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; and (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. (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. (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. (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. (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. (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. (G) Emergency preparedness: (i) Providers are required to create an emergency preparedness plan in each of the following areas: (1) Evacuation; (2) Relocating; (3) Shelter-in-place; (4) Lockdown; (5) Reunification with families; (6) Continuity of operations; (7) Accommodations of infants and toddlers; (8) Accommodations of children with disabilities; (9) Completing fire drills; and (10) Completing tornados drills. (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. (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. (J) Pediatric first aid and cardiopulmonary resuscitation. (i) Training completion required prior to approval and maintain current certification during approval period. (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. (L) Child development. (i) Providers must have an understanding of child development which includes physical, intellectual, social, and emotional changes in children.