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: He-C 4002.10(d)-(j): (d) The program shall request and maintain on file for each child documentation of immunizations in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14. (e) The documentation described in (d) above shall be on file on the first day the child is in attendance at the program or, pursuant to 45 CFR § 98, 41(a)(1)(i)(C), for children experiencing homelessness or for children in foster care within 60 days of the first date of attendance, to allow families or persons responsible for their care to obtain and provide documentation of immunizations. (f) Exemptions from the immunizations required under (d) above shall be in accordance with RSA 141-C:20-c. (g) Programs shall complete the department’s annual report of children’s immunizations in accordance with RSA 141-C:20-e and He-P 301.15(d). (h) The program shall maintain on file a completed child health screening form ￿New Hampshire Early Childhood Health Assessment Record￿ (May 2012) provided by the department, or an equivalent record of physical examination which is available for review by the department for each child no more than 60 calendar days after the date of admission. (i) A written record of a health screening or physical examination update shall be on file in accordance with the following: (1) For children younger than 6 years of age, programs shall have on file a copy of a physical examination completed within 60 days of the date of expiration of the last record of physical exam on file; and (2) For children ages 6 and older, programs shall have on file a copy of the physical examination record completed within the year prior to enrollment. (j) Programs shall not be required to obtain physical examination records for children whose parents object in writing, on the grounds that such physical examination is contrary to their religious beliefs. He-C 4002.11: (a) Child care staff shall observe each child, each day upon arrival and throughout the day for injuries and symptoms of illness which: (1) Impair or prohibit the child’s participation in the regular child care activities; or (2) Require more care than child care staff are able to provide without compromising the health and safety of the ill, or injured child, or the other children in their care. (b) Unless a program is following guidance issued by the department’s division of public health as a result of a disease outbreak or public health emergency, the program shall not deny admission or dismiss a child due to illness, unless one of the following conditions exist: (1) An oral or forehead temperature of 101 degrees Fahrenheit or greater, or 100 degrees Fahrenheit or greater when taken via the armpit, accompanied by behavior changes or signs or symptoms of illness until medical evaluation indicates inclusion in the program; (2) Symptoms and signs of possible severe illness such as unusual lethargy, uncontrolled coughing, irritability, persistent crying, difficult breathing, wheezing, or other unusual signs until medical evaluation allows inclusion; (3) Uncontrolled diarrhea, that is, increased number of stools, increased stool water, and/or decreased form that is not contained by the diaper, until diarrhea stops; (4) Vomiting illness, including two or more episodes of vomiting in the previous 24 hours, until vomiting resolves or until healthcare provider determines illness to be non-communicable, and the child is not in danger of dehydration; (5) Rash with fever or behavior change, until a healthcare provider determines that these symptoms do not indicate a communicable disease; or (6) The conditions in (a)(1) or (a)(2) are met. (c) Child care staff shall provide any child who is ill an opportunity to rest or an opportunity to do a quiet activity in a comfortable, private, supervised area, including areas not regularly considered child care space, such as offices, provided the space is safe for children to occupy, until parents arrive to remove the child from the program. (d) The family child care provider, center director, site director, or designee shall contact the bureau of disease control and prevention for instructions in accordance with the following: (1) When child care staff or children in the program have symptoms of or are known to have a communicable disease to determine whether the ill individual is required to be excluded from the program; and (2) To determine reporting requirements in accordance with RSA 141-C:7, He-P 301.03(c) and (d), and He-P 301.03(h). (e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. He-C 4002.23(ah): Child care staff shall immediately clean spills of bodily fluids, including urine, feces, blood, saliva, and discharges from the nose, eyes, or an injury, using soap and water and then disinfectant. Surfaces requiring such action include tabletops, toys, floors, walls, toilets, potty chairs, and diaper changing surfaces. He-C 4002.27: (a) Programs shall have a safe supply of water under pressure available for drinking and household use in accordance with the following: (1) Hot water under pressure, which measures at least 60 degrees Fahrenheit shall be available at all sinks during operating hours; (2) Hot water at taps which are accessible to children shall have an automatic control to maintain a temperature at the tap of not higher than 120 degrees Fahrenheit; (3) In accordance with Env-Dw 501.04(c), a program that is considered to be a public water system as defined in RSA 485:1-a, XV, subject to regulation by the department of environmental services, shall have on file, available for review by the health officer and the department, a written document which lists the United States Environmental Protection Agency identification number of the system, assigned by the department of environmental services; (4) Programs that have their own independent water supply and are not considered to be public water systems as defined in RSA 485:1-a, XV and confirmed by DES, shall test their water supply in accordance with the following: a. Water testing shall be performed by a laboratory accredited under the environmental laboratory accreditation program in accordance with Env-C 300; b. For new applicants, not more than 90 days prior to the date the application is submitted to the department, water testing shall be conducted for arsenic, bacteria, nitrate, nitrite, lead, both stagnant and flushed, copper, both stagnant and flushed, and fluoride, and results provided to the department with the application; and c. Ongoing water testing shall be conducted as follows and results maintained on file at the program, available for review by the health officer and the department: 1. Once every 3 months for bacteria; 2. Annually for arsenic, nitrate, and nitrite; and 3. At least once every 3 years for stagnant lead, stagnant copper, and fluoride; (5) The results of water tests required by (a)(4)b. and c. above, and results of any other water tests shall be in compliance with the maximum contaminant levels established in Env-Dw 700 for bacteria, nitrates, nitrites, arsenic, and fluoride, and shall not exceed the action levels established in Env-Dw 714 for lead and copper; (6) Any program whose water test result has exceeded maximum contaminant levels or action levels shall: a. Immediately contact the department to report that finding, and provide the department with a plan for how it will ensure that children will not be at risk from exposure to the unsafe water; and b. Within 30 days of the date the program learns that they have failed a water test submit to the department an acceptable corrective action plan which details what action will be taken to correct the unsafe condition of the water and a date by which that action will be complete, unless the program requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria: 1. The program demonstrates that it has made a good faith effort to develop and submit the corrective action plan within the 30 day period but has been unable to do so; and 2. The department determines that the health, safety, or well-being of children will not be jeopardized as a result of granting the extension; and (7) When a program fails to submit a written proposed corrective action plan within 30 days of receiving the unacceptable test result under (a)(6)b. above, the department shall initiate action to suspend the license or permit in accordance with He-C 4002.44(q) and (r), until such time as laboratory results meeting those requirements are received by the department. (b) During all hours of operation there shall be functional sewage disposal facilities designed to accommodate the license capacity of the program, in accordance with the following: (1) There shall be no visible sewage on the grounds; (2) There shall be flush toilets in working order connected to a sewage disposal system; and (3) Any program whose septic system is showing signs of failure shall: a. Immediately make arrangements with a contractor licensed to evaluate and repair or replace septic systems to: 1. Make temporary repairs to the septic system to correct the problem so that the program may continue to operate; or 2. Make permanent repairs to the septic system or replace the septic system; b. Immediately contact the local health officer to inform him or her of the problem; c. Immediately contact the department to verbally report the problem, and give the department a plan for how it will immediately provide that: 1. All required bathroom units function properly; and 2. Children will not be exposed to any risks from the failed septic system; d. Within 10 days of the date that child care staff first notice signs indicating that the septic system is in failure, submit to the department a written plan, which includes: 1. What action has been taken to correct the failed septic system; 2. The date by which that action will be completed; 3. An explanation of how the program will ensure that the requirements in c.1. and c.2. above will continue to be met until repair or replacements are completed; and e. Request an extension to d. above, which the department shall grant if additional time is necessary to develop a written plan and the safety and well-being of the children is maintained. (c) Privies are permissible in lieu of, or in addition to, (b)(2) above under the following conditions: (1) The licensee shall obtain approval by the town health officer for use of a privy; (2) The privy shall be constructed in accordance with Env-Wq 1022.01; (3) There shall be running water for handwashing available and accessible inside the privy area or immediately upon exiting the privy; (4) Privies shall be located: a. At least 100 feet from any place where food is prepared or served; b. At least 75 feet from any surface water; and c. At least 200 feet up- gradient of any well or spring; (5) Privy contents shall be: a. Removed as often as necessary to prevent the pit from being filled to within one foot of the top of the pit; and b. Disposed of in accordance with Env-Wq 1600; (6) The contents of the pit shall be covered daily with lime or other suitable agent to eliminate insects and odors; (7) The materials for liming and disinfection shall be kept: a. In proximity to the privy where they are readily available for use; and b. Stored in a manner where children cannot access the contents; (8) The privy and the pit shall be made fly-tight and provided with self-closing lids; and (9) Child care staff shall maintain the privy in clean and sanitary conditions at all times. (d) The licensee shall maintain chemical toilets in accordance with Env-Wq 1600, which shall be pumped by a septage hauler licensed by the department of environmental services. He-C 4002.28: (a) Bathrooms shall have a means of outside ventilation. (b) Prior to use, the local health officer or designee and the department shall approve portable sinks intended for use to meet any of the requirements of He-C 4002. (c) Toilet facilities shall afford adequate privacy appropriate to the ages of children enrolled in the program while allowing for age appropriate supervision of each child. (d) Programs licensed to care for children younger than 3 years of age shall: (1) Provide potty chairs or adult toilets with adapters at a ratio of one unit for every 10 children ages 18 months through 35 months, in addition to the requirements for toilets in He-C 4002.22(d); (2) Place potty chairs within easy access to a toilet and sink to allow child care staff to proceed to the toilet to empty the potty chair and proceed to the hand washing sink without having to open doors or gates, or have physical contact with other children; (3) Not place potty chairs in food preparation areas or food service areas; and (4) Empty and sanitize each potty receptacle after each use. He-C 4002.29: (a) Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: (1) Be located adjacent to or in close proximity to a designated hand washing sink to allow access for hand washing without having to open doors or gates or have physical contact with other children; (2) Have a non-porous, washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; (3) Contain a covered, hand-free receptacle, lined with a plastic bag, and located within reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and (4) Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. (b) In addition to the requirements in (a) above, in center-based programs the diaper changing area shall be: (1) Located in the room where the children in diapers are cared for; and (2) Equipped with a sink adjacent to or in close proximity to the diaper changing area designated exclusively for adult and child hand washing before or after diaper changing or toileting. (c) Programs shall not use a sink for hand washing after diapering or toileting if food preparation or washing dishes or eating utensils occurs in the sink. (d) At least every 2 hours, child care staff shall check children in diapers and change diapers and clothing if they are soiled or wet. (e) During each diaper change, soiled areas of children shall be washed with disposable, single use cleansing articles such as baby wipes or soft paper towels that have been moistened with water. (h) When non-disposable diapers are used: (1) The diaper shall have an absorbent inner lining completely contained within an outer covering made of waterproof material that prevents the escape of feces and urine; (2) The diaper shall contain a waterproof cover that is adherent to the cloth material; or (3) The outer covering and inner lining shall be changed at the same time as a unit when a diaper with a separate lining is used. (i) Soiled disposable diapers and cleansing articles shall immediately be placed in a plastic bag lined, hands-free receptacle. (j) The plastic bag containing the soiled diapers and cleansing articles shall be removed daily, securely closed, and placed outside in covered garbage cans for collection or removal at regular intervals. (k) Covered hands-free receptacles used to dispose of diapers and cleansing articles shall be cleaned and sanitized at least once each day. (l) Soiled non-disposable diapers shall: (1) Be immediately placed in an individual sealed plastic bag which shall be inaccessible to children and not in contact with other’s belongings; and (2) Be returned to the parent at the end of each day. (m) Programs using a commercial diaper service shall handle soiled diapers in accordance with written instructions from the service. He-C 4002.30: (a) Child care staff shall wash their hands with liquid soap and running water as needed and: (1) After each diaper change or toileting; (2) After handling any bodily fluid; (3) After cleaning up or handling the garbage; (4) After playing outdoors; (5) Before and after eating; (6) Before and after administering medication; and (7) Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross contamination when changing tasks or from raw to ready to eat foods. (b) Child care staff shall: (1) Teach children the importance of hand washing with liquid soap and running water; and (2) Instruct, encourage, remind, or assist infants and children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above. (c) Sinks that are used for food preparation or clean up, including sinks used for getting water for baby bottles, rinsing bottles, or dishes, and washing toys, shall not be used for hand washing after toileting or diaper changing. He-C 4002.31: (a) Programs shall provide developmentally appropriate individual eating utensils, cups, and bottles, as applicable, for each meal and snack, which children shall not share. (b) Eating and drinking utensils shall be free from defects, cracks, and chips. (c) Child care staff shall clean all dishes and cooking utensils in a dishwasher or manually wash them in clean hot water and detergent, rinse them in hot water, and allow manually washed dishes to air dry. (d) Child care staff shall serve all food items on a plate or napkin, except foods for infants and toddlers which can be served on a chair tray or table that has been cleaned and sanitized before being used as an eating surface. (e) Child care staff shall sanitize all tables used for meals and snacks, both before and after serving meals or snacks. (f) Only food contact surfaces that are easily cleanable, smooth, free of cracks, breaks, open seams, or similar difficult to clean imperfections which are kept clean, shall be used for food preparation. (i) Child care staff shall thoroughly wash all fruit and vegetables before cutting or serving those foods to children. (p) Programs that provide meals and snacks for children shall: (1) Ensure that snacks and meals are prepared and served in a safe and sanitary manner, including washing fruits and vegetables before serving them; (2) Not serve food to children beyond the recommended dates of use, or beyond 3 days of storage in the refrigerator for perishable leftover food; (3) Store all food in the original containers or in a clean, covered container labeled with the date open and expiration date; (4) Store all unopened food at least 6 inches above the floor, separate from non-food items; (5) Store food items separate from non-food items that could contaminate food or be mistaken for food; (6) In addition to (c) above, properly wash and sanitize all infant bottles between each use. (q) Child care program personnel shall store perishable food in accordance with the following: (1) Refrigeration and storage for food shall be at not less than 32°F, nor more than 40°F for all food requiring refrigeration; (2) There shall be a non- mercury, food service approved thermometers verifying temperatures maintained in all refrigerators; and (3) Refrigerators and freezers used to store foods intended for serving to children shall be maintained in clean condition. (r) Child care program personnel shall not serve to children any canned goods that are dented, bulging or rusted. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.10(d)-(j): (d) The program shall request and maintain on file for each child documentation of immunizations in accordance with RSA 141-C:20-a, RSA 141- C:20-b, and He-P 301.14. (e) The documentation described in (d) above shall be on file on the first day the child is in attendance at the program or, pursuant to 45 CFR § 98, 41(a)(1)(i)(C), for children experiencing homelessness or for children in foster care within 60 days of the first date of attendance, to allow families or persons responsible for their care to obtain and provide documentation of immunizations. (f) Exemptions from the immunizations required under (d) above shall be in accordance with RSA 141-C:20-c. (g) Programs shall complete the department’s annual report of children’s immunizations in accordance with RSA 141-C:20-e and He-P 301.15(d). (h) The program shall maintain on file a completed child health screening form ￿New Hampshire Early Childhood Health Assessment Record￿ (May 2012) provided by the department, or an equivalent record of physical examination which is available for review by the department for each child no more than 60 calendar days after the date of admission. (i) A written record of a health screening or physical examination update shall be on file in accordance with the following: (1) For children younger than 6 years of age, programs shall have on file a copy of a physical examination completed within 60 days of the date of expiration of the last record of physical exam on file; and (2) For children ages 6 and older, programs shall have on file a copy of the physical examination record completed within the year prior to enrollment. (j) Programs shall not be required to obtain physical examination records for children whose parents object in writing, on the grounds that such physical examination is contrary to their religious beliefs. He-C 4002.11: (a) Child care staff shall observe each child, each day upon arrival and throughout the day for injuries and symptoms of illness which: (1) Impair or prohibit the child’s participation in the regular child care activities; or (2) Require more care than child care staff are able to provide without compromising the health and safety of the ill, or injured child, or the other children in their care. (b) Unless a program is following guidance issued by the department’s division of public health as a result of a disease outbreak or public health emergency, the program shall not deny admission or dismiss a child due to illness, unless one of the following conditions exist: (1) An oral or forehead temperature of 101 degrees Fahrenheit or greater, or 100 degrees Fahrenheit or greater when taken via the armpit, accompanied by behavior changes or signs or symptoms of illness until medical evaluation indicates inclusion in the program; (2) Symptoms and signs of possible severe illness such as unusual lethargy, uncontrolled coughing, irritability, persistent crying, difficult breathing, wheezing, or other unusual signs until medical evaluation allows inclusion; (3) Uncontrolled diarrhea, that is, increased number of stools, increased stool water, and/or decreased form that is not contained by the diaper, until diarrhea stops; (4) Vomiting illness, including two or more episodes of vomiting in the previous 24 hours, until vomiting resolves or until healthcare provider determines illness to be non-communicable, and the child is not in danger of dehydration; (5) Rash with fever or behavior change, until a healthcare provider determines that these symptoms do not indicate a communicable disease; or (6) The conditions in (a)(1) or (a)(2) are met. (c) Child care staff shall provide any child who is ill an opportunity to rest or an opportunity to do a quiet activity in a comfortable, private, supervised area, including areas not regularly considered child care space, such as offices, provided the space is safe for children to occupy, until parents arrive to remove the child from the program. (d) The family child care provider, center director, site director, or designee shall contact the bureau of disease control and prevention for instructions in accordance with the following: (1) When child care staff or children in the program have symptoms of or are known to have a communicable disease to determine whether the ill individual is required to be excluded from the program; and (2) To determine reporting requirements in accordance with RSA 141-C:7, He-P 301.03(c) and (d), and He-P 301.03(h). (e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. He-C 4002.23(ah): Child care staff shall immediately clean spills of bodily fluids, including urine, feces, blood, saliva, and discharges from the nose, eyes, or an injury, using soap and water and then disinfectant. Surfaces requiring such action include tabletops, toys, floors, walls, toilets, potty chairs, and diaper changing surfaces. He-C 4002.27: (a) Programs shall have a safe supply of water under pressure available for drinking and household use in accordance with the following: (1) Hot water under pressure, which measures at least 60 degrees Fahrenheit shall be available at all sinks during operating hours; (2) Hot