1) The Department of Health and Human Services shall adopt and promulgate rules and regulations for mandatory training requirements for providers of child care and school-age-care programs. Such requirements shall include preservice orientation and at least four hours of annual in-service training. All child care programs required to be licensed under section 71-1911 shall show completion of a preservice orientation approved or delivered by the department prior to receiving a provisional license. (3) The training requirements shall be designed to meet the health, safety, and developmental needs of children and shall be tailored to the needs of licensed providers of child care programs. Preservice orientation and the training requirements for providers of child care programs shall include, but not be limited to, information on sudden unexpected infant death syndrome, abusive head trauma in infants and children, crying plans, and child abuse. 391 Neb. Admin. Code (NAC) § 3-006.08A Safety Training: The director must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 3-006.09A Safety Training: Teachers must complete training developed by the Early Childhood Training Center (ECTC) on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 3-006.15B Staffing Requirements 1. All staff must be awake and alert to the needs of the children at all times, including napping/sleeping times. 3. During naptime, at least one teacher must be in the room where children are napping, as long as the staff-to-child ratio is maintained center-wide. 391 Neb. Admin. Code (NAC) § 3-006.22B Beds, Cribs, and Sleeping Surfaces: The licensee must ensure that sleeping surfaces appropriate to the child's age and level of development are available for each child in care. 1. Acceptable sleeping surfaces for children over 12 months of age are: a. Beds; b. Cots; c. Cribs; d. Playpens; e. Sofas; f. Washable sleeping bags; and g. Waterproof mats, which must be at least one inch thick and at least 45 inches long. 2. The only acceptable sleeping surfaces for children age 12 months and under are cribs and playpens. When used, cribs and playpens must meet the following standards: a. Cribs and playpens must be federally approved; b. Cribs must be equipped with a waterproof crib mattress covered by a fitted sheet. The mattress pad for a playpen must be specifically designed for playpen use and covered by a fitted sheet; c. Cribs and playpens must contain no soft objects, bumper pads, toys, or loose bedding. If a blanket is used, it must be secured or tucked under the crib mattress or the pad of the playpen and reach no higher than the infant’s chest; and d. Cribs and playpens must be kept clean, in good repair, and not have any surface covered by lead-based paint. 3. Cribs, playpens, cots, and mats must be separated by at least three feet of space. 4. Cribs, playpens, cots, and mats must be disinfected daily or marked for individual use and disinfected weekly or more often when needed. 5. For evening care, each child must be provided with a cot with a waterproof mattress. 6. The following must not be used as sleeping surfaces: a. The top level of a bunk for children age 5 and under; b. Stackable cribs; c. Waterbeds for children age 3 and under; and d. Cots, cushions, futons, mats, or pillows for infants 12 months and under. 391 Neb. Admin. Code (NAC) § 3-006.23 Infant/Toddler Care: If care is provided to infants and/or toddlers, the licensee must ensure that the emotional and physical needs of infants and toddlers are met consistently and promptly. Staff assigned to infants must be identified in writing and assigned to the same infants whenever possible. Center staff must: 6. Place infants on their backs to sleep unless there is a medical reason for a child to sleep in a different position. A written note from the infant’s physician, physician assistant, or nurse practitioner indicating that the infant must sleep in a different position must be obtained, kept on file, and available for review by the Department. 391 Neb. Admin. Code (NAC) § 3-006.23A Infant Care Rooms: Rooms where infants are receiving care must be limited to the care of no more than 12 children at any one time. 1. If five or more infants are receiving care in a room, at least two staff members must be in the room. 2. If nine or more infants are receiving care in a room, at least three staff members must be in the room. 3. Equipment such as cribs with wheels, buggies, wagons, or laundry carts must be available for emergency evacuation unless additional staff above the ratio are available to carry infants. 391 Neb. Admin. Code (NAC) § 3-006.24 Overnight Care: If overnight care is provided, center staff must: 2. Remain awake and alert to the needs of children through the night. 391 Neb. Admin. Code (NAC) § 3-006.02 Director Requirements: The director is responsible for managing the day-today operations of the child care center. The director must report to the licensee all matters related to the maintenance, operation, and management of the child care center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the child care center, in the child’s home, or elsewhere, or ensure that a report is filed; ii. All CCDF-eligible licensed family child care homes. Provide the standard: State Statute § 71-1917.01. Blankets; prohibited in cribs. Blankets shall not be used in cribs in any child care facility State Statute § 43-2606. Providers of child care and school-age-care programs; training requirements; use of Nebraska Early Childhood Professional Record System. (1) The Department of Health and Human Services shall adopt and promulgate rules and regulations for mandatory training requirements for providers of child care and school-age-care programs. Such requirements shall include preservice orientation and at least four hours of annual in-service training. All child care programs required to be licensed under section 71-1911 shall show completion of a preservice orientation approved or delivered by the department prior to receiving a provisional license. (3) The training requirements shall be designed to meet the health, safety, and developmental needs of children and shall be tailored to the needs of licensed providers of child care programs. Preservice orientation and the training requirements for providers of child care programs shall include, but not be limited to, information on sudden unexpected infant death syndrome, abusive head trauma in infants and children, crying plans, and child abuse. 391 Neb. Admin. Code (NAC) § 1-006.04B Safety Training: The licensee must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 1-006.15B Beds, Cribs, and Sleeping Surfaces: Appropriate sleeping surfaces must be available for each child in care. 1. Acceptable sleeping surfaces for children over 12 months of age are: a. Beds; b. Cots; c. Cribs; d. Playpens; e. Sofas; f. Washable sleeping bags; and g. Waterproof mats. 2. The only acceptable sleeping surfaces for children age 12 months and under are cribs and playpens. When used, cribs and playpens must meet the following standards: a. Cribs and playpens must be federally approved; b. Cribs must be equipped with a tight-fitting waterproof mattress covered by a fitted sheet. The mattress pad for a playpen must be specifically designed for playpen use and covered by a fitted sheet; c. Cribs and playpens must contain no soft objects, bumper pads, toys, or loose bedding, and d. Cribs and playpens must be clean, in good repair, and not have any surface covered by lead-based paint. 3. The following must not be used as sleeping surfaces: a. The top level of a bunk bed for children age 5 and under; b. Stackable cribs; c. Waterbeds for children age 3 and under; and d. Cots, cushions, futons, mats, or pillows for infants 12 months and under. 391 Neb. Admin. Code (NAC) § 1-006.16 Infant/Toddler Care: If care is provided to infants and/or toddlers, the licensee and staff must: 6. Place infants on their backs to sleep unless there is a medical reason for a child to sleep in a different position. A written note from the infant’s physician, nurse practitioner, or physician assistant indicating that the infant must sleep in a different position must be obtained, kept on file, and available for review by the Department. 391 Neb. Admin. Code (NAC) § 1-006.17 Overnight Care: If overnight care is provided, the licensee must ensure that: 2. The following fire safety standards for overnight care are met: a. The licensee/staff remain awake until all children are asleep; b. The licensee/staff sleep on the same level of the home as the 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004 PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (B) Prevention of sudden infant death syndrome and use of safe sleeping practices: (i) Providers must practice and ensure safety for nap or sleep times: (1) Infants must sleep on their back unless there is a medical reason and written note from a physician; and (2) Providers must have appropriate sleeping surfaces for all children. (ii) The following must not be used as sleeping surfaces: (1) The top level of a bunk bed for children age five and under; (2) Stackable cribs; (3) Waterbeds for children age three and under; and (4) Cots, cushions, futons, mats, or pillows for infants 12 months or under. 392 Neb. Admin. Code (NAC) § 4-001 GENERAL STANDARDS Provide and use clean and comfortable napping and sleeping arrangements for the children; Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 2. Prevention of sudden infant death syndrome and use of safe sleeping practices a. Providers must practice and ensure safety for nap and sleep times: a. Infants must sleep on their back unless there is a medical reason and written note from a physician; and, Providers must have appropriate sleeping surfaces for all children. b. The following must not be used as sleep surfaces for infants: The top level of a bunk bed for children age five and under; Stackable cribs; Waterbeds for children age three and under; and, Cots, cushions, futons, mats or pillows for infants 12 months or under. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004 PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (B) Prevention of sudden infant death syndrome and use of safe sleeping practices: (i) Providers must practice and ensure safety for nap or sleep times: (1) Infants must sleep on their back unless there is a medical reason and written note from a physician; and (2) Providers must have appropriate sleeping surfaces for all children. (ii) The following must not be used as sleeping surfaces: (1) The top level of a bunk bed for children age five and under; (2) Stackable cribs; (3) Waterbeds for children age three and under; and (4) Cots, cushions, futons, mats, or pillows for infants 12 months or under. 392 Neb. Admin. Code (NAC) § 4-001 GENERAL STANDARDS Provide and use clean and comfortable napping and sleeping arrangements for the children; Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 2. Prevention of sudden infant death syndrome and use of safe sleeping practices a. Providers must practice and ensure safety for nap and sleep times: a. Infants must sleep on their back unless there is a medical reason and written note from a physician; and, Providers must have appropriate sleeping surfaces for all children. b. The following must not be used as sleep surfaces for infants: The top level of a bunk bed for children age five and under; Stackable cribs; Waterbeds for children age three and under; and, Cots, cushions, futons, mats or pillows for infants 12 months or under. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: State Statute § 43-2606. Providers of child care and school-age-care programs; training requirements; use of Nebraska Early Childhood Professional Record System. (1) The Department of Health and Human Services shall adopt and promulgate rules and regulations for mandatory training requirements for providers of child care and school-age-care programs. Such requirements shall include preservice orientation and at least four hours of annual in-service training. All child care programs required to be licensed under section 71-1911 shall show completion of a preservice orientation approved or delivered by the department prior to receiving a provisional license. (3) The training requirements shall be designed to meet the health, safety, and developmental needs of children and shall be tailored to the needs of licensed providers of child care programs. Preservice orientation and the training requirements for providers of child care programs shall include, but not be limited to, information on sudden unexpected infant death syndrome, abusive head trauma in infants and children, crying plans, and child abuse. 391 Neb. Admin. Code (NAC) § 4-006.07A Safety Training: The director must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 4-006.08A Safety Training: Teachers must complete training developed by the Early Childhood Training Center (ECTC) on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 4-391 Neb. Admin. Code (NAC) § 006.14B Staffing Requirements 1. All staff must be awake and alert to the needs of the children at all times, including napping/sleeping times. 3. During naptime, at least one teacher must be in the room where children are napping, as long as the staff-to- child ratio is maintained center-wide. 4-006.21B Sleeping Surfaces: When children nap or sleep at the center, the licensee must ensure that appropriate sleeping surfaces are available for each child in care. Acceptable sleeping surfaces for school-age children are: 1. Beds; 2. Cots; 3. Sofas; 4. Washable sleeping bags; and 5. Waterproof mats which must be at least one inch thick and at least 45 inches long. 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: 391 Neb. Admin. Code (NAC) § 3-006.27 Medications: The licensee must ensure the following conditions are met when center staff or volunteers give or apply medication. 391 Neb. Admin. Code (NAC) § 3-006.27A Giving or Applying Medication: Any staff who gives or applies medication must do so in accordance with the "Five Rights" as set out in the Medication Aide Act. The Five Rights are: 1. The right drug; 2. The right recipient; 3. In the right dose; 4. By the right route; and 5. At the right time. 391 Neb. Admin. Code (NAC) § 3-006.27B Competence to Give or Apply Medication: Parents or any licensed health care professional are responsible for determining if center staff are competent to give or apply medication. Any licensed health care professional, as directed by the prescribing health professional, is competent to give or apply medication under any circumstances as long as it is within the scope of practice of that health care professional. The center director has the responsibility to assess the ability of staff to give or apply medication. 391 Neb. Admin. Code (NAC) § 3-006.27C Confidentiality: Any staff who gives or applies medication must not disclose information about a child’s medication or physical or mental health condition unless such information is needed to protect the health of other children or staff. The use of a posted medication sign-in sheet does not violate confidentiality if the parent has been advised in writing that the parent has the option of using a private method of informing center staff of the child’s medication needs. 391 Neb. Admin. Code (NAC) § 3-006.27F Hand Washing: All individuals must properly wash their hands before giving or applying any medication. If handling any bodily fluids is involved, individuals must properly wash their hands after giving or applying medication. 391 Neb. Admin. Code (NAC) § 3-006.27G Storage: All medications must be kept in proper storage. This includes: 1. All prescription and non-prescription medications must be kept in locked storage at all times children are in care; 2. Separate locked storage must be provided for medications requiring refrigeration; 3. All medications must be kept in the original container and stored according to instructions, clearly labeled for the named child, and returned to the parent when no longer needed; and 4. Over-the-counter, non-toxic topical ointments such as lip balm, petroleum jelly, sun block and diaper ointment must be kept out of the reach of children. 391 Neb. Admin. Code (NAC) § 3-006.27H Record-Keeping: The licensee/director must maintain a record as to the time and amount of medication given or applied. 391 Neb. Admin. Code (NAC) § 3-006.32E Other Environmental Safety Requirements 2. … medications (both prescription and nonprescription) … must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.20 Medications: The licensee must ensure the following conditions are met when center staff or volunteers give or apply medication. 391 Neb. Admin. Code (NAC) § 1-006.20A Giving or Applying Medication: Any staff who gives or applies medication must do so in accordance with the "Five Rights" as set out in the Medication Aide Act. The Five Rights are: 1. The right drug; 2. The right recipient; 3. In the right dose; 4. By the right route; and 5. At the right time. 391 Neb. Admin. Code (NAC) § 1-006.20B Competence to Give or Apply Medication: Parents or any licensed health care professional are responsible for determining if center staff are competent to give or apply medication. Any licensed health care professional, as directed by the prescribing health professional, is competent to give or apply medication under any circumstances as long as it is within the scope of practice of that health care professional. The center director has the responsibility to assess the ability of staff to give or apply medication. 391 Neb. Admin. Code (NAC) § 1-006.20C Confidentiality: Any staff who gives or applies medication must not disclose information about a child’s medication or physical or mental health condition unless such information is needed to protect the health of other children or staff. The use of a posted medication sign-in sheet does not violate confidentiality if the parent has been advised in writing that the parent has the option of using a private method of informing center staff of the child’s medication needs. 391 Neb. Admin. Code (NAC) § 1-006.20F Hand Washing: All individuals must properly wash their hands before giving or applying any medication. If handling any bodily fluids is involved, individuals must properly wash their hands after giving or applying medication. 391 Neb. Admin. Code (NAC) § 1-006.20G Storage: All medications must be kept in proper storage. This includes: 1. All prescription and non-prescription medications must be kept in locked storage at all times children are in care; 2. Separate locked storage must be provided for medications requiring refrigeration; 3. All medications must be kept in the original container and stored according to instructions, clearly labeled for the named child, and returned to the parent when no longer needed; and 4. Over-the-counter, non-toxic topical ointments such as lip balm, petroleum jelly, sun block and diaper ointment must be kept out of the reach of children. 391 Neb. Admin. Code (NAC) § 1-006.20H Record-Keeping: The licensee/director must maintain a record as to the time and amount of medication given or applied. 391 Neb. Admin. Code (NAC) § 1-006.25E Other Environmental Safety Requirements 2. … medications (both prescription and nonprescription) … must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (C) Administration of medication: (i) Providers who give or apply medication must follow the Five Rights: (1) The right drug; (2) The right recipient; (3) In the right dose; (4) By the right route; and (5) At the right time. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 3. Administration of medication a. Providers who give or apply medication must follow the Five Rights: The right drug; The right recipient; In the right dose; By the right route; and, At the right time. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (C) Administration of medication: (i) Providers who give or apply medication must follow the Five Rights: (1) The right drug; (2) The right recipient; (3) In the right dose; (4) By the right route; and (5) At the right time. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 3. Administration of medication a. Providers who give or apply medication must follow the Five Rights: The right drug; The right recipient; In the right dose; By the right route; and, At the right time. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.24 Medications: The licensee must ensure the following conditions are met when center staff give or apply medication. 391 Neb. Admin. Code (NAC) § 4-006.24A Giving or Applying Medication: Any staff who gives or applies medication must do so in accordance with the "Five Rights" as set out in the Medication Aide Act. The Five Rights are: 1. The right drug; 2. The right recipient; 3. In the right dose; 4. By the right route; and 5, At the right time. 391 Neb. Admin. Code (NAC) § 4-006.24B Competence to Give or Apply Medication: Parents or any licensed health care professional are responsible for determining if center staff are competent to give or apply medication. Any licensed health care professional, as directed by the prescribing health professional, is competent to give or apply medication under any circumstances as long as it is within the scope of practice of that health care professional. The center director has the responsibility to assess the ability of staff to give or apply medication. 391 Neb. Admin. Code (NAC) § 4-006.24C Confidentiality: Any staff who gives or applies medication must not disclose information about a child’s medication or physical or mental health condition unless such information is needed to protect the health of other children or staff. The use of a posted medication sign-in sheet does not violate confidentiality if the parent has been advised in writing that the parent has the option of using a private method of informing center staff of the child’s medication needs. 391 Neb. Admin. Code (NAC) § 4-006.24G Storage: All medications must be kept in proper storage. This includes: 1. All prescription and non-prescription medications must be kept in locked storage at all times children are in care; 2. Separate locked storage must be provided for medications requiring refrigeration; 3. All medications must be kept in the original container and stored according to instructions, clearly labeled for a named child, and returned to the parent when no longer needed; and 4. Over-the-counter, non-toxic topical ointment such as lip balm, petroleum jelly, sun block and diaper ointment must be kept out of the reach of children. 391 Neb. Admin. Code (NAC) § 4-006.24H Record-Keeping: The licensee/director must maintain a record as to the time and amount of medication given or applied. 391 Neb. Admin. Code (NAC) § 4-006.24I Children Taking/Applying Medication: With written permission of the parent, a school-age child may take or apply his/her own medications at the direction of the parent who is responsible for direction and monitoring. 391 Neb. Admin. Code (NAC) § 4-006.29E Other Environmental Safety Requirements 2. … medications (both prescription and nonprescription) … must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 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: 391 Neb. Admin. Code (NAC) § 3-006.27D Written Permission and Instructions: Any staff who gives or applies prescription or non-prescription medication may do so only with prior written permission and written instructions from a parent. Staff must comply with the instructions provided by the parent or inform the parent the medications will not be given or applied. 1. Any error in the giving or applying of medication must be reported to the parent. 2. The dosage must not exceed that which is printed on the label. 3. Expired medication must not be given or applied to a child and must be returned to the parent or destroyed. 391 Neb. Admin. Code (NAC) § 3-006.27E Unusual Circumstances: The licensee must obtain a written statement from the licensed health care professional who prescribed the medication allowing center staff to give the medication when: 1. Any prescription medication is given or applied as needed (PRN); or 2. By a route other than oral, topical, inhalant, or instillation. The written statement must describe the route and what symptoms need to exist in order for the medication to be given or applied. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.20D Written Permission and Instructions: Any staff who gives or applies prescription or non-prescription medication may do so only with prior written permission and written instructions from a parent. Staff must comply with the instructions provided by the parent or inform the parent the medications will not be given or applied. 1. Any error in the giving or applying of medication must be reported to the parent. 2. The dosage must not exceed that which is printed on the label. 3. Expired medication must not be given or applied to a child and must be returned to the parent or destroyed. 391 Neb. Admin. Code (NAC) § 1-006.20E Unusual Circumstances: The licensee must obtain a written statement from the licensed health care professional who prescribed the medication allowing center staff to give the medication when: 1. Any prescription medication is given or applied as needed (PRN); or 2. By a route other than oral, topical, inhalant, or instillation. The written statement must describe the route and what symptoms need to exist in order for the medication to be given or applied. 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: To ensure the provider follows the Five Rights when dispensing medication, the Department expects the provider will receive written instructions from the parent/guardian before dispensing medication. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: To ensure the provider follows the Five Rights when dispensing medication, the Department expects the provider will receive written instructions from the parent/guardian before dispensing medication. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.24D Written Permission and Instructions: Any staff who gives or applies prescription or non- prescription medication may do so only with prior written permission and written instructions from a parent. Staff must comply with the instructions provided by the parent or inform the parent the medications will not be given or applied. 1. Any error in the giving or applying of medication must be reported to the parent. 2. The dosage must not exceed that which is printed on the label. 3. Expired medication must not be given or applied to a child and must be returned to the parent or destroyed. 391 Neb. Admin. Code (NAC) § 4-006.24E Unusual Circumstances: The licensee must obtain a written statement from the licensed health care professional who prescribed the medication allowing center staff to give the medication when: 1. Any prescription medication is given or applied as needed (PRN); or 2. By a route other than oral, topical, inhalant, or instillation. The written statement must describe the route and what symptoms need to exist in order for the medication to be given or applied. 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: 391 Neb. Admin. Code (NAC) § 3-006.12 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.21 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (D) Prevention and response to emergencies due to food or allergic reaction. (i) Providers must keep records that include but are not limited to, the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 4.Prevention and response to emergencies due to food and allergic reaction a. Providers must keep records that include but are not limited to the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (D) Prevention and response to emergencies due to food or allergic reaction. (i) Providers must keep records that include but are not limited to, the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 4.Prevention and response to emergencies due to food and allergic reaction a. Providers must keep records that include but are not limited to the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.11 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. 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: 391 Neb. Admin. Code (NAC) § 3-006.12 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. 391 Neb. Admin. Code (NAC) § 3-006.30 Emergency Preparedness 391 Neb. Admin. Code (NAC) § 3-006.30A Telephone: A working, non-coin operated telephone must be available on the premises at all times. Emergency telephone numbers, including fire, rescue, police (or 911) and Poison Control, must be prominently posted. 391 Neb. Admin. Code (NAC) § 3-006.30E Notification to the Department of Emergencies: The licensee/director must notify the Department within 24 hours or next business day of the following occurrences at the center: 1. The death of a child; 2. Any accident or injury to a child which requires hospitalization or treatment at a medical facility; ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.21 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. 391 Neb. Admin. Code (NAC) § 1-006.23 Emergency Preparedness 391 Neb. Admin. Code (NAC) § 1-006.23A Telephone: A working, non-coin operated telephone must be available on the premises at all times. Emergency telephone numbers, including fire, rescue, police (or 911) and Poison Control, must be prominently posted. 391 Neb. Admin. Code (NAC) § 1-006.23E Notification to the Department of Emergencies: The licensee/director must notify the Department within 24 hours or next business day of the following occurrences at the center: 1. The death of a child; 2. Any accident or injury to a child which requires hospitalization or treatment at a medical 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (D) Prevention and response to emergencies due to food or allergic reaction. (i) Providers must keep records that include but are not limited to, the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 4. Prevention and response to emergencies due to food and allergic reaction a. Providers must keep records that include but are not limited to the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (D) Prevention and response to emergencies due to food or allergic reaction. (i) Providers must keep records that include but are not limited to, the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 4. Prevention and response to emergencies due to food and allergic reaction a. Providers must keep records that include but are not limited to the following: list of child’s allergies and intolerance to food, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.11 Child’s Record: A Child’s Record must be completed before the child’s enrollment. The record must be kept current and available for review upon request by the Department. A Child’s Record form may be used or a form may be created and must contain the following information for each child: 11. List of child’s allergies and intolerance to food, insect bites, or stings, or other factors that result in a medical reaction, and clear instructions in the event of an exposure to the factor. 391 Neb. Admin. Code (NAC) § 4-006.27 Emergency Preparedness 391 Neb. Admin. Code (NAC) § 4-006.27A Telephone: A working, non-coin operated telephone must be available on the premises at all times. Emergency telephone numbers, including fire, rescue, police (or 911) and Poison Control, must be prominently posted. 391 Neb. Admin. Code (NAC) § 4-006.27E Notification to the Department of Emergencies: The licensee/director must notify the Department within 24 hours or next business day of the following occurrences at the center: 1. The death of a child; 2. Any accident or injury to a child which requires hospitalization or treatment at a medical facility; 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: 391 Neb. Admin. Code (NAC) § 3-006.15A Licensed Capacity: The number of children in care at any one time must not exceed the center’s licensed capacity. Licensed capacity will be determined by the Department based on available space and the capacity authorized by the State Fire Marshal or delegated authority. Whichever number is smaller will be the licensed capacity of the center. 391 Neb. Admin. Code (NAC) § 3-006.32E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must not be on the premises of the center, unless the center is located in a private residence. If the center is located in a private residence, all firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children under age six must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. The licensee must ensure storage that is: a. Clean and adequate for all personal items of staff; b. Clean and adequate for all personal items of children; c. Covered and waterproof for soiled or wet clothing; and d. For staff and children’s storage, areas separate from where food and medication are kept. 7. Deep freezers that cannot be opened from the inside must be locked or stored in a locked room. 391 Neb. Admin. Code (NAC) § 3-007 PHYSICAL PLANT STANDARDS: The center must be designed, constructed and maintained in a manner that is safe, clean and functional for child care. The following regulations apply to all areas of the center. 391 Neb. Admin. Code (NAC) § 3-007.01 Activity Space: The center must have space for children’s activities, napping, and free play. The activity space must: 3. Have at least 35 square feet of activity space per child. Bathrooms, kitchen, isolation room, office, passageways, storage, or space occupied by cribs, cots, or built-in cabinets must not be considered when computing activity space. 391 Neb. Admin. Code (NAC) § 3-007.02A Plumbing: The licensee must ensure that: 1. No plumbing fixture or other device that provides a connection between a drinking water supply and a drainage, soil, waste, or other sewer pipe so as to make possible the backflow of sewage or waste water into the potable water supply system. Water that has been used for cooling or for any other purpose must not be returned to the system; and 2. All plumbing conforms to the local plumbing code. Where no plumbing code is in effect, plumbing must conform to national standards. the center has and maintains an accessible, adequate, safe, and potable supply of water for drinking, food preparation, and hand washing. 1. If water is obtained from a source other than a public water supply system, the water must not contain contaminants that exceed the maximum contaminant levels set for nitrate, or total coliform for public water supply systems or the lead action level. The licensee must report to the Department the results of all tests that show the water contains contaminants that exceed a maximum contaminant or action level. a. The water supply must be tested annually and the tests results must be available for review upon request. b. If the water supply does not meet nitrate, total coliform bacteria and lead standards, the licensee must, until the contaminants are lowered to acceptable levels: (1) Obtain water from a source approved by the Department; or (2) Purchase water from a commercial source. 2. Drinking water must be provided by sanitary drinking fountains or individual or disposable cups. a. Drinking fountains must have mouth guards with water issuing under sufficient pressure. b. Sanitary dispensing and disposal units must be provided for paper cups. 3. The licensee must ensure that: a. Running water under pressure is provided; b. Each hot water storage tank is provided with a pressure and temperature relief valve; c. Adequate water heating facilities are provided so that a sufficient amount of hot water for general cleaning as well as washing and sanitizing utensils is available at proper temperatures; d. Water supply to all hand washing and bathing locations is maintained between a minimum of 100 degrees Fahrenheit and a maximum of 120 degrees Fahrenheit; and e. Soap is available for hand washing. 391 Neb. Admin. Code (NAC) § 3-007.02C Sewer Requirements: When a municipal sewage system is not available, the licensee must: 1. Collect, treat, and dispose of sewage and all liquid waste with a sewage system that conforms to local ordinances; or 2. Where local ordinances do not exist, sewage disposal systems must comply with the regulations of the Nebraska Department of Environmental Quality. 391 Neb. Admin. Code (NAC) § 3-007.03 Fenced Outdoor Play Area: When care is provided to children between the ages of six weeks and school-age, the licensee must ensure that a fenced outdoor play area is available. 391 Neb. Admin. Code (NAC) § 3-007.05 Fire Safety: The licensee must maintain fire safety approval at all times. 391 Neb. Admin. Code (NAC) § 3-007.06 Sanitation: The licensee must maintain sanitation approval at all times. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.08A Licensed Capacity: The number of children in care at any one time must not exceed the licensed capacity. Licensed capacity will be determined by the Department based on available space and the capacity authorized by the State Fire Marshal or delegated authority. Whichever number is smaller will be the licensed capacity of the child care home. 391 Neb. Admin. Code (NAC) § 1-006.25E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. Waterproof storage must be provided for soiled or wet clothing and must not be accessible to children. 391 Neb. Admin. Code (NAC) § 1-007 PHYSICAL PLANT STANDARDS: The child care home must be maintained in a manner that is safe, clean, and functional for child care. 391 Neb. Admin. Code (NAC) § 1-007.01 Activity Space: The center must have space for children’s activities, napping, and free play. The activity space must: 3. Have at least 35 square feet of activity space per child. Bathrooms, kitchen, isolation room, office, passageways, storage, or space occupied by cribs, cots, or built-in cabinets must not be considered when computing activity space. 391 Neb. Admin. Code (NAC) § 1-007.02A Water Supply: The licensee must have and maintain an accessible, adequate, safe, and potable supply of water for drinking, bathing, and hand washing. 1. If water is obtained from a source other than a public water supply system, the water must not contain contaminants that exceed the maximum contaminant levels set for nitrate, or total coliform for public water supply systems or the lead action level. The licensee must report to the Department the results of all tests that show the water contains contaminants that exceed a maximum contaminant or action level. a. The water supply must be tested annually and the tests results must be available for review upon request. b. If the water supply does not meet nitrate, total coliform bacteria and lead standards, the licensee must, until the contaminants are lowered to acceptable levels: (1) Obtain water from a source approved by the Department; or (2) Purchase water from a commercial source. 