water at taps which are accessible to children shall have an automatic control to maintain a temperature at the tap of not higher than 120 degrees Fahrenheit; (3) In accordance with Env-Dw 501.04(c), a program that is considered to be a public water system as defined in RSA 485:1-a, XV, subject to regulation by the department of environmental services, shall have on file, available for review by the health officer and the department, a written document which lists the United States Environmental Protection Agency identification number of the system, assigned by the department of environmental services; (4) Programs that have their own independent water supply and are not considered to be public water systems as defined in RSA 485:1-a, XV and confirmed by DES, shall test their water supply in accordance with the following: a. Water testing shall be performed by a laboratory accredited under the environmental laboratory accreditation program in accordance with Env-C 300; b. For new applicants, not more than 90 days prior to the date the application is submitted to the department, water testing shall be conducted for arsenic, bacteria, nitrate, nitrite, lead, both stagnant and flushed, copper, both stagnant and flushed, and fluoride, and results provided to the department with the application; and c. Ongoing water testing shall be conducted as follows and results maintained on file at the program, available for review by the health officer and the department: 1. Once every 3 months for bacteria; 2. Annually for arsenic, nitrate, and nitrite; and 3. At least once every 3 years for stagnant lead, stagnant copper, and fluoride; (5) The results of water tests required by (a)(4)b. and c. above, and results of any other water tests shall be in compliance with the maximum contaminant levels established in Env-Dw 700 for bacteria, nitrates, nitrites, arsenic, and fluoride, and shall not exceed the action levels established in Env-Dw 714 for lead and copper; (6) Any program whose water test result has exceeded maximum contaminant levels or action levels shall: a. Immediately contact the department to report that finding, and provide the department with a plan for how it will ensure that children will not be at risk from exposure to the unsafe water; and b. Within 30 days of the date the program learns that they have failed a water test submit to the department an acceptable corrective action plan which details what action will be taken to correct the unsafe condition of the water and a date by which that action will be complete, unless the program requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria: 1. The program demonstrates that it has made a good faith effort to develop and submit the corrective action plan within the 30 day period but has been unable to do so; and 2. The department determines that the health, safety, or well-being of children will not be jeopardized as a result of granting the extension; and (7) When a program fails to submit a written proposed corrective action plan within 30 days of receiving the unacceptable test result under (a)(6)b. above, the department shall initiate action to suspend the license or permit in accordance with He-C 4002.44(q) and (r), until such time as laboratory results meeting those requirements are received by the department. (b) During all hours of operation there shall be functional sewage disposal facilities designed to accommodate the license capacity of the program, in accordance with the following: (1) There shall be no visible sewage on the grounds; (2) There shall be flush toilets in working order connected to a sewage disposal system; and (3) Any program whose septic system is showing signs of failure shall: a. Immediately make arrangements with a contractor licensed to evaluate and repair or replace septic systems to: 1. Make temporary repairs to the septic system to correct the problem so that the program may continue to operate; or 2. Make permanent repairs to the septic system or replace the septic system; b. Immediately contact the local health officer to inform him or her of the problem; c. Immediately contact the department to verbally report the problem, and give the department a plan for how it will immediately provide that: 1. All required bathroom units function properly; and 2. Children will not be exposed to any risks from the failed septic system; d. Within 10 days of the date that child care staff first notice signs indicating that the septic system is in failure, submit to the department a written plan, which includes: 1. What action has been taken to correct the failed septic system; 2. The date by which that action will be completed; 3. An explanation of how the program will ensure that the requirements in c.1. and c.2. above will continue to be met until repair or replacements are completed; and e. Request an extension to d. above, which the department shall grant if additional time is necessary to develop a written plan and the safety and well-being of the children is maintained. (c) Privies are permissible in lieu of, or in addition to, (b)(2) above under the following conditions: (1) The licensee shall obtain approval by the town health officer for use of a privy; (2) The privy shall be constructed in accordance with Env-Wq 1022.01; (3) There shall be running water for handwashing available and accessible inside the privy area or immediately upon exiting the privy; (4) Privies shall be located: a. At least 100 feet from any place where food is prepared or served; b. At least 75 feet from any surface water; and c. At least 200 feet up- gradient of any well or spring; (5) Privy contents shall be: a. Removed as often as necessary to prevent the pit from being filled to within one foot of the top of the pit; and b. Disposed of in accordance with Env-Wq 1600; (6) The contents of the pit shall be covered daily with lime or other suitable agent to eliminate insects and odors; (7) The materials for liming and disinfection shall be kept: a. In proximity to the privy where they are readily available for use; and b. Stored in a manner where children cannot access the contents; (8) The privy and the pit shall be made fly-tight and provided with self-closing lids; and (9) Child care staff shall maintain the privy in clean and sanitary conditions at all times. (d) The licensee shall maintain chemical toilets in accordance with Env-Wq 1600, which shall be pumped by a septage hauler licensed by the department of environmental services. He-C 4002.28: (a) Bathrooms shall have a means of outside ventilation. (b) Prior to use, the local health officer or designee and the department shall approve portable sinks intended for use to meet any of the requirements of He-C 4002. (c) Toilet facilities shall afford adequate privacy appropriate to the ages of children enrolled in the program while allowing for age appropriate supervision of each child. (d) Programs licensed to care for children younger than 3 years of age shall: (1) Provide potty chairs or adult toilets with adapters at a ratio of one unit for every 10 children ages 18 months through 35 months, in addition to the requirements for toilets in He-C 4002.22(d); (2) Place potty chairs within easy access to a toilet and sink to allow child care staff to proceed to the toilet to empty the potty chair and proceed to the hand washing sink without having to open doors or gates, or have physical contact with other children; (3) Not place potty chairs in food preparation areas or food service areas; and (4) Empty and sanitize each potty receptacle after each use. He-C 4002.29: (a) Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: (1) Be located adjacent to or in close proximity to a designated hand washing sink to allow access for hand washing without having to open doors or gates or have physical contact with other children; (2) Have a non-porous, washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; (3) Contain a covered, hand-free receptacle, lined with a plastic bag, and located within reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and (4) Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. (b) In addition to the requirements in (a) above, in center-based programs the diaper changing area shall be: (1) Located in the room where the children in diapers are cared for; and (2) Equipped with a sink adjacent to or in close proximity to the diaper changing area designated exclusively for adult and child hand washing before or after diaper changing or toileting. (c) Programs shall not use a sink for hand washing after diapering or toileting if food preparation or washing dishes or eating utensils occurs in the sink. (d) At least every 2 hours, child care staff shall check children in diapers and change diapers and clothing if they are soiled or wet. (e) During each diaper change, soiled areas of children shall be washed with disposable, single use cleansing articles such as baby wipes or soft paper towels that have been moistened with water. (h) When non-disposable diapers are used: (1) The diaper shall have an absorbent inner lining completely contained within an outer covering made of waterproof material that prevents the escape of feces and urine; (2) The diaper shall contain a waterproof cover that is adherent to the cloth material; or (3) The outer covering and inner lining shall be changed at the same time as a unit when a diaper with a separate lining is used. (i) Soiled disposable diapers and cleansing articles shall immediately be placed in a plastic bag lined, hands-free receptacle. (j) The plastic bag containing the soiled diapers and cleansing articles shall be removed daily, securely closed, and placed outside in covered garbage cans for collection or removal at regular intervals. (k) Covered hands-free receptacles used to dispose of diapers and cleansing articles shall be cleaned and sanitized at least once each day. (l) Soiled non-disposable diapers shall: (1) Be immediately placed in an individual sealed plastic bag which shall be inaccessible to children and not in contact with other’s belongings; and (2) Be returned to the parent at the end of each day. (m) Programs using a commercial diaper service shall handle soiled diapers in accordance with written instructions from the service. He-C 4002.30: (a) Child care staff shall wash their hands with liquid soap and running water as needed and: (1) After each diaper change or toileting; (2) After handling any bodily fluid; (3) After cleaning up or handling the garbage; (4) After playing outdoors; (5) Before and after eating; (6) Before and after administering medication; and (7) Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross contamination when changing tasks or from raw to ready to eat foods. (b) Child care staff shall: (1) Teach children the importance of hand washing with liquid soap and running water; and (2) Instruct, encourage, remind, or assist infants and children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above. (c) Sinks that are used for food preparation or clean up, including sinks used for getting water for baby bottles, rinsing bottles, or dishes, and washing toys, shall not be used for hand washing after toileting or diaper changing. He-C 4002.31: (a) Programs shall provide developmentally appropriate individual eating utensils, cups, and bottles, as applicable, for each meal and snack, which children shall not share. (b) Eating and drinking utensils shall be free from defects, cracks, and chips. (c) Child care staff shall clean all dishes and cooking utensils in a dishwasher or manually wash them in clean hot water and detergent, rinse them in hot water, and allow manually washed dishes to air dry. (d) Child care staff shall serve all food items on a plate or napkin, except foods for infants and toddlers which can be served on a chair tray or table that has been cleaned and sanitized before being used as an eating surface. (e) Child care staff shall sanitize all tables used for meals and snacks, both before and after serving meals or snacks. (f) Only food contact surfaces that are easily cleanable, smooth, free of cracks, breaks, open seams, or similar difficult to clean imperfections which are kept clean, shall be used for food preparation. (i) Child care staff shall thoroughly wash all fruit and vegetables before cutting or serving those foods to children. (p) Programs that provide meals and snacks for children shall: (1) Ensure that snacks and meals are prepared and served in a safe and sanitary manner, including washing fruits and vegetables before serving them; (2) Not serve food to children beyond the recommended dates of use, or beyond 3 days of storage in the refrigerator for perishable leftover food; (3) Store all food in the original containers or in a clean, covered container labeled with the date open and expiration date; (4) Store all unopened food at least 6 inches above the floor, separate from non-food items; (5) Store food items separate from non-food items that could contaminate food or be mistaken for food; (6) In addition to (c) above, properly wash and sanitize all infant bottles between each use. (q) Child care program personnel shall store perishable food in accordance with the following: (1) Refrigeration and storage for food shall be at not less than 32°F, nor more than 40°F for all food requiring refrigeration; (2) There shall be a non- mercury, food service approved thermometers verifying temperatures maintained in all refrigerators; and (3) Refrigerators and freezers used to store foods intended for serving to children shall be maintained in clean condition. (r) Child care program personnel shall not serve to children any canned goods that are dented, bulging or rusted. 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: He-C 6916.10 Prevention and Control of Infectious Diseases, Including Immunizations. Staff and children shall wash their hands with liquid soap and warm running water as needed and: After each diaper change or toileting; After handling any bodily fluid; After cleaning up or handling garbage; After playing outdoors; Before and after eating; Before and after administering medication; and Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross-contamination when changing tasks or from raw to ready-to-eat foods. Child care staff shall: Teach children the importance of handwashing with liquid soap and warm running water; and Instruct, encourage, remind, or assist children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above. Staff shall observe each child for symptoms of illness or injury throughout the day and contact the parent if a child has: More than one episode of vomiting in one day; More than one episode of diarrhea in one day; Uncontrolled coughing or wheezing; Skin lesions which have not been diagnosed or treated by a licensed health care practitioner; or An oral temperature of 101 degrees Fahrenheit or higher or an under arm temperature of 100 degrees Fahrenheit or higher combined with any of the following: Diarrhea; Rash; Earache; Sore throat; or Vomiting. Any time there is spill of bodily fluids, or any staff or child in the program have symptoms of, or are known to have, a communicable disease: Any spills of bodily fluids shall be immediately cleaned and sanitized; Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; and The program shall contact the bureau of disease control and prevention at (800) 852-3345, ext. 4496 for instructions regarding whether the ill individual is required to be excluded from the program and to determine reporting requirements in accordance with RSA 141-C:7 and He-P 301.03(c), (d), and (h) and He-P 301.05(i)(3)b. All foods prepared and served to children shall be free from spoilage, filth, and other contamination. Programs shall clean and disinfect bathroom facilities whenever visibly soiled, but at a minimum of once per week. Programs with pets on the premises shall: Ensure dogs and cats have a current vaccination for rabies; Keep cages that house small animals, fish tanks, and litter boxes away from food preparation, food service areas, and any other area where children play; and Ensure children do not have direct contact with animal feces or urine either indoors or outdoors. Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141- C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance at the program. Exemptions from the immunizations required under (h) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. Programs shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. Documentation for the exemptions listed in (j) above shall be on file with the program, and shall be in accordance with RSA 141-C:20-c. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations. (a) Providers and children shall wash their hands with liquid soap and warm running water as needed and: (1) After each diaper change or toileting; (2) After handling any bodily fluid; (3) After cleaning up or handling garbage; (4) After playing outdoors; (5) Before and after eating; (6) Before and after administering medication; and (7) Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross-contamination when changing tasks or from raw to ready-to-eat foods. (b) Providers shall: (1) Teach children the importance of handwashing with liquid soap and warm running water; (2) Instruct, encourage, remind, or assist children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above; and (3) Wash the hands of infants as necessary to comply with (a)(4) and (a)(5) above. (c) Providers shall observe each child for symptoms of illness or injury throughout the day and contact the parent if a child has: (1) More than one episode of vomiting in one day; (2) More than one episode of diarrhea in one day; (3) Uncontrolled coughing or wheezing; (4) Skin lesions which have not been diagnosed or treated by a licensed health care practitioner; or (5) An oral temperature of 101 degrees Fahrenheit or higher or an under arm temperature of 100 degrees Fahrenheit or higher combined with any of the following: Diarrhea; Rash; Earache; Sore throat; or Vomiting. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; and The provider shall contact the bureau of disease control and prevention at (800) 852-3345, ext. 4496 for instructions regarding whether the ill individual is required to be excluded from child care and to determine reporting requirements in accordance with RSA 141- C:7 and He- P 301.03(d) and (e), He-P 301.03(i), and He-P 301.05(i)(3)b. (e) All foods prepared and served to children shall be free from spoilage, filth, and other contamination. (f) Providers shall check children in diapers and change diapers and clothing if they are soiled or wet as needed, and at minimum once every 2 hours. (g) The plastic bag containing the soiled diapers and cleansing articles shall be removed daily, securely closed, and placed outside in covered garbage cans for collection or removal at regular intervals. (h) Providers shall clean and disinfect bathroom facilities whenever visibly soiled but at a minimum of once per week. (i) All bedding used by children in care shall be cleaned at least once per week and more frequently if soiled. (j) Providers shall ensure that the presence of pets does not present a hazard to the children. (k) When there are pets in a provider’s home, providers shall: (1) Ensure dogs and cats have a current vaccination for rabies; (2) Keep cages that house small animals, fish tanks, and litter boxes away from food preparation, or food service areas, as well as any other area where children play; and (3) Ensure children do not have direct contact with animal feces or urine either indoors or outdoors. (l) Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance with the provider. (m) Exemptions from the immunizations required under (l) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. (n) Providers shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. (o) Documentation for the exemptions listed in (n) above shall be on file with the provider, and shall be in accordance with RSA 141-C:20-c. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations.(a) Providers and children shall wash their hands with liquid soap and warm running water as needed and: (1) After each diaper change or toileting; (2) After handling any bodily fluid; (3) After cleaning up or handling garbage; (4) After playing outdoors; (5) Before and after eating; (6) Before and after administering medication; and (7) Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross contamination when changing tasks or from raw to ready-to-eat foods,(b) Providers shall: (1) Teach children the importance of handwashing with liquid soap and warm running water; (2) Instruct, encourage, remind, or assist children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above; and (3) Wash the hands of infants as necessary to comply with (a)(4) and (a)(5) above. (c) Providers shall observe each child for symptoms of illness or injury throughout the day and contact the parent if a child has: (1) More than one episode of vomiting in one day; (2) More than one episode of diarrhea in one day; (3) Uncontrolled coughing or wheezing; (4) Skin lesions which have not been diagnosed or treated by a licensed health care practitioner; or (5) An oral temperature of 101 degrees Fahrenheit or higher or an under arm temperature of 100 degrees Fahrenheit or higher combined with any of the following: Diarrhea; Rash; Earache; Sore throat; or Vomiting. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; and the provider shall contact the bureau of disease control and prevention at (800) 852-3345, ext. 4496 for instructions regarding whether the ill individual is required to be excluded from child care and to determine reporting requirements in accordance with RSA 141-C:7 and He- P 301.03(d) and (e), He-P 301.03(i), and He-P 301.05(i)(3)b.(e) All foods prepared and served to children shall be free from spoilage, filth, and other contamination. (f) Providers shall check children in diapers and change diapers and clothing if they are soiled or wet as needed, and at minimum once every 2 hours. (g) The plastic bag containing the soiled diapers and cleansing articles shall be removed daily, securely closed, and placed outside in covered garbage cans for collection or removal at regular intervals. (h) Providers shall clean and disinfect bathroom facilities whenever visibly soiled but at a minimum of once per week. (i) All bedding used by children in care shall be cleaned at least once per week and more frequently if soiled. (j) Providers shall ensure that the presence of pets does not present a hazard to the children. (k) When there are pets in a provider’s home, providers shall: (1) Ensure dogs and cats have a current vaccination for rabies; (2) Keep cages that house small animals, fish tanks, and litter boxes away from food preparation, or food service areas, as well as any other area where children play; and (3) Ensure children do not have direct contact with animal feces or urine either indoors or outdoors. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.10 Prevention and Control of Infectious Diseases, Including Immunizations. Staff and children shall wash their hands with liquid soap and warm running water as needed and: After each diaper change or toileting; After handling any bodily fluid; After cleaning up or handling garbage; After playing outdoors; Before and after eating; Before and after administering medication; and Before and during any food preparation or service as often as necessary to remove soil and contamination and prevent cross- contamination when changing tasks or from raw to ready-to-eat foods. Child care staff shall: Teach children the importance of handwashing with liquid soap and warm running water; and Instruct, encourage, remind, or assist children as needed throughout each day to wash their hands as necessary to comply with (a)(1) through (5) above. Staff shall observe each child for symptoms of illness or injury throughout the day and contact the parent if a child has: More than one episode of vomiting in one day; More than one episode of diarrhea in one day; Uncontrolled coughing or wheezing; Skin lesions which have not been diagnosed or treated by a licensed health care practitioner; or An oral temperature of 101 degrees Fahrenheit or higher or an under arm temperature of 100 degrees Fahrenheit or higher combined with any of the following: Diarrhea; Rash; Earache; Sore throat; or Vomiting. Any time there is spill of bodily fluids, or any staff or child in the program have symptoms of, or are known to have, a communicable disease: Any spills of bodily fluids shall be immediately cleaned and sanitized; Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; and The program shall contact the bureau of disease control and prevention at (800) 852-3345, ext. 4496 for instructions regarding whether the ill individual is required to be excluded from the program and to determine reporting requirements in accordance with RSA 141-C:7 and He-P 301.03(c), (d), and (h) and He-P 301.05(i)(3)b. All foods prepared and served to children shall be free from spoilage, filth, and other contamination. Programs shall clean and disinfect bathroom facilities whenever visibly soiled, but at a minimum of once per week. Programs with pets on the premises shall: Ensure dogs and cats have a current vaccination for rabies; Keep cages that house small animals, fish tanks, and litter boxes away from food preparation, food service areas, and any other area where children play; and Ensure children do not have direct contact with animal feces or urine either indoors or outdoors. Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance at the program. Exemptions from the immunizations required under (h) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. Programs shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. Documentation for the exemptions listed in (j) above shall be on file with the program, and shall be in accordance with RSA 141-C:20-c. 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: He-C 4002.10(d)-(f): (d) The program shall request and maintain on file for each child documentation of immunizations in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14. (e) The documentation described in (d) above shall be on file on the first day the child is in attendance at the program or, pursuant to 45 CFR § 98, 41(a)(1)(i)(C), for children experiencing homelessness or for children in foster care within 60 days of the first date of attendance, to allow families or persons responsible for their care to obtain and provide documentation of immunizations. (f) Exemptions from the immunizations required under (d) above shall be in accordance with RSA 141-C:20-c. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.10(d)-(f): (d) The program shall request and maintain on file for each child documentation of immunizations in accordance with RSA 141-C:20-a, RSA 141- C:20-b, and He-P 301.14. (e) The documentation described in (d) above shall be on file on the first day the child is in attendance at the program or, pursuant to 45 CFR § 98, 41(a)(1)(i)(C), for children experiencing homelessness or for children in foster care within 60 days of the first date of attendance, to allow families or persons responsible for their care to obtain and provide documentation of immunizations. (f) Exemptions from the immunizations required under (d) above shall be in accordance with RSA 141-C:20-c. 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: He-C 6916.10 Prevention and Control of Infectious Diseases, Including Immunizations. outdoors. (h) Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance at the program. (i) Exemptions from the immunizations required under (h) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. (j) Programs shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. (k) Documentation for the exemptions listed in (j) above shall be on file with the program, and shall be in accordance with RSA 141-C:20-c. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations.(l) Documentation of immunizations, in accordance with RSA 141- C:20-a, RSA 141-C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance with the provider. (m) Exemptions from the immunizations required under (l) above shall be in accordance with RSA 141-C:20- c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. (n) Providers shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. (o) Documentation for the exemptions listed in (n) above shall be on file with the provider, and shall be in accordance with RSA 141-C:20-c. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations.(l) Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141- C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance with the provider. (m) Exemptions from the immunizations required under (l) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. (n) Providers shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. (o) Documentation for the exemptions listed in (n) above shall be on file with the provider, and shall be in accordance with RSA 141-C:20-c. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.10 Prevention and Control of Infectious Diseases, Including Immunizations. outdoors. (h) Documentation of immunizations, in accordance with RSA 141-C:20-a, RSA 141-C:20-b, and He-P 301.14, shall be on file for each child on the first day the child is in attendance at the program. (i) Exemptions from the immunizations required under (h) above shall be in accordance with RSA 141-C:20-c and pursuant to 45 CFR Part 98.41(a)(1)(i)(C) for children experiencing homelessness or children in foster care. Providers may enroll children and allow for 60 days for families to obtain and provide documentation of immunizations. (j) Programs shall not be required to obtain immunization records for children whose parent objects, on the grounds that such immunization is contrary to their religious beliefs, or for children with medical conditions that contraindicate immunization. (k) Documentation for the exemptions listed in (j) above shall be on file with the program, and shall be in accordance with RSA 141-C:20-c. 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: He-C 4002.26: (e) No crib shall be used unless manufactured on or after June 28, 2011, or if manufactured prior to that date, has a Children’s Product Certificate (CPC), or test report from a consumer product safety commission (CPSC) accepted third-party lab, provided by the manufacturer documenting the crib’s compliance with 16 CFR 1219 as required by 16 CFR 1219 and 1220. (f) Cribs and play pens required under (c) above shall: (1) Not be stacked; (2) Be free of cracked or peeling paint, splinters, and rough edges; (3) Have no more than 2⅜ inches between slats; (4) Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards, or other loose hardware, or damaged parts on the crib or mattress supports; (5) Not have corner posts that extend more than 1/16 of an inch above the end panels; (6) Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or play pen; (7) Have fitted sheets designed for the size mattress, including elastic corners so that there is no excess fabric with visible folds or bunching, and that do not compress the mattress; (8) Not have bumper pads, blankets, flat sheets, pillows, quilts, comforters, sleep positioners, or any soft items or toys with infants up to 12 months of age; and (9) Have mattresses which are in good repair, free of rips or tears, and fit the crib or playpen so that the space between the mattress and crib or playpen is not more than 2 adult fingers wide and does not create a suffocation hazard. (g) Pursuant to He-C 4002.33(b)(3), all child care staff in programs licensed for children 12 months and younger shall complete training on safe sleep practices prior to working with infants. (h) Infants up to 12 months shall not nap or sleep in a car safety seat, beanbag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, moses basket, or any other type of furniture or equipment that is not a play pen or crib that meets the requirements of (f) above. (i) If an infant up to 12 months falls asleep outside of their crib or play pen, including entering the program asleep in a car safety seat, staff shall immediately move the infant and place him or her on their back in a crib or play pen. (j) When child care staff place infants in their crib or play pen for sleep, they shall check to ensure that the temperature in the room is comfortable for a lightly clothed adult, check the infants to ensure that they are comfortably clothed and not overheated or sweaty, and that bibs and garments with ties or hoods are removed. (k) Children older than 3 months shall not be swaddled or placed in restrictive or weighted sleep suits or devices unless there are written medical orders from the child’s primary health practitioner. (l) In family and family group child care homes, use of an electronic monitor shall only be used to monitor sleeping children on the same level in lieu of direct supervision, in accordance with the following: (1) There is written authorization on file from the parents of the child, indicating that they are aware of and agree to the use of the monitor; (2) The child care staff responsible for their supervision can easily hear sounds from the monitor and respond; and (3) Every 15 minutes, the child care staff responsible for their supervision conduct in-person checks of infants and toddlers sleeping in a crib or playpen, to ensure that each child is safe and comfortable, including a check of their faces, viewing the color of their skin and to check on their breathing. (m) In center-based programs, use of an electronic monitor, whether only audio or both audio and visual, shall be permissible in lieu of having staff in the same room with infants and toddlers sleeping in cribs or playpens, in accordance with the following: (1) There is written authorization on file from the parents of the child, indicating that they are aware of and agree to the use of the monitor; (2) The child care staff responsible for their supervision are located in an adjoining room where they can easily hear sounds from the monitor and respond; and (3) Every 15 minutes, the child care staff responsible for their supervision conduct in-person checks of infants and toddlers sleeping in a crib or playpen, to ensure that each child is safe and comfortable, including a check of their faces, viewing the color of their skin and to check on their breathing. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.26: (e) No crib shall be used unless manufactured on or after June 28, 2011, or if manufactured prior to that date, has a Children’s Product Certificate (CPC), or test report from a consumer product safety commission (CPSC) accepted third- party lab, provided by the manufacturer documenting the crib’s compliance with 16 CFR 1219 as required by 16 CFR 1219 and 1220. (f) Cribs and play pens required under (c) above shall: (1) Not be stacked; (2) Be free of cracked or peeling paint, splinters, and rough edges; (3) Have no more than 2⅜ inches between slats; (4) Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards, or other loose hardware, or damaged parts on the crib or mattress supports; (5) Not have corner posts that extend more than 1/16 of an inch above the end panels; (6) Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or play pen; (7) Have fitted sheets designed for the size mattress, including elastic corners so that there is no excess fabric with visible folds or bunching, and that do not compress the mattress; (8) Not have bumper pads, blankets, flat sheets, pillows, quilts, comforters, sleep positioners, or any soft items or toys with infants up to 12 months of age; and (9) Have mattresses which are in good repair, free of rips or tears, and fit the crib or playpen so that the space between the mattress and crib or playpen is not more than 2 adult fingers wide and does not create a suffocation hazard. (g) Pursuant to He-C 4002.33(b)(3), all child care staff in programs licensed for children 12 months and younger shall complete training on safe sleep practices prior to working with infants. (h) Infants up to 12 months shall not nap or sleep in a car safety seat, beanbag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, moses basket, or any other type of furniture or equipment that is not a play pen or crib that meets the requirements of (f) above. (i) If an infant up to 12 months falls asleep outside of their crib or play pen, including entering the program asleep in a car safety seat, staff shall immediately move the infant and place him or her on their back in a crib or play pen. (j) When child care staff place infants in their crib or play pen for sleep, they shall check to ensure that the temperature in the room is comfortable for a lightly clothed adult, check the infants to ensure that they are comfortably clothed and not overheated or sweaty, and that bibs and garments with ties or hoods are removed. (k) Children older than 3 months shall not be swaddled or placed in restrictive or weighted sleep suits or devices unless there are written medical orders from the child’s primary health practitioner. (l) In family and family group child care homes, use of an electronic monitor shall only be used to monitor sleeping children on the same level in lieu of direct supervision, in accordance with the following: (1) There is written authorization on file from the parents of the child, indicating that they are aware of and agree to the use of the monitor; (2) The child care staff responsible for their supervision can easily hear sounds from the monitor and respond; and (3) Every 15 minutes, the child care staff responsible for their supervision conduct in-person checks of infants and toddlers sleeping in a crib or playpen, to ensure that each child is safe and comfortable, including a check of their faces, viewing the color of their skin and to check on their breathing. (m) In center-based programs, use of an electronic monitor, whether only audio or both audio and visual, shall be permissible in lieu of having staff in the same room with infants and toddlers sleeping in cribs or playpens, in accordance with the following: (1) There is written authorization on file from the parents of the child, indicating that they are aware of and agree to the use of the monitor; (2) The child care staff responsible for their supervision are located in an adjoining room where they can easily hear sounds from the monitor and respond; and (3) Every 15 minutes, the child care staff responsible for their supervision conduct in-person checks of infants and toddlers sleeping in a crib or playpen, to ensure that each child is safe and comfortable, including a check of their faces, viewing the color of their skin and to check on their breathing. 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: He-C 6917.13 Prevention of Sudden Infant Death Syndrome and Use of Safe Sleeping Practices. Providers shall consult with the parent of each child and observe children on an ongoing basis to determine each child’s resting or napping needs. To reduce the risk of Sudden Infant Death Syndrome (SIDS), infants up to 12 months of age shall be placed on their backs to sleep in a crib or playpen, unless there are written medical orders from the infant’s primary health practitioner requiring alternate positioning. Infants up to 12 months of age shall not nap or sleep in a car safety seat, beanbag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, moses basket, or any other type of furniture or equipment that is not a playpen or crib that meets the requirements of (f) below. There shall be an individual crib or playpen for each child 12 months of age and younger, except for siblings for whom co-sleeping is part of their family culture, and written authorization is given by the child’s parent and the child’s primary health care provider. No crib shall be used unless manufactured on or after June 28, 2011 or, if manufactured prior to that date, has a Children’s Product Certificate (CPC) or test report from a consumer product safety commission (CPSC) accepted third- party lab, provided by the manufacturer documenting the crib’s compliance as required by 16 CFR 1219 and 1220. All cribs and playpens required in (e) above shall: Be free of cracked or peeling paint, splinters, and rough edges; Have no more than 2⅜ inches between slats; Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards, or other loose hardware, or damaged parts on the crib or mattress supports; Not have corner posts which extend more than 1/16 of an inch above the end panels; Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or playpen; Have properly fitted sheets which do not have excess fabric or that compress the mattress; and Have mattresses which: Are in good repair, and free of rips or tears; and, Fit the crib or playpen so that the space between the mattress and crib or playpen is not more than 2 adult fingers wide and does not create a suffocation hazard. Cribs or playpens used by infants up to 12 months of age shall not have bumper pads, blankets, flat sheets, pillows, quilts, comforters, sleep positioners, or any soft items or toy. When the provider places an infant in a crib or playpen for sleep, the provider shall: Check to ensure that the temperature in the room is comfortable for a lightly clothed adult; Check the infant to ensure that the infant is comfortably clothed and not overheated or sweaty; and Check to ensure that bibs and garments with ties or hoods are removed from the infant. Children older than 3 months shall not be swaddled or placed in restrictive or weighted sleep suits or devices unless there are written medical orders from the child’s primary health practitioner on file at the provider. A provider may use electronic monitors to supervise sleeping children provided that: The parent provides a signed and dated authorization stating that the parent is aware of and agreeable to the use of an electronic monitor as a means of supervising their child when their child is asleep; Sounds from the monitor shall be easily heard by the provider; Every 10 minutes the provider shall observe the sleeping children, in person, to ensure that the child is safe and comfortable; and Video monitors shall not replace a physical check of the child by the provider. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.13 Prevention of Sudden Infant Death Syndrome and Use of Safe Sleeping Practices. Providers shall consult with the parent of each child and observe children on an ongoing basis to determine each child’s resting or napping needs. To reduce the risk of Sudden Infant Death Syndrome (SIDS), infants up to 12 months of age shall be placed on their backs to sleep in a crib or playpen, unless there are written medical orders from the infant’s primary health practitioner requiring alternate positioning. Infants up to 12 months of age shall not nap or sleep in a car safety seat, beanbag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, moses basket, or any other type of furniture or equipment that is not a playpen or crib that meets the requirements of (f) below. There shall be an individual crib or playpen for each child 12 months of age and younger, except for siblings for whom co-sleeping is part of their family culture, and written authorization is given by the child’s parent and the child’s primary health care provider. No crib shall be used unless manufactured on or after June 28, 2011 or, if manufactured prior to that date, has a Children’s Product Certificate (CPC) or test report from a consumer product safety commission (CPSC) accepted third-party lab, provided by the manufacturer documenting the crib’s compliance as required by 16 CFR 1219 and 1220. All cribs and playpens required in (e) above shall: Be free of cracked or peeling paint, splinters, and rough edges; Have no more than 2⅜ inches between slats; Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards, or other loose hardware, or damaged parts on the crib or mattress supports; Not have corner posts which extend more than 1/16 of an inch above the end panels; Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or playpen; Have properly fitted sheets which do not have excess fabric or that compress the mattress; and Have mattresses which: Are in good repair, and free of rips or tears; and, Fit the crib or playpen so that the space between the mattress and crib or playpen is not more than 2 adult fingers wide and does not create a suffocation hazard. Cribs or playpens used by infants up to 12 months of age shall not have bumper pads, blankets, flat sheets, pillows, quilts, comforters, sleep positioners, or any soft items or toy. When the provider places an infant in a crib or playpen for sleep, the provider shall: Check to ensure that the temperature in the room is comfortable for a lightly clothed adult; Check the infant to ensure that the infant is comfortably clothed and not overheated or sweaty; and Check to ensure that bibs and garments with ties or hoods are removed from the infant. Children older than 3 months shall not be swaddled or placed in restrictive or weighted sleep suits or devices unless there are written medical orders from the child’s primary health practitioner on file at the provider. A provider may use electronic monitors to supervise sleeping children provided that: The parent provides a signed and dated authorization stating that the parent is aware of and agreeable to the use of an electronic monitor as a means of supervising their child when their child is asleep; Sounds from the monitor shall be easily heard by the provider; Every 10 minutes the provider shall observe the sleeping children, in person, to ensure that the child is safe and comfortable; and Video monitors shall not replace a physical check of the child by the provider. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.13 Prevention of Sudden Infant Death Syndrome and Use of Safe Sleeping Practices. Providers shall consult with the parent of each child and observe children on an ongoing basis to determine each child’s resting or napping needs. To reduce the risk of Sudden Infant Death Syndrome (SIDS), infants up to 12 months of age shall be placed on their backs to sleep in a crib or playpen, unless there are written medical orders from the infant’s primary health practitioner requiring alternate positioning. Infants up to 12 months of age shall not nap or sleep in a car safety seat, beanbag chair, bouncy seat, infant seat, swing, jumping chair, highchair, chair, futon, moses basket, or any other type of furniture or equipment that is not a playpen or crib that meets the requirements of (f) below. There shall be an individual crib or playpen for each child 12 months of age and younger, except for siblings for whom co-sleeping is part of their family culture, and written authorization is given by the child’s parent and the child’s primary health care provider. No crib shall be used unless manufactured on or after June 28, 2011 or, if manufactured prior to that date, has a Children’s Product Certificate (CPC) or test report from a consumer product safety commission (CPSC) accepted third-party lab, provided by the manufacturer documenting the crib’s compliance as required by 16 CFR 1219 and 1220. All cribs and playpens required in (e) above shall: Be free of cracked or peeling paint, splinters, and rough edges; Have no more than 2⅜ inches between slats; Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards, or other loose hardware, or damaged parts on the crib or mattress supports; Not have corner posts which extend more than 1/16 of an inch above the end panels; Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or playpen; Have properly fitted sheets which do not have excess fabric or that compress the mattress; and Have mattresses which: Are in good repair, and free of rips or tears; and, Fit the crib or playpen so that the space between the mattress and crib or playpen is not more than 2 adult fingers wide and does not create a suffocation hazard. Cribs or playpens used by infants up to 12 months of age shall not have bumper pads, blankets, flat sheets, pillows, quilts, comforters, sleep positioners, or any soft items or toy. When the provider places an infant in a crib or playpen for sleep, the provider shall: Check to ensure that the temperature in the room is comfortable for a lightly clothed adult; Check the infant to ensure that the infant is comfortably clothed and not overheated or sweaty; and Check to ensure that bibs and garments with ties or hoods are removed from the infant. Children older than 3 months shall not be swaddled or placed in restrictive or weighted sleep suits or devices unless there are written medical orders from the child’s primary health practitioner on file at the provider. A provider may use electronic monitors to supervise sleeping children provided that: The parent provides a signed and dated authorization stating that the parent is aware of and agreeable to the use of an electronic monitor as a means of supervising their child when their child is asleep; Sounds from the monitor shall be easily heard by the provider; Every 10 minutes the provider shall observe the sleeping children, in person, to ensure that the child is safe and comfortable; and Video monitors shall not replace a physical check of the child by the provider. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A 5.3.3 Administration of medication, consistent with standards for parental consent health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the administration of medication for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: He-C 4002.21: (a) Programs shall administer any medication, treatment, or other remedy to any child, as provided by the child’s parents and in accordance with this section. (b) For the purposes of this section, ￿administer￿ means an act whereby a single dose of a medication is instilled into the body of, applied to the body of, or otherwise given to a child for immediate consumption or use. (c) Only authorized staff, a registered nurse (RN), licensed practical nurse (LPN), or licensed practitioner shall administer prescription and over-the-counter medications to children, in accordance with the child’s medication order. (d) Authorized staff shall administer only those medications for which there is a medication order provided by a licensed practitioner, and written permission from the parent. (e) Programs shall not accept any prescription medications that do not include a prescription label or medication order from a licensed professional. (f) Each medication order shall legibly display: (1) The child’s name; (2) The medication name, strength, the prescribed dose and method of administration; (3) The frequency of administration; (4) The indications for usage of all medications to be used pro re nata (PRN); and (5) The dated signature of the licensed practitioner for orders other than the prescription label. (g) Medication orders for PRN medication shall include: (1) The indications and any special precautions or limitations regarding administration of the medication; (2) The maximum dosage allowed in a 24-hour period; (3) The dated signature of the parent for topical substances or over-the- counter medication; and (4) For other than the prescription label, the dated signature of the licensed health care practitioner for prescription medication. (h) In the event of a medication error in the administration of medication, the family child care provider, center director, site director, or designee shall notify the child’s parents immediately. (i) In the event of a medication error in the documentation of the administration of medication, the family child care provider, center director, or designee shall notify the child’s parents by the end of the day in which the error occurred. (j) Prior to administering prescription and over-the-counter medication to any child, child care staff shall complete and document training on medication administration, as required by He-C 4002.33(b)(4), delivered by the department, a physician, RN, or LPN practicing under the direction of an APRN, RN, or physician, or online training approved by the department. (k) Authorized staff shall complete training in medication safety and administration every 3 years. (l) Documentation of training in medication safety and administration shall be maintained on file at the child care program and be available for review by the department. (m) For each child receiving medication, child care staff shall maintain medication information on file and available for review by the department, including medication orders, parental authorization to administer medication, and information regarding a child’s allergies, if applicable. (n) Child care staff shall maintain a written record for each dose of medication administered to each child, which shall: (1) Be maintained on file in the program, available for review by the department; (2) Be completed by the authorized staff who administered the medication immediately after the medication is administered; and (3) For each administered medication, include at a minimum: a. The name of the child; b. The date and time the medication was taken; c. A notation of any medication error or the reason why any medication was not taken as ordered or approved; d. The dated signature of the authorized staff who administered the medication to the child; and e. For administration of a PRN, documentation shall also include the reason for administration. (o) All medication shall be: (1) Inaccessible to children; (2) Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; (3) Stored in a secondary container separate from food if in a refrigerator; and (4) Labeled with the child’s name to ensure correct identification of each child's medication. (p) Medications such as insulin, inhalers, and epi pens shall be readily accessible to child care staff caring for children requiring such medications, to assure timely administration when needed and in accordance with parental instructions in He-C 4002.20(g)(2)a. (q) Medications described in (p) above shall be permitted to be in the possession of a school-age child as long as the following are on file at the program: (1) Written authorization from the prescribing health care practitioner; and (2) Written permission from the child’s parents. (r) The only exception to (q) above shall be when a school-age child is with children younger than 6 years of age, Insulin, inhalers, and epi-pens shall not be in the school-age child’s possession, but shall be readily accessible to staff. (s) All medications belonging to staff shall be stored separate from children’s medications in a locked area, or otherwise inaccessible to children. (t) All prescription or over-the-counter medication and topical substances shall be kept in the original containers or pharmacy packaging and properly closed after each use. (u) Any contaminated, expired, or discontinued medication, whether prescription or over-the-counter, and topical substances shall be returned to the child’s parents or, if belonging to the program, disposed of properly by authorized staff. (v) Child care staff shall administer over-the- counter medications in accordance with the manufacturer’s instructions or written instructions from the child’s health care practitioner. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.21: (a) Programs shall administer any medication, treatment, or other remedy to any child, as provided by the child’s parents and in accordance with this section. (b) For the purposes of this section, ￿administer￿ means an act whereby a single dose of a medication is instilled into the body of, applied to the body of, or otherwise given to a child for immediate consumption or use. (c) Only authorized staff, a registered nurse (RN), licensed practical nurse (LPN), or licensed practitioner shall administer prescription and over-the-counter medications to children, in accordance with the child’s medication order. (d) Authorized staff shall administer only those medications for which there is a medication order provided by a licensed practitioner, and written permission from the parent. (e) Programs shall not accept any prescription medications that do not include a prescription label or medication order from a licensed professional. (f) Each medication order shall legibly display: (1) The child’s name; (2) The medication name, strength, the prescribed dose and method of administration; (3) The frequency of administration; (4) The indications for usage of all medications to be used pro re nata (PRN); and (5) The dated signature of the licensed practitioner for orders other than the prescription label. (g) Medication orders for PRN medication shall include: (1) The indications and any special precautions or limitations regarding administration of the medication; (2) The maximum dosage allowed in a 24-hour period; (3) The dated signature of the parent for topical substances or over-the-counter medication; and (4) For other than the prescription label, the dated signature of the licensed health care practitioner for prescription medication. (h) In the event of a medication error in the administration of medication, the family child care provider, center director, site director, or designee shall notify the child’s parents immediately. (i) In the event of a medication error in the documentation of the administration of medication, the family child care provider, center director, or designee shall notify the child’s parents by the end of the day in which the error occurred. (j) Prior to administering prescription and over-the-counter medication to any child, child care staff shall complete and document training on medication administration, as required by He-C 4002.33(b)(4), delivered by the department, a physician, RN, or LPN practicing under the direction of an APRN, RN, or physician, or online training approved by the department. (k) Authorized staff shall complete training in medication safety and administration every 3 years. (l) Documentation of training in medication safety and administration shall be maintained on file at the child care program and be available for review by the department. (m) For each child receiving medication, child care staff shall maintain medication information on file and available for review by the department, including medication orders, parental authorization to administer medication, and information regarding a child’s allergies, if applicable. (n) Child care staff shall maintain a written record for each dose of medication administered to each child, which shall: (1) Be maintained on file in the program, available for review by the department; (2) Be completed by the authorized staff who administered the medication immediately after the medication is administered; and (3) For each administered medication, include at a minimum: a. The name of the child; b. The date and time the medication was taken; c. A notation of any medication error or the reason why any medication was not taken as ordered or approved; d. The dated signature of the authorized staff who administered the medication to the child; and e. For administration of a PRN, documentation shall also include the reason for administration. (o) All medication shall be: (1) Inaccessible to children; (2) Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; (3) Stored in a secondary container separate from food if in a refrigerator; and (4) Labeled with the child’s name to ensure correct identification of each child's medication. (p) Medications such as insulin, inhalers, and epi pens shall be readily accessible to child care staff caring for children requiring such medications, to assure timely administration when needed and in accordance with parental instructions in He-C 4002.20(g)(2)a. (q) Medications described in (p) above shall be permitted to be in the possession of a school-age child as long as the following are on file at the program: (1) Written authorization from the prescribing health care practitioner; and (2) Written permission from the child’s parents. (r) The only exception to (q) above shall be when a school-age child is with children younger than 6 years of age, Insulin, inhalers, and epi-pens shall not be in the school-age child’s possession, but shall be readily accessible to staff. (s) All medications belonging to staff shall be stored separate from children’s medications in a locked area, or otherwise inaccessible to children. (t) All prescription or over-the-counter medication and topical substances shall be kept in the original containers or pharmacy packaging and properly closed after each use. (u) Any contaminated, expired, or discontinued medication, whether prescription or over-the-counter, and topical substances shall be returned to the child’s parents or, if belonging to the program, disposed of properly by authorized staff. (v) Child care staff shall administer over-the- counter medications in accordance with the manufacturer’s instructions or written instructions from the child’s health care practitioner. 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: He-C 6916.09 Administration of Medication. Staff shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. Staff shall only administer medication with: A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and Signed and dated written permission from the parent. Administration of non-prescription topical substances may be performed by any staff, with written permission from the child’s parent.In the event of a medication error in the administration of medication, staff shall notify the child’s parent immediately. For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the program, if there is any alteration of any kind to the administration of the medication.Staff shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. In the event of an error documenting the administration of medication, staff shall notify the child’s parent by the end of the day in which the error occurred.All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer, or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child's medication. Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to staff caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6916.08(a)(2). All prescription or non- prescription medication and topical substances shall be kept in the original container or pharmacy packaging and properly closed after each use. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.09 Administration of Medication. (a) Providers shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. (b) Providers shall only administer medication with: (1) A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and (2) Signed and dated written permission from the parent. (c) Administration of non- prescription topical substances may be performed by the provider, with written permission from the child’s parent. (d) In the event of a medication error in the administration of medication, the provider shall notify the child’s parent immediately. (e) For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. (f) The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the provider, if there is any alteration of any kind to the administration of the medication. (g) Providers shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. (h) In the event of an error documenting the administration of medication, the provider shall notify the child’s parent by the end of the day in which the error occurred. (i) All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child’s medication. (j) Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to providers caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6917.08(a)(2). (k) All prescription or non-prescription medication and topical substances shall be kept in the original container or pharmacy packaging. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.09 Administration of Medication. (a) Providers shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. (b) Providers shall only administer medication with: (1) A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and (2) Signed and dated written permission from the parent. (c) Administration of non- prescription topical substances may be performed by the provider, with written permission from the child’s parent. (d) In the event of a medication error in the administration of medication, the provider shall notify the child’s parent immediately. (e) For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. (f) The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the provider, if there is any alteration of any kind to the administration of the medication. (g) Providers shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. (h) In the event of an error documenting the administration of medication, the provider shall notify the child’s parent by the end of the day in which the error occurred. (i) All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child’s medication. (j) Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to providers caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6917.08(a)(2). (k) All prescription or non-prescription medication and topical substances shall be kept in the original container or pharmacy packaging. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.09 Administration of Medication. Staff shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. Staff shall only administer medication with: A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and Signed and dated written permission from the parent. Administration of non-prescription topical substances may be performed by any staff, with written permission from the child’s parent.In the event of a medication error in the administration of medication, staff shall notify the child’s parent immediately. For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the program, if there is any alteration of any kind to the administration of the medication.Staff shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. In the event of an error documenting the administration of medication, staff shall notify the child’s parent by the end of the day in which the error occurred.All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer, or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child's medication. Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to staff caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6916.08(a)(2). All prescription or non- prescription medication and topical substances shall be kept in the original container or pharmacy packaging and properly closed after each use. 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: e-C 4002.21(a) Programs shall administer any medication, treatment, or other remedy to any child, as provided by the child’s parents and in accordance with this section. ii. All CCDF-eligible licensed family child care homes. Provide the standard: e-C 4002.21(a) Programs shall administer any medication, treatment, or other remedy to any child, as provided by the child’s parents and in accordance with this section. 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: He-C 6916.09 Administration of Medication. Staff shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. Staff shall only administer medication with: A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and Signed and dated written permission from the parent. Administration of non-prescription topical substances may be performed by any staff, with written permission from the child’s parent. In the event of a medication error in the administration of medication, staff shall notify the child’s parent immediately. For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the program, if there is any alteration of any kind to the administration of the medication. Staff shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. In the event of an error documenting the administration of medication, staff shall notify the child’s parent by the end of the day in which the error occurred. All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer, or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child's medication. Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to staff caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6916.08(a)(2). All prescription or non- prescription medication and topical substances shall be kept in the original container or pharmacy packaging and properly closed after each use. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.09 Administration of Medication. (a) Providers shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. (b) Providers shall only administer medication with: (1) A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and (2) Signed and dated written permission from the parent. (c) Administration of non- prescription topical substances may be performed by the provider, with written permission from the child’s parent. (d) In the event of a medication error in the administration of medication, the provider shall notify the child’s parent immediately. (e) For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. (f) The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the provider, if there is any alteration of any kind to the administration of the medication. (g) Providers shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. (h) In the event of an error documenting the administration of medication, the provider shall notify the child’s parent by the end of the day in which the error occurred. (i) All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child’s medication. (j) Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to providers caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6917.08(a)(2). (k) All prescription or non-prescription medication and topical substances shall be kept in the original container or pharmacy packaging. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.09 Administration of Medication. (a) Providers shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. (b) Providers shall only administer medication with: (1) A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and (2) Signed and dated written permission from the parent. (c) Administration of non- prescription topical substances may be performed by the provider, with written permission from the child’s parent. (d) In the event of a medication error in the administration of medication, the provider shall notify the child’s parent immediately. (e) For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. (f) The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the provider, if there is any alteration of any kind to the administration of the medication. (g) Providers shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. (h) In the event of an error documenting the administration of medication, the provider shall notify the child’s parent by the end of the day in which the error occurred. (i) All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child’s medication. (j) Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to providers caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6917.08(a)(2). (k) All prescription or non-prescription medication and topical substances shall be kept in the original container or pharmacy packaging. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.09 Administration of Medication. Staff shall administer any medication, treatment, or other remedy as required under the provisions of the Americans with Disabilities Act of 1990. Staff shall only administer medication with: A valid and current prescription or signed and dated written instructions for administering the medication from the child’s physician; and Signed and dated written permission from the parent. Administration of non-prescription topical substances may be performed by any staff, with written permission from the child’s parent. In the event of a medication error in the administration of medication, staff shall notify the child’s parent immediately. For any chronic condition requiring medication that is to be administered for more than 12 months, the written parental authorization specified in (b)(2) above shall be updated annually. The written instructions for administering the medication from the child’s physician specified in (b)(1) above shall be updated by the parent, and on file at the program, if there is any alteration of any kind to the administration of the medication. Staff shall maintain a written log for each dose of medication, excluding topical substances, administered to each child. In the event of an error documenting the administration of medication, staff shall notify the child’s parent by the end of the day in which the error occurred. All medication shall be: Inaccessible to children; Stored at the temperature and conditions recommended by the manufacturer, or as directed on the prescription label; and Labeled with the child’s name to ensure correct identification of each child's medication. Medications such as insulin, inhalers, and epinephrine shall be immediately accessible to staff caring for children requiring such medications to assure timely administration when needed, and in accordance with instructions in He-C 6916.08(a)(2). All prescription or non-prescription medication and topical substances shall be kept in the original container or pharmacy packaging and properly closed after each use. 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: He-C 4002.20: (g) The program shall obtain the following documents from the parents of each child with a food allergy or other allergy, which results in a serious reaction: (1) A written care plan that includes instructions regarding food(s) or other allergens to which the child is allergic and steps for child care staff to take to avoid the allergens; and (2) A written treatment plan, detailing the treatment to be implemented in the event of an allergic reaction, which shall include: a. The names, doses, and methods of prompt administration of any medications, where the medication needs to be stored in relation to the child, taking into consideration the storage requirements in He-C 4002.21(o)(2), and instructions on how to administer the prescribed medication; and b. Specific symptoms that would indicate the need to administer one or more medications. (h) At all times, at least one child care staff supervising a child with an allergy care plan shall have completed the training specified in He-C 4002.33(b)(5). (i) The program shall post each allergy care plan in accordance with the posting requirements in He-C 4002.14. (j) All child care staff responsible for food preparation and food service, and all child care staff responsible for supervising children with an allergy, including staff covering breaks, shall read and familiarize themselves with the care plans and treatment plans, to ensure that no child is accidentally exposed to an allergen. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.20: (g) The program shall obtain the following documents from the parents of each child with a food allergy or other allergy, which results in a serious reaction: (1) A written care plan that includes instructions regarding food(s) or other allergens to which the child is allergic and steps for child care staff to take to avoid the allergens; and (2) A written treatment plan, detailing the treatment to be implemented in the event of an allergic reaction, which shall include: a. The names, doses, and methods of prompt administration of any medications, where the medication needs to be stored in relation to the child, taking into consideration the storage requirements in He-C 4002.21(o)(2), and instructions on how to administer the prescribed medication; and b. Specific symptoms that would indicate the need to administer one or more medications. (h) At all times, at least one child care staff supervising a child with an allergy care plan shall have completed the training specified in He-C 4002.33(b)(5). (i) The program shall post each allergy care plan in accordance with the posting requirements in He-C 4002.14. (j) All child care staff responsible for food preparation and food service, and all child care staff responsible for supervising children with an allergy, including staff covering breaks, shall read and familiarize themselves with the care plans and treatment plans, to ensure that no child is accidentally exposed to an allergen. 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: He-C 6916.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Programs shall obtain an allergy care plan, signed by the child’s physician, from the parent(s) of each child with a food allergy or other allergy which results in a serious reaction that includes at a minimum: Instructions regarding the foods or other allergens to which the child is allergic and steps to be taken to avoid consuming or coming into contact with those allergens; A list of specific symptoms that would indicate the need to administer one or more of the medications referenced in (3) below; and Details describing the course of action to take in response to an allergic reaction, including the name, dose, and method of prompt administration of any required medication. With the permission of the parent, each child’s allergy care plan shall be posted prominently wherever the child might come in contact with the allergen. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Providers shall obtain an allergy care plan, signed by the child’s physician, from the parent of each child with a food allergy or other allergy, which results in a serious reaction, that includes at a minimum: Instructions regarding the food(s) or other allergens to which the child is allergic and steps to be taken to avoid consuming or coming into contact with those allergens; A list of specific symptoms that would indicate the need to administer one or more of the medications referenced in (3) below; and Details describing the course of action to take in response to an allergic reaction, including the name, dose, and method of prompt administration of any required medication. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Providers shall obtain an allergy care plan, signed by the child’s physician, from the parent of each child with a food allergy or other allergy, which results in a serious reaction, that includes at a minimum: Instructions regarding the food(s) or other allergens to which the child is allergic and steps to be taken to avoid consuming or coming into contact with those allergens; A list of specific symptoms that would indicate the need to administer one or more of the medications referenced in (3) below; and Details describing the course of action to take in response to an allergic reaction, including the name, dose, and method of prompt administration of any required medication. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Programs shall obtain an allergy care plan, signed by the child’s physician, from the parent(s) of each child with a food allergy or other allergy which results in a serious reaction that includes at a minimum: Instructions regarding the foods or other allergens to which the child is allergic and steps to be taken to avoid consuming or coming into contact with those allergens; A list of specific symptoms that would indicate the need to administer one or more of the medications referenced in (3) below; and Details describing the course of action to take in response to an allergic reaction, including the name, dose, and method of prompt administration of any required medication. With the permission of the parent, each child’s allergy care plan shall be posted prominently wherever the child might come in contact with the allergen. 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: e-C 4002.20: (g) The program shall obtain the following documents from the parents of each child with a food allergy or other allergy, which results in a serious reaction: (2) A written treatment plan, detailing the treatment to be implemented in the event of an allergic reaction, which shall include: a. The names, doses, and methods of prompt administration of any medications, where the medication needs to be stored in relation to the child, taking into consideration the storage requirements in He-C 4002.21(o)(2), and instructions on how to administer the prescribed medication; and b. Specific symptoms that would indicate the need to administer one or more medications. He-C 4002.15(c)(8): The center director, site director, family child care provider, or designee shall notify a child’s parent(s) Immediately in the event of a suspected allergic reaction or ingestion of or contact with a known allergen, even if a reaction did not occur. He-C 4002.15(e): In addition to the circumstances for notifying emergency services as prescribed in first aid and CPR training, the licensee or permittee shall notify emergency services: (2) Immediately whenever staff administer epinephrine (Epi-pen) to a child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: e-C 4002.20: (g) The program shall obtain the following documents from the parents of each child with a food allergy or other allergy, which results in a serious reaction: (2) A written treatment plan, detailing the treatment to be implemented in the event of an allergic reaction, which shall include: a. The names, doses, and methods of prompt administration of any medications, where the medication needs to be stored in relation to the child, taking into consideration the storage requirements in He-C 4002.21(o)(2), and instructions on how to administer the prescribed medication; and b. Specific symptoms that would indicate the need to administer one or more medications. He-C 4002.15(c)(8): The center director, site director, family child care provider, or designee shall notify a child’s parent(s) Immediately in the event of a suspected allergic reaction or ingestion of or contact with a known allergen, even if a reaction did not occur. He-C 4002.15(e): In addition to the circumstances for notifying emergency services as prescribed in first aid and CPR training, the licensee or permittee shall notify emergency services: (2) Immediately whenever staff administer epinephrine (Epi-pen) to a child. iii. All CCDF-eligible licensed in-home care. Provide the standard:: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: He-C 6916.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Staff shall immediately notify the parent of any suspected allergic reactions, as well as the ingestion of or contact with, a known allergen even if a reaction did not occur. Staff shall call 911 immediately after epinephrine has been administered. Staff shall comply with dietary restrictions as requested in writing by the parent of each child, due to food allergies, or religious or philosophical beliefs. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. With permission of the parent, each child’s allergy care plan shall be posted prominently wherever the child might come in contact with the allergen. Providers shall immediately notify the parent of any suspected allergic reactions, as well as the ingestion of or contact with a known allergen even if a reaction did not occur. Providers shall call 911 immediately after epinephrine has been administered. Providers shall comply with dietary restrictions as requested in writing by the parent of each child, due to food allergies, religious, or philosophical beliefs. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. With permission of the parent, each child’s allergy care plan shall be posted prominently wherever the child might come in contact with the allergen. Providers shall immediately notify the parent of any suspected allergic reactions, as well as the ingestion of or contact with a known allergen even if a reaction did not occur. Providers shall call 911 immediately after epinephrine has been administered. Providers shall comply with dietary restrictions as requested in writing by the parent of each child, due to food allergies, religious, or philosophical beliefs. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.08 Prevention of and Response to Emergencies Due to Food and Allergic Reactions. Staff shall immediately notify the parent of any suspected allergic reactions, as well as the ingestion of or contact with, a known allergen even if a reaction did not occur. Staff shall call 911 immediately after epinephrine has been administered. Staff shall comply with dietary restrictions as requested in writing by the parent of each child, due to food allergies, or religious or philosophical beliefs. 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: He-C 4002.23: (b) Child care staff shall ensure that the indoor space is: (1) Safe, clean, free of clutter, and in good repair; (2) Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked or crimped cords, or unprotected outlets; (3) Well-ventilated by means of unobstructed mechanical ventilation system or open, screened window; (4) Well-lit to allow for the supervision of children and for child care staff and children to move about safely; (5) Free of damp conditions which result in visible mold, mildew, or a musty odor; (6) Free of heavy furnishings or items not secured to the wall or floor that could easily tip or are unstable; (7) Free of fumes from toxic or harmful chemicals or materials; (8) Free of tripping hazards; and (9) Free of poisonous plants. (c) Child care staff shall ensure that potentially harmful items, including but not limited to matches, lighters, chemicals, materials labeled ￿harmful if swallowed,￿ flammable materials, sharp objects, and staffs’ personal belongings are locked or inaccessible to children. (d) All substances labeled ￿harmful if swallowed￿ or ￿flammable￿ and all containers storing cleaning materials shall be labeled as to the contents and stored separately from food and medications. (f) Cords or strings long enough to encircle a child’s neck, such as cords on window blinds, curtains or shades, shall be kept out of children’s reach. (g) Child care staff shall ensure that the presence of pets in the program does not present a hazard to the children, including but not limited to: (1) Reptiles, amphibians and birds, including baby chicks and ducklings, shall not be permitted in rooms or outdoor spaces regularly occupied by children; (2) When bringing animals into a child care, staff shall supervise children when the animals are available, designated areas shall be cleaned and sanitized after animal contact, and food or drink shall not be consumed in these areas; (3) Cages or other habitats shall be cleaned of all fecal material and sanitized on an as needed basis but no less than once per week; (4) Staff shall wear gloves while cleaning animal cages or habitats; (5) All staff and children shall wash hands with soap and warm running water after contact with animals or their cages or habitats; and (6) Dogs, cats, and ferrets shall be kept clean and free of parasites, fleas, ticks, mites, and lice, and vaccinated against rabies, with proof of current vaccination on site at the program and available for review by department staff. (h) Programs shall maintain bathroom facilities in accordance with the following: (1) Sinks, toilets, footstools, potty chairs, and adapters shall be cleaned and sanitized at least once a day and when visibly soiled; (2) Bathroom floors and other surfaces adjacent to toilets, including but not limited to walls, shall be cleaned and sanitized at least weekly, and when visibly soiled; (3) Toilet paper, individual cloth or paper towels, and liquid soap from a dispenser shall be available and accessible to children and staff; and (4) Bathrooms shall have a functional means of outside ventilation. (i) The program shall take prompt action to eliminate insects or rodents, and clean and sanitize all surfaces where there is visible evidence of their presence. (j) When using pesticides, programs shall: (1) Notify parents and staff in writing at least 2 days prior to the pesticide application, except in emergencies where pests pose an immediate threat to children; and (2) Document the date, time, and type of pesticide used for each time a pesticide is used. (k) Pesticides shall not be used in areas used by children while children are present, and any treated indoor area shall be aired out per manufacturers’ instructions prior to allowing children to return to that area. (l) Programs shall maintain the child care space free from non-compliance of Saf-FMO 300 and Saf-C 6000 by not blocking exits, or evacuation routes, including doorways, hallways, and stairs that are a means of egress, and by maintaining smoke detectors in working order. (m) The licensee shall prohibit smoking in the building anytime for center-based programs or during operating hours for family child care homes, with the following exceptions: (1) Child care staff who smoke during their breaks shall not smoke in view of children or while responsible for the care of children; and (2) Child care staff who smoke on their breaks shall wash their hands and change into fresh clothing, or remove smoke contaminated outerwear prior to returning to work to reduce exposure to second-hand smoke. (n) Child care staff shall: (1) Arrange space to provide clear pathways for movement from one area to another and to allow visual supervision by staff; (2) Arrange furnishings and fixtures safely, with sharp edges protected, and in such a way as to not present hazards to children; and (3) Store their personal belongings out of reach of children. (q) All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. (r) Garbage shall be disposed of in a lined and covered container and staff shall empty trash containers daily or sooner if contents create an odor or a health risk. (s) Stairways with more than 3 steps shall be equipped with handrails. (t) In programs serving children younger than 3 years old, the licensee shall ensure that there are barriers placed at the top and bottom of stairwells opening into areas used by children younger than three years, unless prohibited by building or fire department regulations. Pressure gates at the top of stairs shall not be used. (u) Open stairways used by children younger than school age shall have railings or banisters installed along the open or unprotected side(s). (v) Programs shall: (1) Have a safe, functioning heating system; (2) Maintain a temperature of not less than 65 degrees Fahrenheit whenever children are present; and (3) Protect children from contact with exposed heat sources, including steam and hot water pipes, and radiators, via the use of permanent screens, guards, insulation or another suitable device that prevents children from coming in contact with them. (w) Prior to using portable space heaters or portable radiators in child care space, programs shall obtain written approval from the local fire inspector with documentation of the approval available for review by department staff during on-site visits. (x) All portable space heaters or radiators shall: (1) Be inaccessible to children; (2) Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); (3) Be placed at least 3 feet from curtains, papers, furniture, or any other flammable object; and (4) Be installed and operated in accordance with the manufacturer’s specifications. (y) All fuel burning stoves, including but not limited to wood, coal, pellet, or gas, when used during child care, shall: (1) Meet applicable local and state codes with documentation of such approval available for review by department staff during on-site visits; and (2) Be maintained in a manner that ensures the safety of all children, by use of partitions, screens, guards, or other similar barricades, as approved by the local fire official; (z) Child care staff shall be in the room with children whenever a fireplace is in use. (aa) All working fireplaces in space used by children shall: (1) Have a secure child proof barrier in place at all times; and (2) Be equipped with padding or otherwise protected if the hearth presents a hazard to children. (ab) Guns, weapons, or live or spent ammunition shall be kept in locked storage with the key stored separately and out of the reach of children. (ac) Pursuant to 40 CFR 745, when interior surfaces of a building built prior to 1978 are in a deteriorating condition, including but not limited to flaking, chipping, and peeling paint, or are subject to renovations or construction, the licensee shall utilize a U.S. Environmental Protection Agency certified Renovation, Repair, and Painting (RRP) contractor, in accordance with 40 CFR 745.90(a) and (b) and He-P 1600. (ad) In addition to (ac) above, until the deteriorated surfaces can be made intact, the program shall provide the department with a plan, in writing, that ensures children will not have access to those surfaces and includes the expected date of completion of the work. (ae) Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. (af) When there is information or evidence indicating that the building may contain asbestos hazards, programs shall submit evidence that the building has been inspected by a licensed asbestos inspector and is free of asbestos hazards, or submit a plan of action to reduce or eliminate any existing contamination to be approved by the department. (ag) When there is information indicating that the building or water supply may contain radon hazards, programs shall submit evidence that the building has been inspected by a licensed radon inspector and is free of radon hazards or submit a plan of action to reduce or eliminate any existing contamination to be approved by the department. He-C 4002.24: (a) The play area shall: (4) Be free from hazards, including but not limited to: a. Water hazards such as unprotected pools, wells, or bodies of water; b. Animal feces; c. Poisonous plants; d. Broken toys, broken glass or other sharp items; e. Chipping, peeling, or flaking paint; f. Dangerous machinery or tools; g. Small objects that could present a choking hazard to young children; and h. Other dangerous items or substances. (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (1) A street or road; (2) A swimming pool or other body of water, including a river, pond, or stream; (3) An active railroad track or crossing; (4) Sharp inclines or embankments; or (5) Any dangerous area. (c) All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: (1) Have no gaps greater than 4 inches and be designed to restrain preschool children from climbing out of, over, under, or through the fence; and (2) Either: a. Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or b. Be equipped with a child proof lock if the area is determined to be hazardous to children. (d) The licensee shall protect outdoor play space located on a roof with a barrier at least 7 feet high, which children cannot climb. (e) The licensee shall install suitable barriers, including but not limited to bulkhead doors, to prevent falls into outdoor stair or window wells. (g) Porches and decks shall comply with the following: (1) If they are more than three feet from ground level, there shall be protective railings in accordance with applicable building codes; (2) Railings shall be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them; (3) There shall be a child safety gate or other barricade on stairs whenever the porch or deck is in use by children younger than three years old; and (4) The family child care provider, center director, or site director shall monitor the condition of porches and decks to ensure that there are no splinters, cracks, protruding nails or screws, and discontinue use of the area until repairs are complete. (i) To prevent injury, programs shall not allow children to play on equipment or structures that require energy absorptive material pursuant to (h) above when the energy absorptive material is compacted and unable to be loosened, such as when frozen. (j) All fencing, balusters, handrails, and guardrails, or slats on lofts, stairways, decks, porches, or balconies that are accessible to children shall be constructed and maintained to prevent entrapment hazards. (k) All swimming pools on the premises of the child care program and used as part of the child care operations shall be clean and maintained in accordance with the manufacturer’s or installer’s printed instructions regarding cleaning, filtration, and chemical treatment. (l) All swimming pools on the premises of the child care program shall be inaccessible to children in accordance with the following: (1) In-ground pools shall be enclosed by a fence with a gate equipped with a child proof, self-latching device and a lock; (2) Above ground pools shall be enclosed by a fence with a gate which has a child proof, self-latching device and a lock, or equipped with a lockable gate, lockable swing up stairway, or other lockable barrier to prevent access to the stairs or ladders, or otherwise make the pool inaccessible to children; (3) A pool that is directly accessible from inside the building shall have a secure, lockable barrier that meets the requirements in (1) and (2) above to make the pool inaccessible to children; (4) Pool gates, fences, or other barriers as required in (1), (2), and (3) above shall be locked during all operating hours, except when the children are involved in a supervised water activity in the pool; and (5) The keys, combinations, or other means to open the locks required in (1) through (4) above shall not be accessible to children. (m) Each swimming pool shall be equipped with a ring buoy, and attached rope of sufficient length to reach the center of the pool from the edge of the pool and shall not be accessible to children. (n) Wading pools shall: (1) Be emptied and cleaned after each use; (2) Be stored so that water does not collect in them; and (3) Not contain water that is more than 10 inches deep. (o) Pursuant to 40 CFR 745 when exterior surfaces of a building built prior to 1978 are in a deteriorating condition, including but not limited to flaking, chipping, and peeling paint, or are subject to renovations or construction, a U.S. Environmental Protection Agency certified Renovation, Repair, and Painting (RRP) contractor shall be utilized, in accordance with 40 CFR 745.90(a) and (b) and He-P 1600. (p) In addition to (o) above, until such time as the deteriorated surfaces can be made intact, the program shall provide the department with a plan, in writing, that ensures children will not have access to those surfaces and includes the expected date of completion of the work. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.23: (b) Child care staff shall ensure that the indoor space is: (1) Safe, clean, free of clutter, and in good repair; (2) Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked or crimped cords, or unprotected outlets; (3) Well-ventilated by means of unobstructed mechanical ventilation system or open, screened window; (4) Well-lit to allow for the supervision of children and for child care staff and children to move about safely; (5) Free of damp conditions which result in visible mold, mildew, or a musty odor; (6) Free of heavy furnishings or items not secured to the wall or floor that could easily tip or are unstable; (7) Free of fumes from toxic or harmful chemicals or materials; (8) Free of tripping hazards; and (9) Free of poisonous plants. (c) Child care staff shall ensure that potentially harmful items, including but not limited to matches, lighters, chemicals, materials labeled ￿harmful if swallowed,￿ flammable materials, sharp objects, and staffs’ personal belongings are locked or inaccessible to children. (d) All substances labeled ￿harmful if swallowed￿ or ￿flammable￿ and all containers storing cleaning materials shall be labeled as to the contents and stored separately from food and medications. (f) Cords or strings long enough to encircle a child’s neck, such as cords on window blinds, curtains or shades, shall be kept out of children’s reach. (g) Child care staff shall ensure that the presence of pets in the program does not present a hazard to the children, including but not limited to: (1) Reptiles, amphibians and birds, including baby chicks and ducklings, shall not be permitted in rooms or outdoor spaces regularly occupied by children; (2) When bringing animals into a child care, staff shall supervise children when the animals are available, designated areas shall be cleaned and sanitized after animal contact, and food or drink shall not be consumed in these areas; (3) Cages or other habitats shall be cleaned of all fecal material and sanitized on an as needed basis but no less than once per week; (4) Staff shall wear gloves while cleaning animal cages or habitats; (5) All staff and children shall wash hands with soap and warm running water after contact with animals or their cages or habitats; and (6) Dogs, cats, and ferrets shall be kept clean and free of parasites, fleas, ticks, mites, and lice, and vaccinated against rabies, with proof of current vaccination on site at the program and available for review by department staff. (h) Programs shall maintain bathroom facilities in accordance with the following: (1) Sinks, toilets, footstools, potty chairs, and adapters shall be cleaned and sanitized at least once a day and when visibly soiled; (2) Bathroom floors and other surfaces adjacent to toilets, including but not limited to walls, shall be cleaned and sanitized at least weekly, and when visibly soiled; (3) Toilet paper, individual cloth or paper towels, and liquid soap from a dispenser shall be available and accessible to children and staff; and (4) Bathrooms shall have a functional means of outside ventilation. (i) The program shall take prompt action to eliminate insects or rodents, and clean and sanitize all surfaces where there is visible evidence of their presence. (j) When using pesticides, programs shall: (1) Notify parents and staff in writing at least 2 days prior to the pesticide application, except in emergencies where pests pose an immediate threat to children; and (2) Document the date, time, and type of pesticide used for each time a pesticide is used. (k) Pesticides shall not be used in areas used by children while children are present, and any treated indoor area shall be aired out per manufacturers’ instructions prior to allowing children to return to that area. (l) Programs shall maintain the child care space free from non-compliance of Saf-FMO 300 and Saf-C 6000 by not blocking exits, or evacuation routes, including doorways, hallways, and stairs that are a means of egress, and by maintaining smoke detectors in working order. (m) The licensee shall prohibit smoking in the building anytime for center-based programs or during operating hours for family child care homes, with the following exceptions: (1) Child care staff who smoke during their breaks shall not smoke in view of children or while responsible for the care of children; and (2) Child care staff who smoke on their breaks shall wash their hands and change into fresh clothing, or remove smoke contaminated outerwear prior to returning to work to reduce exposure to second-hand smoke. (n) Child care staff shall: (1) Arrange space to provide clear pathways for movement from one area to another and to allow visual supervision by staff; (2) Arrange furnishings and fixtures safely, with sharp edges protected, and in such a way as to not present hazards to children; and (3) Store their personal belongings out of reach of children. (q) All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. (r) Garbage shall be disposed of in a lined and covered container and staff shall empty trash containers daily or sooner if contents create an odor or a health risk. (s) Stairways with more than 3 steps shall be equipped with handrails. (t) In programs serving children younger than 3 years old, the licensee shall ensure that there are barriers placed at the top and bottom of stairwells opening into areas used by children younger than three years, unless prohibited by building or fire department regulations. Pressure gates at the top of stairs shall not be used. (u) Open stairways used by children younger than school age shall have railings or banisters installed along the open or unprotected side(s). (v) Programs shall: (1) Have a safe, functioning heating system; (2) Maintain a temperature of not less than 65 degrees Fahrenheit whenever children are present; and (3) Protect children from contact with exposed heat sources, including steam and hot water pipes, and radiators, via the use of permanent screens, guards, insulation or another suitable device that prevents children from coming in contact with them. (w) Prior to using portable space heaters or portable radiators in child care space, programs shall obtain written approval from the local fire inspector with documentation of the approval available for review by department staff during on-site visits. (x) All portable space heaters or radiators shall: (1) Be inaccessible to children; (2) Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); (3) Be placed at least 3 feet from curtains, papers, furniture, or any other flammable object; and (4) Be installed and operated in accordance with the manufacturer’s specifications. (y) All fuel burning stoves, including but not limited to wood, coal, pellet, or gas, when used during child care, shall: (1) Meet applicable local and state codes with documentation of such approval available for review by department staff during on-site visits; and (2) Be maintained in a manner that ensures the safety of all children, by use of partitions, screens, guards, or other similar barricades, as approved by the local fire official; (z) Child care staff shall be in the room with children whenever a fireplace is in use. (aa) All working fireplaces in space used by children shall: (1) Have a secure child proof barrier in place at all times; and (2) Be equipped with padding or otherwise protected if the hearth presents a hazard to children. (ab) Guns, weapons, or live or spent ammunition shall be kept in locked storage with the key stored separately and out of the reach of children. (ac) Pursuant to 40 CFR 745, when interior surfaces of a building built prior to 1978 are in a deteriorating condition, including but not limited to flaking, chipping, and peeling paint, or are subject to renovations or construction, the licensee shall utilize a U.S. Environmental Protection Agency certified Renovation, Repair, and Painting (RRP) contractor, in accordance with 40 CFR 745.90(a) and (b) and He-P 1600. (ad) In addition to (ac) above, until the deteriorated surfaces can be made intact, the program shall provide the department with a plan, in writing, that ensures children will not have access to those surfaces and includes the expected date of completion of the work. (ae) Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. (af) When there is information or evidence indicating that the building may contain asbestos hazards, programs shall submit evidence that the building has been inspected by a licensed asbestos inspector and is free of asbestos hazards, or submit a plan of action to reduce or eliminate any existing contamination to be approved by the department. (ag) When there is information indicating that the building or water supply may contain radon hazards, programs shall submit evidence that the building has been inspected by a licensed radon inspector and is free of radon hazards or submit a plan of action to reduce or eliminate any existing contamination to be approved by the department. He-C 4002.24: (a) The play area shall: (4) Be free from hazards, including but not limited to: a. Water hazards such as unprotected pools, wells, or bodies of water; b. Animal feces; c. Poisonous plants; d. Broken toys, broken glass or other sharp items; e. Chipping, peeling, or flaking paint; f. Dangerous machinery or tools; g. Small objects that could present a choking hazard to young children; and h. Other dangerous items or substances. (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (1) A street or road; (2) A swimming pool or other body of water, including a river, pond, or stream; (3) An active railroad track or crossing; (4) Sharp inclines or embankments; or (5) Any dangerous area. (c) All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: (1) Have no gaps greater than 4 inches and be designed to restrain preschool children from climbing out of, over, under, or through the fence; and (2) Either: a. Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or b. Be equipped with a child proof lock if the area is determined to be hazardous to children. (d) The licensee shall protect outdoor play space located on a roof with a barrier at least 7 feet high, which children cannot climb. (e) The licensee shall install suitable barriers, including but not limited to bulkhead doors, to prevent falls into outdoor stair or window wells. (g) Porches and decks shall comply with the following: (1) If they are more than three feet from ground level, there shall be protective railings in accordance with applicable building codes; (2) Railings shall be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them; (3) There shall be a child safety gate or other barricade on stairs whenever the porch or deck is in use by children younger than three years old; and (4) The family child care provider, center director, or site director shall monitor the condition of porches and decks to ensure that there are no splinters, cracks, protruding nails or screws, and discontinue use of the area until repairs are complete. (i) To prevent injury, programs shall not allow children to play on equipment or structures that require energy absorptive material pursuant to (h) above when the energy absorptive material is compacted and unable to be loosened, such as when frozen. (j) All fencing, balusters, handrails, and guardrails, or slats on lofts, stairways, decks, porches, or balconies that are accessible to children shall be constructed and maintained to prevent entrapment hazards. (k) All swimming pools on the premises of the child care program and used as part of the child care operations shall be clean and maintained in accordance with the manufacturer’s or installer’s printed instructions regarding cleaning, filtration, and chemical treatment. (l) All swimming pools on the premises of the child care program shall be inaccessible to children in accordance with the following: (1) In-ground pools shall be enclosed by a fence with a gate equipped with a child proof, self-latching device and a lock; (2) Above ground pools shall be enclosed by a fence with a gate which has a child proof, self-latching device and a lock, or equipped with a lockable gate, lockable swing up stairway, or other lockable barrier to prevent access to the stairs or ladders, or otherwise make the pool inaccessible to children; (3) A pool that is directly accessible from inside the building shall have a secure, lockable barrier that meets the requirements in (1) and (2) above to make the pool inaccessible to children; (4) Pool gates, fences, or other barriers as required in (1), (2), and (3) above shall be locked during all operating hours, except when the children are involved in a supervised water activity in the pool; and (5) The keys, combinations, or other means to open the locks required in (1) through (4) above shall not be accessible to children. (m) Each swimming pool shall be equipped with a ring buoy, and attached rope of sufficient length to reach the center of the pool from the edge of the pool and shall not be accessible to children. (n) Wading pools shall: (1) Be emptied and cleaned after each use; (2) Be stored so that water does not collect in them; and (3) Not contain water that is more than 10 inches deep. (o) Pursuant to 40 CFR 745 when exterior surfaces of a building built prior to 1978 are in a deteriorating condition, including but not limited to flaking, chipping, and peeling paint, or are subject to renovations or construction, a U.S. Environmental Protection Agency certified Renovation, Repair, and Painting (RRP) contractor shall be utilized, in accordance with 40 CFR 745.90(a) and (b) and He-P 1600. (p) In addition to (o) above, until such time as the deteriorated surfaces can be made intact, the program shall provide the department with a plan, in writing, that ensures children will not have access to those surfaces and includes the expected date of completion of the work. 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: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. 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: He-C 4002.24: (a) The play area shall: (4) Be free from hazards, including but not limited to: a. Water hazards such as unprotected pools, wells, or bodies of water. (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (2) A swimming pool or other body of water, including a river, pond, or stream. (c) All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: (1) Have no gaps greater than 4 inches and be designed to restrain preschool children from climbing out of, over, under, or through the fence; and (2) Either: a. Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or b. Be equipped with a child proof lock if the area is determined to be hazardous to children. (l) All swimming pools on the premises of the child care program shall be inaccessible to children in accordance with the following: (1) In-ground pools shall be enclosed by a fence with a gate equipped with a child proof, self-latching device and a lock; (2) Above ground pools shall be enclosed by a fence with a gate which has a child proof, self-latching device and a lock, or equipped with a lockable gate, lockable swing up stairway, or other lockable barrier to prevent access to the stairs or ladders, or otherwise make the pool inaccessible to children; (3) A pool that is directly accessible from inside the building shall have a secure, lockable barrier that meets the requirements in (1) and (2) above to make the pool inaccessible to children; (4) Pool gates, fences, or other barriers as required in (1), (2), and (3) above shall be locked during all operating hours, except when the children are involved in a supervised water activity in the pool; and (5) The keys, combinations, or other means to open the locks required in (1) through (4) above shall not be accessible to children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.24: (a) The play area shall: (4) Be free from hazards, including but not limited to: a. Water hazards such as unprotected pools, wells, or bodies of water. (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (2) A swimming pool or other body of water, including a river, pond, or stream. (c) All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: (1) Have no gaps greater than 4 inches and be designed to restrain preschool children from climbing out of, over, under, or through the fence; and (2) Either: a. Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or b. Be equipped with a child proof lock if the area is determined to be hazardous to children. (l) All swimming pools on the premises of the child care program shall be inaccessible to children in accordance with the following: (1) In-ground pools shall be enclosed by a fence with a gate equipped with a child proof, self-latching device and a lock; (2) Above ground pools shall be enclosed by a fence with a gate which has a child proof, self-latching device and a lock, or equipped with a lockable gate, lockable swing up stairway, or other lockable barrier to prevent access to the stairs or ladders, or otherwise make the pool inaccessible to children; (3) A pool that is directly accessible from inside the building shall have a secure, lockable barrier that meets the requirements in (1) and (2) above to make the pool inaccessible to children; (4) Pool gates, fences, or other barriers as required in (1), (2), and (3) above shall be locked during all operating hours, except when the children are involved in a supervised water activity in the pool; and (5) The keys, combinations, or other means to open the locks required in (1) through (4) above shall 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: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.05 Building and Physical Premises Safety Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.05 Building and Physical Premises Safety Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.05 Building and Physical Premises Safety. Both indoor and outdoor premises shall be safe, clean, free of clutter, and in good repair. Programs shall maintain the child care environment and ensure the indoor space is: Free from electrical hazards, such as overloaded outlets or extension cords, frayed, cracked, or crimped cords, or unprotected outlets; Free from fire hazards; Well-ventilated by means of unobstructed mechanical ventilation system or open screened window; Free from guns, weapons, or live or spent ammunition which are not in locked storage; Free from accessible knives and sharp objects unless the object is being used under the direct supervision of a staff member; Free from heavy furnishings or other heavy items that could easily tip or fall on children and would be likely to cause injury; Free from accessible loose and flaking paint; Well-lit to allow for the supervision of children and for child care staff and children to move about safely; Free from damp conditions which result in visible mold, mildew, or a musty odor; Free from poisonous plants; Free from trampoline use during child care hours, with the exception of small indoor trampolines intended for individual use with direct staff supervision only; and Free from accessible items labeled ￿keep of out of reach of children￿ unless the item is non-toxic and being used under the direct supervision of a staff member. All windows used for ventilation shall include screens in good repair, to prevent insects from entering the building. Windows and glass doors shall be constructed, adapted, or adjusted via the use of window guards or other means to prevent injury to children. Stairways with more than 3 steps shall be equipped with handrails. Construction, remodeling, or alteration of structures during child care operations shall be done in a manner as to prevent exposure of children to hazardous or unsafe conditions including, but not limited to, fumes, dust, construction materials, and tools which pose a safety hazard. Programs shall ensure that all indoor areas used by children: Have a safe, functioning heating system; Include protection for children from exposed heat sources which present a hazard, including but not limited to baseboard heaters, radiators, fireplaces, and woodstoves; and Have working smoke detectors on each level. Portable electric space heaters shall: Be inaccessible to children; Bear the safety certification of a recognized laboratory such as Underwriters Laboratory (UL) or Electro Technical Laboratory (ETL); and Be installed and operated in accordance with the manufacturer’s specifications. Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; A swimming pool or other body of water, including a river, pond, or stream; An active railroad track or crossing; Sharp inclines or embankments; or Any other dangerous area. All fencing required by the department or otherwise intended to limit children’s access to a defined area shall: Have no gaps greater than 4 inches and be designed to restrain children from climbing out of, over, under, or through the fence; and Either: Be equipped with a child proof self-latching device on any gates leading to an entrance or egress; or Be equipped with a child proof lock if the area is determined to be hazardous to children as determined by the licensing coordinator during the monitoring visit as described in He-C 6916.16. In outside areas, stationary play equipment accessible to children shall not be over hard surfaces such as cement or asphalt. All swimming pools and wading pools shall be inaccessible to children except during supervised activities. Wading pools shall: Be emptied and cleaned after each use; Be stored so that water does not collect in them; and Not contain water that is more than 10 inches deep. Programs shall have a safe supply of water under pressure available for drinking and program use. Programs shall not use portable toilets, chemical toilets, or any other toilets which are not attached to a functional sewage disposal system. During all hours of operation there shall be functional sewage disposal facilities. Smoking shall not be permitted inside the building at any time. Staff who smoke on their breaks shall: Not smoke in view of children; Wash their hands prior to returning to work; and Change into fresh clothing, or remove smoke-contaminated outerwear prior to returning to work to reduce exposure to third-hand smoke. 