2. Drinking water must be provided by sanitary drinking fountains or individual or disposable cups. 3. The licensee must maintain hot and cold water to all hand washing and bathing locations. The hot water system must be maintained between a minimum of 100 degrees Fahrenheit and a maximum of 120 degrees Fahrenheit. Soap must be available at the hand washing sink. 391 Neb. Admin. Code (NAC) § 1-007.02B Sewer Requirements: The licensee must maintain a sanitary and functioning sewage system which includes no open sewage discharge on the child care premises. When the Department determines that there may be open sewage present on the child care premises, a referral will be made to the Nebraska Department of Environmental Quality for an inspection. 391 Neb. Admin. Code (NAC) § 1-007.03 Outdoor Play Areas: An outdoor play area must be available. 1. Have at least 50 square feet per child of age-appropriate play space; 2. Be kept clean and safe and contain no accident hazards, debris, or stagnant water; 3. Contain no barnyard animals or fowl; and 4. Be free of animal waste. 391 Neb. Admin. Code (NAC) § 1-007.07 Fire Safety: The child care home must maintain fire safety approval in addition to meeting the following standards: 1. There must be two unblocked exits approved by the Fire Marshal from every floor on which child care is provided; 2. Furnaces, wood-burning stoves, and other heaters must be inaccessible to children when in use; 3. Candles or incense must not be used while children are in care; 4. Open flames must not be present while children are in care; 5. All storage areas must be free of excessively combustible or highly flammable materials; 6. Bathroom and closet doors must be designed so they can be unlocked from the outside; 7. There must be properly mounted and operated smoke detection equipment as required by the Fire Marshal; and 8. When overnight care is provided, the licensee must ensure that additional fire safety requirements are met. 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (E) Building and physical premises safety. (i) Physical environment standards must be designed, constructed, and maintained in a manner that is safe, clean, and functional for child care. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Have operable utilities, i.e., electricity, heat, water; Firearms, furnace and water heater are kept inaccessible to children; Maintain the home to be free from fire hazards such as exposed wiring, storage of combustibles near a fire source (furnace, water heater, stove), and blocked exits; Develop an emergency procedure to reach children should they become locked into an area of the home; Maintain an outdoor play area free of safety hazards; Ensure the home has operable smoke and carbon monoxide detectors, maintained according to manufacturer’s recommendations, which are located on each level of the home used to provide care; Ensure a fire extinguisher is on site and not expired; Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 5. Building and physical premises safety a. The indoor and outdoor environment, play area and equipment must be designed, constructed, and maintained in a safe and clean condition for child care. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (E) Building and physical premises safety. (i) Physical environment standards must be designed, constructed, and maintained in a manner that is safe, clean, and functional for child care. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Have operable utilities, i.e., electricity, heat, water; Firearms, furnace and water heater are kept inaccessible to children; Maintain the home to be free from fire hazards such as exposed wiring, storage of combustibles near a fire source (furnace, water heater, stove), and blocked exits; Develop an emergency procedure to reach children should they become locked into an area of the home; Maintain an outdoor play area free of safety hazards; Ensure the home has operable smoke and carbon monoxide detectors, maintained according to manufacturer’s recommendations, which are located on each level of the home used to provide care; Ensure a fire extinguisher is on site and not expired; Child Care Provider Enrollment, page 6: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 5. Building and physical premises safety a. The indoor and outdoor environment, play area and equipment must be designed, constructed, and maintained in a safe and clean condition for child care. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.14A Licensed Capacity: The number of children in care at any one time must not exceed the center’s licensed capacity. Licensed capacity will be determined by the Department based on available space and the capacity authorized by the State Fire Marshal or delegated authority. Whichever number is smaller will be the licensed capacity of the center. 391 Neb. Admin. Code (NAC) § 4-006.29E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must not be on the premises of the center, unless the center is located in a private residence. If the center is located in a private residence, all firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children under age six must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. The licensee must ensure storage that is: a. Clean and adequate for all personal items of staff; b. Clean and adequate for all personal items of children; c. Covered and waterproof for soiled or wet clothing; and d. For staff and children’s storage, areas separate from where food and medication are kept. 7. Deep freezers that cannot be opened from the inside must be locked or stored in a locked room. 391 Neb. Admin. Code (NAC) § 4-007 PHYSICAL PLANT STANDARDS: The center must be designed, constructed and maintained in a manner that is safe, clean and functional for child care. The following regulations apply to all areas of the center. 391 Neb. Admin. Code (NAC) § 4-007.01 Activity Space: The center must have space for children’s activities, napping, and free play. The activity space must: 3. Have at least 35 square feet of activity space per child. Bathrooms, kitchen, isolation room, office, passageways, storage, or space occupied by cribs, cots, or built-in cabinets must not be considered when computing activity space. 391 Neb. Admin. Code (NAC) § 4-007.02A Plumbing: The licensee must ensure that: 1. No plumbing fixture or other device that provides a connection between a drinking water supply and a drainage, soil, waste, or other sewer pipe so as to make possible the backflow of sewage or waste water into the potable water supply system. Water that has been used for cooling or for any other purpose must not be returned to the system; and 2. All plumbing conforms to the local plumbing code. Where no plumbing code is in effect, plumbing must conform to national standards. 391 Neb. Admin. Code (NAC) § 4-007.02B Water Supply: The licensee must ensure the center has and maintains an accessible, adequate, safe, and potable supply of water for drinking, food preparation, and hand washing. 1. If water is obtained from a source other than a public water supply system, the water must not contain contaminants that exceed the maximum contaminant levels set for nitrate, or total coliform for public water supply systems or the lead action level. The licensee must report to the Department the results of all tests that show the water contains contaminants that exceed a maximum contaminant or action level. a. The water supply must be tested annually and the tests results must be available for review upon request. b. If the water supply does not meet nitrate, total coliform bacteria and lead standards, the licensee must, until the contaminants are lowered to acceptable levels: (1) Obtain water from a source approved by the Department; or (2) Purchase water from a commercial source. 2. Drinking water must be provided by sanitary drinking fountains or individual or disposable cups. a. Drinking fountains must have mouth guards with water issuing under sufficient pressure. b. Sanitary dispensing and disposal units must be provided for paper cups. 3. The licensee must ensure that: a. Running water under pressure is provided; b. Each hot water storage tank is provided with a pressure and temperature relief valve; c. Adequate water heating facilities are provided so that a sufficient amount of hot water for general cleaning as well as washing and sanitizing utensils is available at proper temperatures; d. Water supply to all hand washing and bathing locations is maintained between a minimum of 100 degrees Fahrenheit and a maximum of 120 degrees Fahrenheit; and e. Soap is available for hand washing. 391 Neb. Admin. Code (NAC) § 4-007.02C Sewer Requirements: When a municipal sewage system is not available, the licensee must: 1. Collect, treat, and dispose of sewage and all liquid waste with a sewage system that conforms to local ordinances; or 2. Where local ordinances do not exist, sewage disposal systems must comply with the regulations of the Nebraska Department of Environmental Quality. 391 Neb. Admin. Code (NAC) § 4-007.03 Outdoor Play Area: An outdoor play area must be available. 391 Neb. Admin. Code (NAC) § 4-007.05 Fire Safety: The licensee must maintain fire safety approval at all times. 391 Neb. Admin. Code (NAC) § 4-007.06 Sanitation: The licensee must maintain sanitation approval at all times. 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: 391 Neb. Admin. Code (NAC) § 3-007.03 Fenced Outdoor Play Area: When care is provided to children between the ages of six weeks and school-age, the licensee must ensure that a fenced outdoor play area is available. 391 Neb. Admin. Code (NAC) § 3-006.25 Wading and Swimming Activities: Children must be accompanied, kept safe, and adequately supervised during wading and swimming activities while in care. 391 Neb. Admin. Code (NAC) § 3-006.25A Prohibited Water Sources: Children must not be allowed to use the following water sources for wading or swimming activities: 1. Natural bodies of water; 2. Hot tubs, spas or saunas; 3. Livestock tanks; or 4. Decorative ponds. 391 Neb. Admin. Code (NAC) § 3-006.25B Wading: If the licensee allows children to participate in wading or other water play activities: 1. Children must be accompanied and directly supervised; and 2. The licensee must ensure that the wading pool is drained and sanitized daily and is inaccessible to children when not in use. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.18 Wading and Swimming Activities: Children must be accompanied, kept safe, and adequately supervised during wading and swimming activities while in care. 391 Neb. Admin. Code (NAC) § 1-006.18A Prohibited Water Sources: Children must not be allowed to use the following water sources for wading or swimming activities: 1. Natural bodies of water; 2. Hot tubs, spas, or saunas; 3. Livestock tanks; and 4. Decorative ponds. 391 Neb. Admin. Code (NAC) § 1-006.18B Wading: If the licensee allows children to participate in wading or other water play activities: 1. Children must be accompanied and directly supervised; and 2. The licensee must ensure that the wading pool is drained and sanitized daily and is inaccessible to children when not in use. 391 Neb. Admin. Code (NAC) § 1-007.04 Fencing: A fence is required when the following conditions exist on or near the child care premises: 1. Drainage ditches; 2. Wells; 3. Holes; 6. Bodies of water, including decorative ponds; 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Ensure children do not have unsupervised access to bodies of water. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Ensure children do not have unsupervised access to bodies of water. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.22 Wading and Swimming Activities: Children must be accompanied, kept safe, and adequately supervised during wading and swimming activities while in care. 391 Neb. Admin. Code (NAC) § 4-006.22A Prohibited Water Sources: Children must not be allowed to use the following water sources for swimming or wading activities: 1. Natural bodies of water; 2. Hot tubs, spas or saunas; 3. Livestock tanks; or 4. Decorative ponds. 391 Neb. Admin. Code (NAC) § 4-006.22B Wading: If the licensee allows children to participate in wading or other water play activities: 1. Children must be accompanied and directly supervised; and 2. The licensee must ensure that the wading pool is drained and sanitized daily and is inaccessible to children when not in use. 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: 391 Neb. Admin. Code (NAC) § 3-007.03 Fenced Outdoor Play Area: When care is provided to children between the ages of six weeks and school-age, the licensee must ensure that a fenced outdoor play area is available. 391 Neb. Admin. Code (NAC) § 3-007.03C Outdoor Play Equipment: The licensee must ensure that: 1. Stationary outdoor equipment such as climbing apparatus, swings, or slides are located away from traffic areas in the outdoor play area; ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-007.04 Fencing: A fence is required when the following conditions exist on or near the child care premises: 7. Heavy street traffic; 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Ensure children are protected from streets, alleyways, parking lots and garages; vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: The Department interprets building and physical premises safety to include the following components: Ensure children are protected from streets, alleyways, parking lots and garages; vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 392 Neb. Admin. Code (NAC) § 4-007.03B Outdoor Play Equipment: The licensee must ensure that: 1. Stationary outdoor equipment such as climbing apparatus, swings, or slides must be located away from traffic areas in the outdoor play area; 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: 391 Neb. Admin. Code (NAC) § 3-006.08A Safety Training: The director must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 3-006.09A Safety Training: Teachers must complete training developed by the Early Childhood Training Center (ECTC) on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 3-006.02 Director Requirements: The director is responsible for managing the day-today operations of the child care center. The director must report to the licensee all matters related to the maintenance, operation, and management of the child care center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the child care center, in the child’s home, or elsewhere, or ensure that a report is filed; ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.04B Safety Training: The licensee must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 1-006.01 Licensee Qualifications and Requirements: The Family Child Care Home I licensee must: 17. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the family child care home, in the child’s home, or elsewhere. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (F) Prevention of abusive head trauma. (i) Providers must be trained in recognizing and immediately reporting any signs of abusive head trauma. (1) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 6-7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 6. Prevention of abusive head trauma a. Providers must be trained in recognizing and immediately reporting any signs of abusive head trauma.; Immediately report any signs of suspected child abuse or neglect, including abusive head trauma and shaken baby syndrome to the Nebraska Child Abuse and Neglect Hotline at 1-800- 652-1999 and/or local law enforcement agency. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (F) Prevention of abusive head trauma. (i) Providers must be trained in recognizing and immediately reporting any signs of abusive head trauma. (1) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 6-7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 6. Prevention of abusive head trauma a. Providers must be trained in recognizing and immediately reporting any signs of abusive head trauma.; Immediately report any signs of suspected child abuse or neglect, including abusive head trauma and shaken baby syndrome to the Nebraska Child Abuse and Neglect Hotline at 1-800- 652-1999 and/or local law enforcement agency. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.07A Safety Training: The director must complete training developed by the Early Childhood Training Center on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 4-006.08A Safety Training: Teachers must complete training developed by the Early Childhood Training Center (ECTC) on Sudden Infant Death Syndrome (SIDS), safe sleep, shaken baby syndrome, and child abuse/neglect and reporting. 391 Neb. Admin. Code (NAC) § 4-006.14B Staffing Requirements 1. All staff must be awake and alert to the needs of the children at all times, including napping/sleeping times. 3. During naptime, at least one teacher must be in the room where children are napping, as long as the staff-to-child ratio is maintained center-wide. 391 Neb. Admin. Code (NAC) § 4-006.02 Director Requirements: The director is responsible for managing the day-today operations of the school-age-only center. The director must report to the licensee all matters related to the maintenance, operation, and management of the center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800- 652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect or sexual abuse may be occurring in the school-age-only center, in the child’s home, or elsewhere, or ensure that a report is filed; 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: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Child maltreatment is not a part of shaken baby syndrome and abusive head trauma prevention. 391 Neb. Admin. Code (NAC) § 3-006.02 Director Requirements: The director is responsible for managing the day-today operations of the child care center. The director must report to the licensee all matters related to the maintenance, operation, and management of the child care center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the child care center, in the child’s home, or elsewhere, or ensure that a report is filed; ii. All CCDF-eligible licensed family child care homes. Provide the standard: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Child maltreatment is not a part of shaken baby syndrome and abusive head trauma prevention. 391 Neb. Admin. Code (NAC) § 1-006.01 Licensee Qualifications and Requirements: The Family Child Care Home I licensee must: 17. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the family child care home, in the child’s home, or elsewhere. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: Providers must be trained in recognizing and immediately reporting any signs of child abuse or neglect, including shaken baby syndrome. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: Providers must be trained in recognizing and immediately reporting any signs of child abuse or neglect, including shaken baby syndrome. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Child maltreatment is not a part of shaken baby syndrome and abusive head trauma prevention. 391 Neb. Admin. Code (NAC) § 4-006.02 Director Requirements: The director is responsible for managing the day-today operations of the school-age-only center. The director must report to the licensee all matters related to the maintenance, operation, and management of the center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800- 652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect or sexual abuse may be occurring in the school-age-only center, in the child’s home, or elsewhere, or ensure that a report is filed; 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 [ ] Training [x] Practice drills vi. Volunteer emergency preparedness [ ] 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: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. The Lead Agency expects all subsidy participating programs to be trained in emergency preparedness and to complete practice drills, however this expectation is not currently reflected in regulations for staff and volunteers of Family Child Care Homes I and II. 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: 391 Neb. Admin. Code (NAC) § 3-006.27F Hand Washing: All individuals must properly wash their hands before giving or applying any medication. If handling any bodily fluids is involved, individuals must properly wash their hands after giving or applying medication. 391 Neb. Admin. Code (NAC) § 3-006.32 Environmental Safety: The licensee is responsible for maintaining a safe and hazard-free environment to protect the health and safety of children in care. 391 Neb. Admin. Code (NAC) § 3-006.32A Smoking: Smoking anywhere indoors in a child care center is prohibited at all times, unless the center is located in a private residence. If the center is located in a private residence, the licensee must ensure that: 1. No one smokes indoors during the hours of operation when one or more children who are not occupants of the residence are present; and 2. Parents are informed before enrollment if the licensee or any household member smokes. 391 Neb. Admin. Code (NAC) § 3-006.32B Alcohol and Controlled Substances 1. If the center is located in a private residence, alcohol must not be consumed in any area used for child care during the hours of operation. 2. If the center is not located in a private residence, alcohol must not be present in any area used for child care whenever any child in care is present. 3. The unlawful use or possession of controlled substances is prohibited. Controlled substances that have not been legally prescribed must not be on the premises. 391 Neb. Admin. Code (NAC) § 3-006.32D Prohibited Animals: Exotic or unusual animals, or any animal that has bitten or attacked anyone without provocation or has been determined by the local health authority to be dangerous, must not be allowed on the premises during the hours of operation. 391 Neb. Admin. Code (NAC) § 3-006.32E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must not be on the premises of the center, unless the center is located in a private residence. If the center is located in a private residence, all firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children under age six must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. The licensee must ensure storage that is: a. Clean and adequate for all personal items of staff; b. Clean and adequate for all personal items of children; c. Covered and waterproof for soiled or wet clothing; and d. For staff and children’s storage, areas separate from where food and medication are kept. 7. Deep freezers that cannot be opened from the inside must be locked or stored in a locked room. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.20F Hand Washing: All caregivers must properly wash their hands before giving or applying any medication. If handling any bodily fluids is involved, caregivers must properly wash their hands after giving or applying medication. 391 Neb. Admin. Code (NAC) § 1-006.25 Environmental Safety: The licensee is responsible for maintaining a safe and hazard-free environment. 391 Neb. Admin. Code (NAC) § 1-006.25A Smoking: Smoking anywhere indoors in a child care home is prohibited during the hours of operation when one or more children who are not occupants of the residence are present. If the licensee or any household member smokes, parents must be informed before enrollment of their child(ren). 391 Neb. Admin. Code (NAC) § 1-006.25B Alcohol and Controlled Substances 1. Alcohol must not be consumed in any area used for child care whenever any child in care is present. 2. The unlawful use or possession of controlled substances is prohibited. Controlled substances that have not been legally prescribed must not be on the premises. 391 Neb. Admin. Code (NAC) § 1-006.25D Prohibited Animals: Exotic or unusual animals, or any animal that has bitten or attacked anyone without provocation or has been determined by the local health authority to be dangerous, must not be allowed on the premises during the hours of operation. 391 Neb. Admin. Code (NAC) § 1-006.25E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. Waterproof storage must be provided for soiled or wet clothing and must not be 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (H) Handling and storage of hazardous materials. (i) Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 8. Handling and storage of hazardous materials and the appropriate disposal of bio- contaminants a. Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (H) Handling and storage of hazardous materials. (i) Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 8. Handling and storage of hazardous materials and the appropriate disposal of bio- contaminants a. Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.24F Hand Washing: All individuals must properly wash their hands before giving or applying any medication. If handling any bodily fluids is involved, individuals must properly wash their hands after giving or applying medication. 391 Neb. Admin. Code (NAC) § 4-006.29A Smoking: Smoking anywhere indoors in a school-age-only center is prohibited at all times, unless the center is located in a private residence. If the center is located in a private residence, the licensee must ensure that: 1. No one smokes indoors during the hours of operation when one or more children who are not occupants of the residence are present; and 2. Parents are informed before enrollment if the licensee or any household member smokes. 391 Neb. Admin. Code (NAC) § 4-006.29B Alcohol and Controlled Substances 1. If the center is located in a private residence, alcohol must not be consumed in any area used for child care whenever any child in care is present. 2. If the center is not located in a private residence, alcohol must not be present in any area used for child care during the hours of operation. 3. The unlawful use or possession of controlled substances is prohibited. Controlled substances that have not been legally prescribed must not be on the premises. 391 Neb. Admin. Code (NAC) § 4-006.29D Prohibited Animals: Exotic or unusual animals, or any animal that has bitten or attacked anyone without provocation or has been determined by the local health authority to be dangerous, must not be allowed on the premises during the hours of operation. 