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: He-C 4002.24: (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (1) A street or road; (3) An active railroad track or crossing; (5) Any dangerous area. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.24: (b) Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: (1) A street or road; (3) An active railroad track or crossing; (5) Any dangerous area. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: He-C 6916.05 Building and Physical Premises Safety Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6916.05 Building and Physical Premises Safety Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6916.05 Building and Physical Premises Safety Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6916.05 Building and Physical Premises Safety Outside areas which are accessible to children shall be free from hazards including, but not limited to: Unprotected pools, wells, or other bodies of water; Lawn and farm machinery; Trash, litter, or debris; Animal feces; and Any other dangerous items or substances. Fencing shall enclose all play areas if the department determines the play area is unsafe because it is located adjacent to: A street or road; 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: He-C 4002:18: (e) Child care staff and household members shall not: (1) Abuse or neglect children; (2) Use rough handling on children; (3) Use corporal punishment on children; (f) The applicant, licensee, permittee, and all child care staff shall take prompt action to protect children from abuse, neglect, and corporal punishment, including but not limited to actions in (e) above. He-C 4002.01: (o) ￿Corporal punishment￿ means the intentional infliction of physical pain by any means for the purpose of punishment, correction, discipline, instruction, or any other reason. (bb) ￿Rough handling￿ means an aggressive physical act against a child, except when necessary to protect a child from harming themselves or others. He- C 4002.33: (d) Child care staff who have not completed the training in (1) through (4) below shall work under the direct supervision and observation of a staff member who has completed the following trainings: (2) Prevention of shaken baby syndrome and abusive head trauma; NH was sited and notified as non-compliant on May 23rd 2024 we will address this non-compliance by amending the rule language to include specifically shaken baby syndrome and abusive head trauma. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002:18: (e) Child care staff and household members shall not: (1) Abuse or neglect children; (2) Use rough handling on children; (3) Use corporal punishment on children; (f) The applicant, licensee, permittee, and all child care staff shall take prompt action to protect children from abuse, neglect, and corporal punishment, including but not limited to actions in (e) above. He-C 4002.01: (o) ￿Corporal punishment￿ means the intentional infliction of physical pain by any means for the purpose of punishment, correction, discipline, instruction, or any other reason. (bb) ￿Rough handling￿ means an aggressive physical act against a child, except when necessary to protect a child from harming themselves or others. He-C 4002.33: (d) Child care staff who have not completed the training in (1) through (4) below shall work under the direct supervision and observation of a staff member who has completed the following trainings: (2) Prevention of shaken baby syndrome and abusive head trauma; NH was sited and notified as non-compliant on May 23rd 2024 we will address this non-compliance by amending the rule language to include specifically shaken baby syndrome and abusive head trauma. 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: He- C 6916.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; He-C 6917.14 Prevention of Shaken Baby Syndrome and Abusive Head Trauma and Prevention, Recognition, and Reporting of Child Abuse and Neglect. Providers shall not shake or perform any action likely to cause abusive head trauma, but rather use strategies to cope with a crying, fussing, or distraught infant. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; He-C 6917.14 Prevention of Shaken Baby Syndrome and Abusive Head Trauma and Prevention, Recognition, and Reporting of Child Abuse and Neglect. Providers shall not shake or perform any action likely to cause abusive head trauma, but rather use strategies to cope with a crying, fussing, or distraught infant. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; NH was sited and notified as non-compliant on May 23rd 2024 we will address this non-compliance by amending the rule language to include specifically shaken baby syndrome and abusive head trauma. b. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of child maltreatment and indicate the age of children it applies to for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: He-C 4002.18: (e) Child care staff and household members shall not: (1) Abuse or neglect children; (2) Use rough handling on children; (3) Use corporal punishment on children; (4) Require children to stand or sit facing walls or corners; (5) Shame, humiliate, threaten, or frighten children; (6) Confine infants or toddlers in high chairs or other seating devices or equipment, which restricts their movement, as a disciplinary technique; (7) Place or confine children in equipment that is not appropriate for their age, including but not limited to cribs, playpens, or highchairs; (8) Withhold food from children, forcibly feed children, or discipline children for not eating; (9) Discipline any child for toileting accidents, lapses in toileting habits, or prohibiting children from using the toilet as a form of discipline; (10) Use isolation as a form of discipline; (11) Require children to rest, sleep, or go to their mat, crib, or rest area as a means of discipline, or discipline children for not sleeping or resting during naptime; (12) Yell in anger or frustration at or with children; or (13) Use profanity or obscene language with children or among themselves where children can hear them. (f) The applicant, licensee, permittee, and all child care staff shall take prompt action to protect children from abuse, neglect, and corporal punishment, including but not limited to actions in (e) above. He-C 4002.33: (a) All center directors, agency administrators, site coordinators, or site directors, and all other child care staff who are responsible for the supervision of children, or who are necessary for the staff to child ratios, shall keep on file documentation of completion of a minimum of 6 hours of professional development, which shall be completed in accordance with the following: (1) Within 90 days of the first date of employment; (2) Within 2 weeks for programs operating 3 months of the year or less; or (3) By providing documentation of previous completion. (b) The 6 hours of professional development required in (a) above shall include: (12) Prevention, recognition, and reporting of child abuse and neglect; ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.18: (e) Child care staff and household members shall not: (1) Abuse or neglect children; (2) Use rough handling on children; (3) Use corporal punishment on children; (4) Require children to stand or sit facing walls or corners; (5) Shame, humiliate, threaten, or frighten children; (6) Confine infants or toddlers in high chairs or other seating devices or equipment, which restricts their movement, as a disciplinary technique; (7) Place or confine children in equipment that is not appropriate for their age, including but not limited to cribs, playpens, or highchairs; (8) Withhold food from children, forcibly feed children, or discipline children for not eating; (9) Discipline any child for toileting accidents, lapses in toileting habits, or prohibiting children from using the toilet as a form of discipline; (10) Use isolation as a form of discipline; (11) Require children to rest, sleep, or go to their mat, crib, or rest area as a means of discipline, or discipline children for not sleeping or resting during naptime; (12) Yell in anger or frustration at or with children; or (13) Use profanity or obscene language with children or among themselves where children can hear them. (f) The applicant, licensee, permittee, and all child care staff shall take prompt action to protect children from abuse, neglect, and corporal punishment, including but not limited to actions in (e) above. He-C 4002.33: (a) All center directors, agency administrators, site coordinators, or site directors, and all other child care staff who are responsible for the supervision of children, or who are necessary for the staff to child ratios, shall keep on file documentation of completion of a minimum of 6 hours of professional development, which shall be completed in accordance with the following: (1) Within 90 days of the first date of employment; (2) Within 2 weeks for programs operating 3 months of the year or less; or (3) By providing documentation of previous completion. (b) The 6 hours of professional development required in (a) above shall include: (12) Prevention, recognition, and reporting of child abuse and neglect; 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: He- C 6916.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6917.12 Child Development. Providers and household members shall not: Abuse or neglect children; Use rough handling on children; Use corporal punishment on children; 5.3.7 Emergency preparedness and response planning standard Identify by checking below that the emergency preparedness and response planning due to natural disasters and human-caused events standard includes procedures in the following areas: i. [x] Evacuation ii. [x] Relocation iii. [x] Shelter-in-place iv. [x] Lock down v. Staff emergency preparedness [x] Training [x] Practice drills vi. Volunteer emergency preparedness [ ] Training [ ] 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: NH does not have requirements for volunteer in emergency response preparedness and planning NH was cited and notified of non-compliance on May 23, 2024. We will address this citation in rule changes to include volunteers in the training and practice drills for licensed Child Care Centers. 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: He-C 4002.23: (b) Child care staff shall ensure that the indoor space is: (7) Free of fumes from toxic or harmful chemicals or materials; (c) Child care staff shall ensure that potentially harmful items, including but not limited to matches, lighters, chemicals, materials labeled ￿harmful if swallowed,￿ flammable materials, sharp objects, and staffs’ personal belongings are locked or inaccessible to children. (d) All substances labeled ￿harmful if swallowed￿ or ￿flammable￿ and all containers storing cleaning materials shall be labeled as to the contents and stored separately from food and medications. He-C 4002.11(e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.23: (b) Child care staff shall ensure that the indoor space is: (7) Free of fumes from toxic or harmful chemicals or materials; (c) Child care staff shall ensure that potentially harmful items, including but not limited to matches, lighters, chemicals, materials labeled ￿harmful if swallowed,￿ flammable materials, sharp objects, and staffs’ personal belongings are locked or inaccessible to children. (d) All substances labeled ￿harmful if swallowed￿ or ￿flammable￿ and all containers storing cleaning materials shall be labeled as to the contents and stored separately from food and medications. He-C 4002.11(e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. 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: He- C 6916.06 Handling, Storage, and Disposal of Hazardous Materials. All toxic and flammable materials and tobacco products shall be stored in cabinets which are locked or secured with child proof latches, or otherwise out of reach of children. Pesticides shall not be used in areas used by children while children are present, and any treated indoor area must be aired out per manufacturers’ instructions prior to allowing children to return to that area. Programs shall adhere to state and federal rules and regulations in regards to lead paint and asbestos removal. Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: Be located adjacent to or in close proximity to a designated handwashing sink to allow access for handwashing without having to open doors or gates or have physical contact with other children; Have a non-porous washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; Contain a covered, hands- free receptacle, lined with a plastic bag, and located within the reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.06 Handling, Storage, and Disposal of Hazardous Material. All toxic and flammable materials and tobacco products shall be stored in cabinets which are locked or secured with child proof latches, or otherwise out of reach of children. Pesticides shall not be used in areas used by children while children are present, and any treated indoor area must be aired out per manufacturers’ instructions prior to allowing children to return to that area. Programs shall adhere to state and federal rules and regulations in regards to lead paint and asbestos removal. Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: Be located adjacent to or in close proximity to a designated handwashing sink to allow access for handwashing without having to open doors or gates or have physical contact with other children; Have a non-porous washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; Contain a covered, hands- free receptacle, lined with a plastic bag, and located within the reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.06 Handling, Storage, and Disposal of Hazardous Material. All toxic and flammable materials and tobacco products shall be stored in cabinets which are locked or secured with child proof latches, or otherwise out of reach of children. Pesticides shall not be used in areas used by children while children are present, and any treated indoor area must be aired out per manufacturers’ instructions prior to allowing children to return to that area. Programs shall adhere to state and federal rules and regulations in regards to lead paint and asbestos removal. Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: Be located adjacent to or in close proximity to a designated handwashing sink to allow access for handwashing without having to open doors or gates or have physical contact with other children; Have a non-porous washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; Contain a covered, hands- free receptacle, lined with a plastic bag, and located within the reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6917.06 Handling, Storage, and Disposal of Hazardous Material. All toxic and flammable materials and tobacco products shall be stored in cabinets which are locked or secured with child proof latches, or otherwise out of reach of children. Pesticides shall not be used in areas used by children while children are present, and any treated indoor area must be aired out per manufacturers’ instructions prior to allowing children to return to that area. Programs shall adhere to state and federal rules and regulations in regards to lead paint and asbestos removal. Programs serving diapered children and children who are not toilet trained shall have a designated diaper changing area, which shall: Be located adjacent to or in close proximity to a designated handwashing sink to allow access for handwashing without having to open doors or gates or have physical contact with other children; Have a non-porous washable surface, which shall be used exclusively for diaper changing and sanitized after each diaper change; Contain a covered, hands-free receptacle, lined with a plastic bag, and located within the reach of the diaper changing area for disposal of soiled disposable diapers and cleansing articles; and Not be located in kitchens or in food preparation or food service areas, or on surfaces where food is prepared or served. 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: He-C 4002.23: (ah) Child care staff shall immediately clean spills of bodily fluids, including urine, feces, blood, saliva, and discharges from the nose, eyes, or an injury, using soap and water and then disinfectant. Surfaces requiring such action include tabletops, toys, floors, walls, toilets, potty chairs, and diaper changing surfaces. (ai) Child care staff shall: (1) Wear non-porous gloves when cleaning bodily fluid spills specified above; (2) Place soiled clothing in a plastic bag, tied securely and return the items to the child’s parent at pick up; and (3) Clean, rinse, disinfect, wring, and hang to dry mops used to clean bodily fluids. He-C 4002.11(e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.23: (ah) Child care staff shall immediately clean spills of bodily fluids, including urine, feces, blood, saliva, and discharges from the nose, eyes, or an injury, using soap and water and then disinfectant. Surfaces requiring such action include tabletops, toys, floors, walls, toilets, potty chairs, and diaper changing surfaces. (ai) Child care staff shall: (1) Wear non-porous gloves when cleaning bodily fluid spills specified above; (2) Place soiled clothing in a plastic bag, tied securely and return the items to the child’s parent at pick up; and (3) Clean, rinse, disinfect, wring, and hang to dry mops used to clean bodily fluids. He-C 4002.11(e) When any child care staff or children in the program have symptoms of or are known to have a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contaminated with bodily fluids shall: a. Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and b. Immediately wash their hands with soap and running water after discarding the gloves; and (3) Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be immediately disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands-free receptacle. 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: He-C 6916.10 Prevention and Control of Infectious Diseases, Including Immunizations. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; and vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 6917.10 Prevention and Control of Infectious Diseases, Including Immunizations. (d) Any time there is a spill of bodily fluids, or any provider or child has symptoms of, or are known to have, a communicable disease: (1) Any spills of bodily fluids shall be immediately cleaned and sanitized; (2) Persons involved in cleaning surfaces contained with bodily fluids shall: Wear protective disposable gloves while cleaning, disinfecting, and sanitizing the contaminated surface; and Immediately wash their hands with liquid soap and warm running water after discarding the gloves; Any materials, including disposable gloves and diapers contaminated by bodily fluids, shall be disposed of in a plastic bag with a secure tie or in a covered, plastic bag-lined, hands- free receptacle; 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: He-C 4002.32: (e) Whenever the program provides transportation, it shall ensure that: (1) Any vehicle used for transportation of children is registered and inspected in accordance with the laws of the state of New Hampshire; (2) The vehicle is maintained in a safe operating condition, and is clean and free of obstructions on the floors and seats, and any sharp, heavy, or potentially dangerous objects are placed in the trunk or cargo area and securely restrained; (3) The operator of any vehicle transporting children is at least 18 years old and holds a valid driver’s license; (4) The driver and any other attendants on the vehicle have received training in the safe transportation of children; (5) The driver of the vehicle is alert and not distracted by telephone, radio, or other communications; and (6) The driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that no child is left alone in a vehicle at any time. (f) Child care staff shall not permit any child to remain in any vehicle unattended by staff of the child care program. (g) Any vehicle used to transport children, whether owned by the program, a child care staff member or by a parent who is transporting children other than his or her own, shall have proof of current liability insurance. (h) Child care staff shall ensure: (1) The number of children riding in any vehicle does not exceed the number of persons the vehicle is designed to carry; (2) Individual, age appropriate child restraints or seat belts are provided for and used by each child in accordance with RSA 265:107-a, and the driver and any other adults shall use their seatbelts when transporting children; and (3) All children remain seated when the vehicle is in operation. (i) Child care staff shall carry on all field trips: (1) A copy of each child’s registration and emergency information forms; (2) A first aid kit in the vehicle whenever children are present; (3) A copy of the parental permission slip for the field trip; (4) An attendance sheet documentation that staff accounted for each child every time they entered or exited the vehicle; (5) All emergency and currently prescribed child medications, as applicable; and (6) In each vehicle, a form that includes the program name, address, and phone number. (j) There shall be a working cell phone or other mechanism for making emergency telephone calls available in each vehicle during transport. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.32: (e) Whenever the program provides transportation, it shall ensure that: (1) Any vehicle used for transportation of children is registered and inspected in accordance with the laws of the state of New Hampshire; (2) The vehicle is maintained in a safe operating condition, and is clean and free of obstructions on the floors and seats, and any sharp, heavy, or potentially dangerous objects are placed in the trunk or cargo area and securely restrained; (3) The operator of any vehicle transporting children is at least 18 years old and holds a valid driver’s license; (4) The driver and any other attendants on the vehicle have received training in the safe transportation of children; (5) The driver of the vehicle is alert and not distracted by telephone, radio, or other communications; and (6) The driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that no child is left alone in a vehicle at any time. (f) Child care staff shall not permit any child to remain in any vehicle unattended by staff of the child care program. (g) Any vehicle used to transport children, whether owned by the program, a child care staff member or by a parent who is transporting children other than his or her own, shall have proof of current liability insurance. (h) Child care staff shall ensure: (1) The number of children riding in any vehicle does not exceed the number of persons the vehicle is designed to carry; (2) Individual, age appropriate child restraints or seat belts are provided for and used by each child in accordance with RSA 265:107-a, and the driver and any other adults shall use their seatbelts when transporting children; and (3) All children remain seated when the vehicle is in operation. (i) Child care staff shall carry on all field trips: (1) A copy of each child’s registration and emergency information forms; (2) A first aid kit in the vehicle whenever children are present; (3) A copy of the parental permission slip for the field trip; (4) An attendance sheet documentation that staff accounted for each child every time they entered or exited the vehicle; (5) All emergency and currently prescribed child medications, as applicable; and (6) In each vehicle, a form that includes the program name, address, and phone number. (j) There shall be a working cell phone or other mechanism for making emergency telephone calls available in each vehicle during transport. 