391 Neb. Admin. Code (NAC) § 4-006.29E Other Environmental Safety Requirements 1. Surfaces must be smooth and free of sharp edges, mold, or dirt, and the environment must be kept free of other conditions which may pose a potential risk. 2. All cleaning agents, medications (both prescription and nonprescription), and poisonous materials must be kept in locked storage at all times children are in care. Separate locked storage must be provided for medications requiring refrigeration. 3. All firearms, other potentially hazardous weapons, weapon accessories, and ammunition must not be on the premises of the center, unless the center is located in a private residence. a. If the center is located in a private residence, all firearms, other potentially hazardous weapons, weapon accessories, and ammunition must be kept in locked storage. Firearms must be unloaded and ammunition must be stored separately from firearms. 4. Electrical outlets within reach of children under age six must be covered with safety caps, ground fault interrupters, or have safety outlets installed. 5. Shared use of the following items is prohibited: a. Disposable towelettes; b. Drinking containers, cups, or glasses; c. Personal care items such as toothbrushes and hair brushes; and d. Towels and washcloths. 6. The licensee must ensure storage that is: a. Clean and adequate for all personal items of staff; b. Clean and adequate for all personal items of children; c. Covered and waterproof for soiled or wet clothing; and d. For staff and children’s storage, areas separate from where food and medication are kept. 7. Deep freezers that cannot be opened from the inside must be locked or stored in a locked room. 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: 391 Neb. Admin. Code (NAC) § 3-006.31 Environmental Services: The licensee must ensure that child care is provided in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 3-006.31A Housekeeping and Maintenance: The licensee must ensure that the necessary housekeeping and maintenance are provided to protect the health and safety of children in care. The center and grounds must be kept clean, safe, and in good repair. 2. Rooms, walls, floors, and ceilings must be kept clean, dry, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 5. All garbage and rubbish must be disposed of in a manner that minimizes odor and the transmission of infectious diseases, and prevents the attraction of rodents, flies, and all other insects and vermin. This includes: a. Using containers, both indoor and outdoor, for garbage and rubbish that are watertight, have tight fitting covers, and are fly and rodent-proof; b. Keeping all garbage and rubbish containers clean; and c. Not burning garbage on the premises. 391 Neb. Admin. Code (NAC) § 3-006.23B Diapering and Toileting 1. The licensee must ensure that diapering procedures are established and followed by center staff. The procedures must include: a. Wet and/or soiled diapers are changed immediately; b. Diapers are checked on a frequent and regular basis; c. Individual washcloths or disposable towelettes are used; d. Wet and soiled diapers are properly stored and disposed; e. Diaper-changing surfaces are cleaned after each use by sanitizing the surface or changing the diaper pad or disposable sheeting and are disinfected daily; and f. Proper hand washing is done after each diaper change. 2. The licensee must ensure that toilet training is conducted in a manner agreed upon with the parent. The licensee must also ensure that: a. Potty chairs are not used or stored in eating or play areas; and b. Proper hand washing by the provider and the child is done each time a child is helped with toileting. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.24 Environmental Services: The licensee must provide child care in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 1-006.24A Housekeeping and Maintenance: The licensee must provide the necessary housekeeping and maintenance to protect the health and safety of children in care. The child care home and grounds must be kept clean, safe, and in good repair. 2. Rooms, walls, floors, and ceilings must be kept clean, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 5. All garbage and rubbish must be disposed of in a manner that prevents the attraction of rodents, flies, and all other insects and vermin. The licensee must dispose of garbage so as to minimize odor and the transmission of infectious diseases. 391 Neb. Admin. Code (NAC) § 1-006.16A Diapering and Toileting 1. The licensee must ensure that diapering procedures are established and followed by staff. The procedures must require that: a. Wet and/or soiled diapers are changed immediately; b. Diapers are checked on a frequent and regular basis; c. Individual washcloths or disposable towelettes are used; d. Wet and soiled diapers are properly stored and disposed; e. Diaper-changing surfaces are cleaned after each use by sanitizing the surface or changing the diaper pad or disposable sheeting; and f. Proper hand washing is done after each diaper change. 2. The licensee must ensure that toilet training is conducted in a manner agreed upon by the primary provider and the parent. The licensee must also ensure that: a. Potty chairs are not used or stored in eating or play areas; and b. Proper hand washing by the provider and the child is done each time a child is helped with toileting. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: Hazardous materials includes bio-contaminants. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 8. Handling and storage of hazardous materials and the appropriate disposal of bio- contaminants a. Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS Guidance: Hazardous materials includes bio-contaminants. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 8. Handling and storage of hazardous materials and the appropriate disposal of bio- contaminants a. Poisonous materials and medications must be stored in a safe and locked area to prevent access to children. Waterproof storage must be used for soiled or wet clothing. Providers must follow sewer requirements to maintain sanitation and must properly dispose of garbage and rubbish. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.28 Environmental Services: The licensee must ensure that child care is provided in a safe, clean, comfortable environment. Every area and building on the same premises used for child care must comply with these regulations. 391 Neb. Admin. Code (NAC) § 4-006.28A Housekeeping and Maintenance: The licensee must ensure that the necessary housekeeping and maintenance are provided to protect the health and safety of children in care. The center and grounds must be kept clean, safe, and in good repair. 1. The center and any building on the premises in or around areas where children are present must be kept free of exposed lead-based paint surfaces that are flaking, peeling, or chipped. 2. Rooms, walls, floors, and ceilings must be kept clean, dry, in good repair, and free of odor resulting from sewage, mold, mildew, or other environmental or biological hazards or unsanitary conditions. 5. All garbage and rubbish must be disposed of in a manner that minimizes odor and the transmission of infectious diseases, and prevents the attraction of rodents, flies, and all other insects and vermin. This includes: a. Using containers, both indoor and outdoor, for garbage and rubbish that are watertight, have tight fitting covers, and are fly and rodent proof; b. Keeping all garbage and rubbish containers clean; and c. Not burning garbage on the premises. 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: 391 Neb. Admin. Code (NAC) § 3-006.10C Transportation Training: Individuals who transport children on behalf of a child care center must: 1. Receive and maintain a valid certificate of completion of the "Safe Kids Buckle Up" program within 90 days of employment and every five years thereafter. Individuals who transport children who were employed before the operative date of these regulations must receive and maintain a valid certificate of completion for "Safe Kids Buckle Up" within one year and every five years thereafter. Any proposed equivalent training must be approved by the Department. 2. Maintain valid certificates for Cardiopulmonary Resuscitation (CPR) and First Aid Training. Individuals who transport children who were employed before the operative date of these regulations must complete CPR and First Aid Training within one year and maintain valid certificates thereafter. 391 Neb. Admin. Code (NAC) § 3-006.26 Transportation: When transportation is provided for children in care, the licensee must ensure the following conditions are met: 1. No child must ever be left alone in the vehicle; 2. Smoking is prohibited in the vehicle used to transport children; 3. All doors on the vehicle must be locked when the vehicle is in motion; 4. Any individual who transports children must be at least 18 years of age, and must possess a current and valid driver’s license for the type of vehicle used to transport children, as verified by the Department of Motor Vehicles; 5. The vehicle used to transport children must be properly registered and insured, and must contain a first aid kit and parent contact information for each child being transported; 6. The number of children transported must not exceed the seating capacity of the vehicle as indicated by the manufacturer; 7. All children transported must be properly secured in the appropriate restraint system; 8. All car seats must be federally approved and must be the correct type for the child’s age and developmental level; 9. Written permission from parents for the center to transport children must be obtained, kept on file, and made available to the Department; 10. Children must not be transported to any location without the prior knowledge of the parents, except in a medical or other emergency; 11. Children must not be transported to avoid violations of capacity or staff-to-child ratio; 12. Staff-to-child ratio must be maintained whenever children are in care; 13. School-age children only may be transported with no staff in addition to the driver; 14. School-age children only may be transported in buses over 10,000 pounds, unless the bus is equipped with and the children are properly secured in the appropriate restraint system. The center must have a written transportation policy that is given to all staff who transport children and is available to parents and the Department upon request. The transportation policy must describe: a. Restraints and safety equipment; b. Procedures to ensure children are never left alone in a vehicle at any time; and c. Emergency procedures in the event a child becomes ill, the vehicle breaks down or is involved in an accident, or other emergencies. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.19 Transportation: When transportation is provided for children in care, the licensee must ensure the following conditions are met: 1. No child must ever be left alone in the vehicle; 2. Smoking is prohibited in the vehicle when children are being transported; 3. All doors on the vehicle must be locked when the vehicle is in motion; 4. Any individual who transports children must possess a current and valid driver’s license for the type of vehicle used to transport children, as verified by the Department of Motor Vehicles; 5. The vehicle used to transport children must be properly registered and must contain a first aid kit and parent contact information for each child being transported; 6. The number of children transported must not exceed the seating capacity of the vehicle as indicated by the manufacturer; 7. All children transported must be properly secured in an appropriate restraint system. All car seats must be federally approved and must be the correct type for the child’s age and developmental level; 9. Written permission from parents for the program to transport children must be obtained, kept on file, and made available to the Department; 10. Children must not be transported to any location without the prior knowledge of the parent(s), except in a medical or other emergency; and 11. Children must not be transported to avoid violations of capacity or staff-to child ratio. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (I) Appropriate precautions in transporting children. (i) No child(ren) left alone in a vehicle; (ii) Proper vehicle insurance and registration; (iii) Appropriate car seat; (iv) Written permission from parents; and (v) First aid kit in vehicle. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 9. Appropriate precautions in transporting children a. No child(ren) left alone in a vehicle; b. Proper vehicle insurance and registration; c. Appropriate car seat; d. Written permission from parents; and, e. First aid kit in vehicle. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (I) Appropriate precautions in transporting children. (i) No child(ren) left alone in a vehicle; (ii) Proper vehicle insurance and registration; (iii) Appropriate car seat; (iv) Written permission from parents; and (v) First aid kit in vehicle. Child Care Provider Enrollment, page 7: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 9. Appropriate precautions in transporting children a. No child(ren) left alone in a vehicle; b. Proper vehicle insurance and registration; c. Appropriate car seat; d. Written permission from parents; and, e. First aid kit in vehicle. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.09C Transportation Training: Individuals who transport children on behalf of a school- age only center must: 1. Receive and maintain a valid certificate of completion of the "Safe Kids Buckle Up" program within 90 days of employment and every five years thereafter. Individuals who transport children who were employed before the operative date of these regulations must receive and maintain a valid certificate of completion for "Safe Kids Buckle Up" within one year and every five years thereafter. Any proposed equivalent training must be approved by the Department. 2. Maintain valid certificates for Cardiopulmonary Resuscitation (CPR) and First Aid Training. Individuals who transport children who were employed before the operative date of these regulations must complete CPR and First Aid Training within one year and maintain valid certificates thereafter. 391 Neb. Admin. Code (NAC) § 4-006.23 Transportation: When transportation is provided for children in care, the licensee must ensure the following conditions are met: 1. No child must ever be left alone in the vehicle; 2. Smoking is prohibited in the vehicle used to transport children; 3. All doors on the vehicle must be locked when the vehicle is in motion; 4. Any individual who transports children must be at least 18 years of age, and must possess a current and valid driver’s license for the type of vehicle used to transport children, as verified by the Department of Motor Vehicles; 5. The vehicle used to transport children must be properly registered and insured, and must contain a first aid kit and parent contact information for each child being transported; 6. The number of children transported must not exceed the seating capacity of the vehicle as indicated by the manufacturer; 7. All children transported must be properly secured in the appropriate restraint system; 8. All car/booster seats must be federally approved and must be the correct type for the child’s age and developmental level; 9. Written permission from parents for the center to transport children must be obtained, kept on file, and made available to the Department; 10. Children must not be transported to any location without the prior knowledge of the parents, except in a medical or other emergency; 11. Children must not be transported to avoid violations of capacity or staff-to-child ratio; 12. School-age children only may be transported with no staff in addition to the driver; 13. School-age children only may be transported in buses over 10,000 pounds, unless the bus is equipped with and the children are properly secured in the appropriate restraint system; and 14. The center must have a written transportation policy that is given to all staff who transport children and is available to parents and the Department upon request. The transportation policy must describe: a. Restraints and safety equipment; b. Procedures to ensure children are never left alone in a vehicle at any time; and c. Emergency procedures in the event a child becomes ill, the vehicle breaks down or is involved in an accident, or other emergencies. 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: 391 Neb. Admin. Code (NAC) § 3-006.10E CPR and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. At least one staff member with current CPR and First Aide training must be on the premises at all times during the hours/days of operation. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Subsidy Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.04F Cardiopulmonary Resuscitation (CPR) and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. The licensee must maintain current CPR and First Aid training as long as s/he is licensed. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Subsidy Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. 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: Nebraska does not have CCDF-eligible license-exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Subsidy Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Subsidy Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.09E CPR and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. At least one staff member with current CPR and First Aid training must be on the premises at all times during the hours/days of operation. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Subsidy Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. 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: 391 Neb. Admin. Code (NAC) § 3-006.10E CPR and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. At least one staff member with current CPR and First Aide training must be on the premises at all times during the hours/days of operation. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.04F Cardiopulmonary Resuscitation (CPR) and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. The licensee must maintain current CPR and First Aid training as long as s/he is licensed. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. Child Care Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. 392 Neb. Admin. Code (NAC) § 4-005. STAFF TRAINING REQUIREMENTS Guidance: Staff is defined as an individual who works with children providing direct care and/or who may have unsupervised access to children in a licensed child care facility or license exempt home. This includes, but is not limited to: owners, directors, assistant directors, teachers, aides, substitutes, volunteers, cooks, bus drivers, or caregivers. Child Care Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. 392 Neb. Admin. Code (NAC) § 4-005. STAFF TRAINING REQUIREMENTS Guidance: Staff is defined as an individual who works with children providing direct care and/or who may have unsupervised access to children in a licensed child care facility or license exempt home. This includes, but is not limited to: owners, directors, assistant directors, teachers, aides, substitutes, volunteers, cooks, bus drivers, or caregivers. Child Care Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.09E CPR and First Aid Training 1. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information about approved CPR courses. 2. At least one staff member with current CPR and First Aid training must be on the premises at all times during the hours/days of operation. 3. The CPR card and documentation of First Aid training must be available upon request. 392 Neb. Admin. Code (NAC) § 4-005. STAFF TRAINING REQUIREMENTS Guidance: Staff is defined as an individual who works with children providing direct care and/or who may have unsupervised access to children in a licensed child care facility or license exempt home. This includes, but is not limited to: owners, directors, assistant directors, teachers, aides, substitutes, volunteers, cooks, bus drivers, or caregivers. Child Care Provider Enrollment, page 5: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: Pediatric First Aid and Cardiopulmonary Resuscitation (CPR) Training a. The provider must complete pediatric first aid and CPR training prior to enrollment and maintain current certification during the approval period. Licensed Family Child Care II and Child Care Center staff must complete pediatric CPR and first aid within 90 days of hire. A certified staff member must supervise new hire until training is completed. b. CPR training must be obtained from an entity that has been approved by the Nebraska Board of Emergency Medical Services. The Department will provide the program with information on approved CPR courses. This training must be taken in person and the provider must demonstrate learned skills to the instructor. c. Provider must submit the CPR card and documentation of first aid training to the assigned Resource Developer upon completion. Staff copies must be available for review upon request. 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: 391 Neb. Admin. Code (NAC) § 3-006.02 Director Requirements: The director is responsible for managing the day-today operations of the child care center. The director must report to the licensee all matters related to the maintenance, operation, and management of the child care center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 9. Develop and implement written procedures that require the reporting of any evidence of physical abuse, neglect, or sexual abuse of any child in care at the child care center; 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the child care center, in the child’s home, or elsewhere, or ensure that a report is filed; ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.01 Licensee Qualifications and Requirements: The Family Child Care Home I licensee must: 17. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the family child care home, in the child’s home, or elsewhere. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (K) Recognition and reporting child abuse and neglect. (i) Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. (ii) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 8: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 10. Recognition and reporting child abuse and neglect a. Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (K) Recognition and reporting child abuse and neglect. (i) Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. (ii) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 8: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 10. Recognition and reporting child abuse and neglect a. Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.02 Director Requirements: The director is responsible for managing the day-today operations of the school-age-only center. The director must report to the licensee all matters related to the maintenance, operation, and management of the center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 9. Develop and implement written procedures that require the reporting of any evidence of physical abuse, neglect, or sexual abuse of any child in care at the school-age-only center; 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect or sexual abuse may be occurring in the school-age-only center, in the child’s home, or elsewhere, or ensure that a report is filed 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: 391 Neb. Admin. Code (NAC) § 3-006.02 Director Requirements: The director is responsible for managing the day-today operations of the child care center. The director must report to the licensee all matters related to the maintenance, operation, and management of the child care center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 9. Develop and implement written procedures that require the reporting of any evidence of physical abuse, neglect, or sexual abuse of any child in care at the child care center; 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the child care center, in the child’s home, or elsewhere, or ensure that a report is filed; 391 Neb. Admin. Code (NAC) § 3-006.20 Discipline: When parents are not present, the responsibility for the discipline of children in care lies only with the licensee/director or the designated substitute. 391 Neb. Admin. Code (NAC) § 3- 006.20A Prohibited Forms of Discipline: The following actions are prohibited as a form of discipline: 1. Spanking; 2. Slapping; 3. Pinching 4. Punching; 5. Shaking; 6. Striking with any object; 7. Use of soap, hot sauce, or other unpleasant food and non-food items; 8. Isolating a child in a locked or closed room or closet; 9. Handling roughly; 10. Biting; 11. Denial of food; 12. Forced napping; 13. Subjecting children to derogatory remarks about the child or the child’s family; 14. Abusive or profane language directed at children; 15. Yelling or screaming at children; 16. Threats of physical punishment; or 17. Mechanical restraints. 391 Neb. Admin. Code (NAC) § 3-006.20B Child Behavior That Cannot Be Disciplined: Children must not be disciplined for: 1. Toileting accidents; 2. Refusal to take medication; or 3. Refusal to eat. 391 Neb. Admin. Code (NAC) § 3-006.20C Use of Time Out: Separation from the group, if used, must be brief and appropriate for the child’s age. The time out period must: 1. Take place within a safe, lighted, and well-ventilated area; 2. Occur within direct vision of staff; and 3. Not exceed more than one minute for each year of the child’s age. If the time a child spends in time out is extended, it must be carried out as indicated by a behavioral management plan developed and monitored by a licensed or certified professional qualified to identify the special needs of a child, as having a physical, emotional, or social developmental delay or impairment. 391 Neb. Admin. Code (NAC) § 3-006.20D Use of Physical Hold: Center staff may restrict a child’s movement by the use of a physical hold. A physical hold may be used only: 1. When the child is hurting him/herself, others, or property; 2. When the hold does not prevent the child from breathing or speaking; and 3. Until the child is calm and able to demonstrate reasonable control of his/her behavior. 3- 006.20D1 Notification and Documentation: The licensee/director must notify the child’s parents within 24 hours of the physical hold when a physical hold is used on their child. Written documentation of each use of a physical hold must be available for review by the parents of the child involved in the physical hold and the Department. The documentation must include: 1. Child’s name; 2. Date of the incident; 3. Description of the incident; and 4. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 3-006.20E Use of Restraints: The use of restraints is prohibited except under the following conditions: 1. All staff who participate in restraining a child must have received prior training in de-escalation and the use of restraints; 2. The training curriculum must be accepted by the Department; 3. The training must be taught by a certified trainer; and 4. Written documentation of each use of restraint must be available for review by the parents of the child involved in the restraint and the Department. The documentation must include: a. Child’s name; b. Date of the incident; c. Description of the incident; and d. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 3-006.21 Prohibited Language, Materials, and Actions: Children of any age must not be exposed to: 1. Profanity; 2. Sexually explicit material; 3. Acts of violence toward a person or animal; or 4. Acts of racism. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 391 Neb. Admin. Code (NAC) § 1-006.01 Licensee Qualifications and Requirements: The Family Child Care Home I licensee must: 17. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect, or sexual abuse may be occurring in the family child care home, in the child’s home, or elsewhere. 391 Neb. Admin. Code (NAC) § 1-006.13 Discipline: When parents are not present, the responsibility for the discipline of children in care lies only with the licensee or the designated substitute. 391 Neb. Admin. Code (NAC) § 1-006.13A Prohibited Forms of Discipline: The following actions are prohibited as a form of discipline: 1. Spanking; 2. Slapping; 3. Punching; 4. Pinching; 5. Shaking; 6. Striking with any object; 7. Use of soap, hot sauce or other unpleasant food or non-food items; 8. Isolating a child in a locked or closed room or closet; 9. Handling roughly; 10. Biting; 11. Denial of food; 12. Forced napping; 13. Subjecting a child to derogatory remarks about the child or the child’s family; 14. Abusive or profane language directed at children; 15. Yelling or screaming at children; 16. Threats of physical punishment; or 17. Mechanical restraints. 391 Neb. Admin. Code (NAC) § 1-006.13B Child Behavior That Cannot Be Disciplined: Children must not be disciplined for the following: 1. Toileting accidents; 2. Refusal to take medication; or 3. Refusal to eat. 391 Neb. Admin. Code (NAC) § 1-006.13C Use of Time Out: Separation from the group, if used, must be brief and appropriate for the child’s age. The time out period must: 1. Take place in a safe, lighted, and well-ventilated area; 2. Occur within hearing distance of staff; and 3. Not exceed more than one minute for each year of the child’s age. If the time a child spends in time out is extended, it must be carried out as indicated by a behavioral management plan developed and monitored by a licensed or certified professional qualified to identify the special needs of a child, as having a physical, emotional, or social developmental delay or impairment. 391 Neb. Admin. Code (NAC) § 1-006.13D Use of Physical Hold: The licensee and staff may restrict a child’s movement by the use of a physical hold. A physical hold may be used only: 1. When the child is hurting him/herself, others, or property; 2. When the hold does not prevent the child from breathing or speaking; and 3. Until the child is calm and able to show reasonable control of his/her behavior. 391 Neb. Admin. Code (NAC) § 1-006.13D1 Notification and Documentation: The licensee must notify the child’s parents within 24 hours of the physical hold when a physical hold is used on their child. Written documentation of each use of a physical hold must be available for review by the parents of the child involved in the physical hold and the Department. The documentation must include: 1. Child’s name; 2. Date of the incident; 3. Description of the incident; and 4. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 1-006.13E Use of Restraints: The use of restraints is prohibited except under the following conditions: 1. All staff who participate in restraining a child must have received prior training in de-escalation and the use of restraints. 2. The training curriculum must be accepted by the Department. 3. The training must be taught by a certified trainer. 4. Written documentation of each use of restraint must be available for review by the parents of the child involved in the restraint and the Department. The documentation must include: a. Child’s name; b. Date of the incident; c. Description of the incident; and d. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 1-006.14 Prohibited Language, Materials, and Actions: Children of any age must not be exposed to: 1. Profanity; 2. Sexually explicit material; 3. Acts of violence towards a person or animal; or 4. Acts of racism. 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: Nebraska does not have CCDF-eligible license exempt center care. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (K) Recognition and reporting child abuse and neglect. (i) Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. (ii) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 8: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 10. Recognition and reporting child abuse and neglect a. Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: 392 Neb. Admin. Code (NAC) § 4-004. PROVIDER STANDARDS. All Child Care Development Fund providers and staff must agree to all the terms found in the provider enrollment and must complete and maintain the following health and safety standards: (K) Recognition and reporting child abuse and neglect. (i) Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. (ii) Reports must be made to the Nebraska Child Abuse and Neglect Hotline. Child Care Provider Enrollment, page 8: V. CCDF Health and Safety Requirements Provider and provider’s staff (if applicable) are required to maintain the following health and safety standards: 10. Recognition and reporting child abuse and neglect a. Providers must practice and have an understanding of recognizing and immediately reporting any signs of child abuse or neglect. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: 391 Neb. Admin. Code (NAC) § 4-006.02 Director Requirements: The director is responsible for managing the day-today operations of the school-age-only center. The director must report to the licensee all matters related to the maintenance, operation, and management of the center and be directly responsible to the licensee or to a person delegated governing authority by the licensee. The director must: 9. Develop and implement written procedures that require the reporting of any evidence of physical abuse, neglect, or sexual abuse of any child in care at the school-age-only center; 10. Immediately file a report with the Child Abuse-Neglect Hotline (1-800-652- 1999) and/or appropriate local law enforcement agency when s/he has reason to believe child abuse, neglect or sexual abuse may be occurring in the school-age-only center, in the child’s home, or elsewhere, or ensure that a report is filed; 391 Neb. Admin. Code (NAC) § 4-006.19 Discipline: When parents are not present, the responsibility for the discipline of children in care lies only with the licensee/director or the designated substitute. 391 Neb. Admin. Code (NAC) § 4-006.19A Prohibited Forms of Discipline: The following actions are prohibited as a form of discipline: 1. Spanking; 2. Slapping; 3. Pinching 4. Punching; 5. Shaking; 6. Striking with any object; 7. Use of soap, hot sauce, or other unpleasant food and non-food items; 8. Isolating a child in a locked or closed room or closet; 9. Handling roughly; 10. Biting; 11. Denial of food; 12. Forced napping; 13. Subjecting children to derogatory remarks about the child or the child’s family; 14. Abusive or profane language directed at children; 15. Yelling or screaming at children; 16. Threats of physical punishment; or 17. Mechanical restraints. 391 Neb. Admin. Code (NAC) § 4-006.19B Child Behavior That Cannot Be Disciplined: Children must not be disciplined for: 1. Toileting accidents; 2. Refusal to take medication; or 3. Refusal to eat. 391 Neb. Admin. Code (NAC) § 4-006.19C Use of Time Out: Separation from the group, if used, must be brief and appropriate for the child’s age. The time out period must: 1. Take place within a safe, lighted, and well-ventilated area; 2. Occur within direct vision of staff; and 3. Not exceed more than one minute for each year of the child’s age. If the time a child spends in time out is extended, it must be carried out as indicated by a behavioral management plan developed and monitored by a licensed or certified professional qualified to identify the special needs of a child, as having a physical, emotional, or social developmental delay or impairment. 391 Neb. Admin. Code (NAC) § 4-006.19D Use of Physical Hold: Center staff may restrict a child’s movement by the use of a physical hold. A physical hold may be used only: 1. When the child is hurting him/herself, others, or property; 2. When the hold does not prevent the child from breathing or speaking; and 3. Until the child is calm and able to demonstrate reasonable control of his/her behavior. 391 Neb. Admin. Code (NAC) § 4-006.19D1 Notification and Documentation: The licensee/director must notify the child’s parents within 24 hours of the physical hold when a physical hold is used on their child. Written documentation of each use of a physical hold must be available for review by the parents of the child involved in the physical hold and the Department. The documentation must include: 1. Child’s name; 2. Date of the incident; 3. Description of the incident; and 4. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 4-006.19E Use of Restraints: The use of restraints is prohibited except under the following conditions: 1. All staff who participate in restraining a child must have received prior training in de-escalation and the use of restraints; 2. The training curriculum must be accepted by the Department; 3. The training must be taught by a certified trainer; and 4. Written documentation of each use of restraint must be available for review by the parents of the child involved in the restraint and the Department. The documentation must include: a. Child’s name; b. Date of the incident; c. Description of the incident; and d. Names of the staff involved. 391 Neb. Admin. Code (NAC) § 4-006.20 Prohibited Language, Materials, and Actions: Children of any age must not be exposed to: 1. Profanity; 2. Sexually explicit material; 3. Acts of violence toward a person or animal; or 4. Acts of racism. 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: All staff in licensed center programs who are responsible for menu planning, food preparation, and food safety must complete 4 clock hours of training in nutrition and food safety within 30 days of employment and annually thereafter. All licensed child care providers must meet USDA requirements regarding food groups and serving sizes, meals, and snacks must be appropriate to the needs of children in care, and weekly menus must be given to parents upon request. License-exempt providers are required to serve nutritious meals and snacks. Providers must keep cooking areas, eating areas, and equipment clean and in good repair. All licensed CCDF programs must comply with licensing requirements. ii. Access to physical activity. Describe: Licensed child care programs must have indoor and outdoor play areas, at least 35 square feet of indoor activity space per child, and at least 50 square feet per child outdoor activity space. All licensed CCDF programs must comply with licensing requirements. iii. Caring for children with special needs. Describe: Licensed child care providers are required to assess their ability and the ability of all staff to provide care for children with special needs while meeting the needs of other children in care. Providers must have a written plan of how evacuation of children with special needs will be conducted in the event of a disaster, fire, or tornado. Providers must have toilets and sinks designed to accommodate children with special needs. All licensed CCDF programs must comply with licensing requirements. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: Providers must have an understanding of child development, which includes physical, intellectual, social, and emotional changes in children.