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: He-C 6916.14 Appropriate Precautions in Transporting Children. Programs who wish to take children on routine, unplanned local trips, or scheduled field trips shall obtain a signed and dated permission slip from each child’s parent, which specifies all approved destinations and activities. This permission slip shall include the destination of the trip and the estimated time that the parent can expect the child to return to the program. The following shall be accessible to staff on any field trip: An attendance record which includes the name and age of each child; Copies of the registration and emergency information form required in He-C 6916.07(a), for each child; A first aid kit adequate to meet the needs of the children in attendance on the field trip; All medications requiring administration during the hours of the field trip as required by He-C 6916.09; and All emergency medications as required by He-C 6916.08 for the children in attendance on the field trip. Items referenced in (b) above for each child shall remain with an individual who is with the child, including during transport. During any field trip, at least one staff member shall have access to a working phone, in case of emergency, and that phone number shall be available to parents and to staff remaining at the facility. Children who are transported by the program or during any program-sponsored activity shall be transported in vehicles which are: Registered, insured, and inspected in accordance with the laws and rules of the state of New Hampshire; Driven by individuals who are at least 18 years of age and hold a valid driver’s license; and Maintained in safe operating condition. Staff shall be prohibited from using mobile electronic devices while operating a vehicle to transport children, including hands-free operation. The number of persons who are transported by the program or in any vehicle during any program- sponsored activity shall be limited to the number of persons the vehicle is designed to carry. In all vehicles, age-appropriate child restraints or seat belts shall be provided for and used by each child in accordance with RSA 265:107-a. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.14 Appropriate Precautions in Transporting Children. Programs who wish to take children on routine, unplanned local trips, or scheduled field trips shall obtain a signed and dated permission slip from each child’s parent, which specifies all approved destinations and activities. This permission slip shall include the destination of the trip and the estimated time that the parent can expect the child to return to the program. The following shall be accessible to staff on any field trip: An attendance record which includes the name and age of each child; Copies of the registration and emergency information form required in He-C 6916.07(a), for each child; A first aid kit adequate to meet the needs of the children in attendance on the field trip; All medications requiring administration during the hours of the field trip as required by He-C 6916.09; and All emergency medications as required by He-C 6916.08 for the children in attendance on the field trip. Items referenced in (b) above for each child shall remain with an individual who is with the child, including during transport. During any field trip, at least one staff member shall have access to a working phone, in case of emergency, and that phone number shall be available to parents and to staff remaining at the facility. Children who are transported by the program or during any program-sponsored activity shall be transported in vehicles which are: Registered, insured, and inspected in accordance with the laws and rules of the state of New Hampshire; Driven by individuals who are at least 18 years of age and hold a valid driver’s license; and Maintained in safe operating condition. Staff shall be prohibited from using mobile electronic devices while operating a vehicle to transport children, including hands-free operation. The number of persons who are transported by the program or in any vehicle during any program- sponsored activity shall be limited to the number of persons the vehicle is designed to carry. In all vehicles, age-appropriate child restraints or seat belts shall be provided for and used by each child in accordance with RSA 265:107-a. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.14 Appropriate Precautions in Transporting Children. Programs who wish to take children on routine, unplanned local trips, or scheduled field trips shall obtain a signed and dated permission slip from each child’s parent, which specifies all approved destinations and activities. This permission slip shall include the destination of the trip and the estimated time that the parent can expect the child to return to the program. The following shall be accessible to staff on any field trip: An attendance record which includes the name and age of each child; Copies of the registration and emergency information form required in He-C 6916.07(a), for each child; A first aid kit adequate to meet the needs of the children in attendance on the field trip; All medications requiring administration during the hours of the field trip as required by He-C 6916.09; and All emergency medications as required by He-C 6916.08 for the children in attendance on the field trip. Items referenced in (b) above for each child shall remain with an individual who is with the child, including during transport. During any field trip, at least one staff member shall have access to a working phone, in case of emergency, and that phone number shall be available to parents and to staff remaining at the facility. Children who are transported by the program or during any program-sponsored activity shall be transported in vehicles which are: Registered, insured, and inspected in accordance with the laws and rules of the state of New Hampshire; Driven by individuals who are at least 18 years of age and hold a valid driver’s license; and Maintained in safe operating condition. Staff shall be prohibited from using mobile electronic devices while operating a vehicle to transport children, including hands-free operation. The number of persons who are transported by the program or in any vehicle during any program- sponsored activity shall be limited to the number of persons the vehicle is designed to carry. In all vehicles, age-appropriate child restraints or seat belts shall be provided for and used by each child in accordance with RSA 265:107-a. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 4002.32: (e) Whenever the program provides transportation, it shall ensure that: (1) Any vehicle used for transportation of children is registered and inspected in accordance with the laws of the state of New Hampshire; (2) The vehicle is maintained in a safe operating condition, and is clean and free of obstructions on the floors and seats, and any sharp, heavy, or potentially dangerous objects are placed in the trunk or cargo area and securely restrained; (3) The operator of any vehicle transporting children is at least 18 years old and holds a valid driver’s license; (4) The driver and any other attendants on the vehicle have received training in the safe transportation of children; (5) The driver of the vehicle is alert and not distracted by telephone, radio, or other communications; and (6) The driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that no child is left alone in a vehicle at any time. (f) Child care staff shall not permit any child to remain in any vehicle unattended by staff of the child care program. (g) Any vehicle used to transport children, whether owned by the program, a child care staff member or by a parent who is transporting children other than his or her own, shall have proof of current liability insurance. (h) Child care staff shall ensure: (1) The number of children riding in any vehicle does not exceed the number of persons the vehicle is designed to carry; (2) Individual, age appropriate child restraints or seat belts are provided for and used by each child in accordance with RSA 265:107-a, and the driver and any other adults shall use their seatbelts when transporting children; and (3) All children remain seated when the vehicle is in operation. (i) Child care staff shall carry on all field trips: (1) A copy of each child’s registration and emergency information forms; (2) A first aid kit in the vehicle whenever children are present; (3) A copy of the parental permission slip for the field trip; (4) An attendance sheet documentation that staff accounted for each child every time they entered or exited the vehicle; (5) All emergency and currently prescribed child medications, as applicable; and (6) In each vehicle, a form that includes the program name, address, and phone number. (j) There shall be a working cell phone or other mechanism for making emergency telephone calls available in each vehicle during transport. 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: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. 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: He-C 6916.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). Programs shall have on the premises a selection of non-expired first aid supplies adequate to meet the needs of the children in care. If a child receives an injury or an incident occurs requiring first aid treatment, staff shall inform the child’s parent of the injury on the date the child is injured. He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). Programs shall have on the premises a selection of non-expired first aid supplies adequate to meet the needs of the children in care. If a child receives an injury or an incident occurs requiring first aid treatment, staff shall inform the child’s parent of the injury on the date the child is injured. He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). Programs shall have on the premises a selection of non-expired first aid supplies adequate to meet the needs of the children in care. If a child receives an injury or an incident occurs requiring first aid treatment, staff shall inform the child’s parent of the injury on the date the child is injured. He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. 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: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. 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: He-C 6916.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). If CPR is performed on a child while in the care of the program, staff shall: Notify the child’s parent immediately; Notify the department within 48 hours; and Provide to the department a written report which details the nature and circumstances which led to CPR being performed within one week of the incident He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). If CPR is performed on a child while in the care of the program, staff shall: Notify the child’s parent immediately; Notify the department within 48 hours; and Provide to the department a written report which details the nature and circumstances which led to CPR being performed within one week of the incident He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.11 First Aid and Pediatric Cardiopulmonary Resuscitation (CPR). If CPR is performed on a child while in the care of the program, staff shall: Notify the child’s parent immediately; Notify the department within 48 hours; and Provide to the department a written report which details the nature and circumstances which led to CPR being performed within one week of the incident He-C 6914.04 (h) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below to DHHS that the provider and each employee has current certification in: (1) Pediatric cardiopulmonary resuscitation (CPR) which shall include instruction in CPR and foreign body airway obstruction management for infants and children by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (2) Pediatric first aid. (i) CPR and first aid training as specified in (h)(1) and (h)(2) above may be taken via correspondence or online, provided a skill test is performed in person prior to becoming certified. He-C 6914.05 (8) Complete and maintain current pediatric first aid and CPR certifications as required by He C 6914.04(h); vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 4002.20: (m) The center director, site director, family child care provider, and all staff used to meet staff to child ratios shall: (1) Be certified in pediatric cardiopulmonary resuscitation (CPR) and first aid within 90 days of the first date of employment; (2) Obtain certification in (m)(1) above by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council, or other nationally recognized organization; and (3) Maintain current certifications required in (m)(1) above. (n) During all operating hours, on and off premises, there shall be at least one staff person who is trained and currently certified as specified in (m) above, with all children. (o) CPR and first aid training as specified in (m) above may be received via correspondence or on-line, provided a skill test is required to be performed prior to becoming certified. (p) Programs shall maintain on file, available for review by the department, copies of current CPR and first aid certificates and licenses. 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: He-C 4002.33: (a) All center directors, agency administrators, site coordinators, or site directors, and all other child care staff who are responsible for the supervision of children, or who are necessary for the staff to child ratios, shall keep on file documentation of completion of a minimum of 6 hours of professional development, which shall be completed in accordance with the following: (1) Within 90 days of the first date of employment; (2) Within 2 weeks for programs operating 3 months of the year or less; or (3) By providing documentation of previous completion. (b) The 6 hours of professional development required in (a) above shall include: (12) Prevention, recognition, and reporting of child abuse and neglect; ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.33: (a) All center directors, agency administrators, site coordinators, or site directors, and all other child care staff who are responsible for the supervision of children, or who are necessary for the staff to child ratios, shall keep on file documentation of completion of a minimum of 6 hours of professional development, which shall be completed in accordance with the following: (1) Within 90 days of the first date of employment; (2) Within 2 weeks for programs operating 3 months of the year or less; or (3) By providing documentation of previous completion. (b) The 6 hours of professional development required in (a) above shall include: (12) Prevention, recognition, and reporting of child abuse and neglect; 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: He-C 6914.04 (e) Each license-exempt child care provider and each employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below that the provider and employee has completed a minimum of 6 hours of training in all required health and safety topics listed below: (1) Prevention and control of infectious diseases; (2) Prevention of sudden infant death syndrome and use of safe sleeping practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Recognizing and reporting child abuse and neglect; (8) Emergency preparedness and response planning; (9) Handling and storage of hazardous materials and the appropriate disposal of bio contaminants (10) For providers offering transportation, appropriate precautions in transporting children; and (11) Child development, birth through 12 years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6914.04 (e) Each license-exempt child care provider and each employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below that the provider and employee has completed a minimum of 6 hours of training in all required health and safety topics listed below: (1) Prevention and control of infectious diseases; (2) Prevention of sudden infant death syndrome and use of safe sleeping practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Recognizing and reporting child abuse and neglect; (8) Emergency preparedness and response planning; (9) Handling and storage of hazardous materials and the appropriate disposal of bio contaminants (10) For providers offering transportation, appropriate precautions in transporting children; and (11) Child development, birth through 12 years. e compliance vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6914.04 (e) Each license-exempt child care provider and each employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below that the provider and employee has completed a minimum of 6 hours of training in all required health and safety topics listed below: (1) Prevention and control of infectious diseases; (2) Prevention of sudden infant death syndrome and use of safe sleeping practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Recognizing and reporting child abuse and neglect; (8) Emergency preparedness and response planning; (9) Handling and storage of hazardous materials and the appropriate disposal of bio contaminants (10) For providers offering transportation, appropriate precautions in transporting children; and (11) Child development, birth through 12 years. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 4002.33: (a) All center directors, agency administrators, site coordinators, or site directors, and all other child care staff who are responsible for the supervision of children, or who are necessary for the staff to child ratios, shall keep on file documentation of completion of a minimum of 6 hours of professional development, which shall be completed in accordance with the following: (1) Within 90 days of the first date of employment; (2) Within 2 weeks for programs operating 3 months of the year or less; or (3) By providing documentation of previous completion. (b) The 6 hours of professional development required in (a) above shall include: (12) Prevention, recognition, and reporting of child abuse and neglect; He-C 6914.04 (e) Each license-exempt child care provider and each employee providing supervision of children or required to meet staff to child ratios, shall submit proof according to (k) below that the provider and employee has completed a minimum of 6 hours of training in all required health and safety topics listed below: (1) Prevention and control of infectious diseases; (2) Prevention of sudden infant death syndrome and use of safe sleeping practices; (3) Administration of medication, consistent with standards for parental consent; (4) Prevention of and response to emergencies due to food and allergic reactions; (5) Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic; (6) Prevention of shaken baby syndrome and abusive head trauma; (7) Recognizing and reporting child abuse and neglect; (8) Emergency preparedness and response planning; (9) Handling and storage of hazardous materials and the appropriate disposal of bio contaminants (10) For providers offering transportation, appropriate precautions in transporting children; and (11) Child development, birth through 12 years. 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: He-C 4002.15: (b) A licensee, permittee, or his or her designee shall: (1) As mandated reporters, report to the division for children, youth, and families at 1-800-894-5533, if the licensee, permittee, child care staff, or other person involved with a program suspects that a child is being abused or neglected, in accordance with RSA 169- C:29; ii. All CCDF-eligible licensed family child care homes. Provide the standard: He-C 4002.15: (b) A licensee, permittee, or his or her designee shall: (1) As mandated reporters, report to the division for children, youth, and families at 1-800-894- 5533, if the licensee, permittee, child care staff, or other person involved with a program suspects that a child is being abused or neglected, in accordance with RSA 169-C:29; 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: He-C 6916.13 Prevention, Recognition, and Reporting of Child Abuse and Neglect Any staff or other person involved with a program who suspects that a child is being abused or neglected shall be a mandated reporter in accordance with RSA 169-C:29 and shall report the suspected abuse to the division for children, youth, and families by calling 1-800-894-5533. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: He-C 6917.13 Prevention, Recognition, and Reporting of Child Abuse and Neglect Any staff or other person involved with a program who suspects that a child is being abused or neglected shall be a mandated reporter in accordance with RSA 169-C:29 and shall report the suspected abuse to the division for children, youth, and families by calling 1-800-894-5533. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: He-C 6917.13 Prevention, Recognition, and Reporting of Child Abuse and Neglect Any staff or other person involved with a program who suspects that a child is being abused or neglected shall be a mandated reporter in accordance with RSA 169- C:29 and shall report the suspected abuse to the division for children, youth, and families by calling 1-800-894-5533. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: He-C 4002.15: (b) A licensee, permittee, or his or her designee shall: (1) As mandated reporters, report to the division for children, youth, and families at 1-800-894-5533, if the licensee, permittee, child care staff, or other person involved with a program suspects that a child is being abused or neglected, in accordance with RSA 169-C:29; 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: He-C 4002.31 (g) Children shall have access to drinking water and be encouraged to drink water throughout the day. (h) Child care programs that provide meals and snacks shall ensure they meet the daily meal patterns listed in the United States Department of Agriculture (USDA) ￿Child Meal Pattern￿ (11/26/2016) and USDA ￿Infant Meal Pattern￿ (11/29/2016) available as listed in Appendix B and copies of which are available in Appendix C. (n) Child care staff shall not serve low fat or non-fat milk, or other non-dairy milk products such as soymilk, oat milk, and almond milk, to children younger than 2 years of age unless authorized to do so in writing by the child’s parent and the child’s licensed health care practitioner. (o) Programs that provide formula or cereal shall provide iron fortified formula or cereal unless restricted in writing by a child’s parent and the child’s licensed health care practitioner. ii. Access to physical activity. Describe: For licensed centers and licensed family providers: He-C 4002.19: (e) Programs shall provide opportunity for at least 60 minutes daily of gross motor activity for children age 18 months and older, except preschools operating 5 or fewer hours per day shall provide at least 20 minutes of gross motor activity daily. iii. Caring for children with special needs. Describe: For licensed centers and licensed family providers: He-C 4002.13: a) The licensee shall accept and make reasonable accommodations to welcome and serve, or continue to serve, any child with a disability. (b) In determining whether accommodations are reasonable and necessary, the program shall: (1) Refer to the Americans with Disabilities Act; and (2) If applicable, request parental release of information from professionals providing services to the child specific to the disability. He-C 4002.24: (a) The play area shall: (1) Be accessible to children with disabilities; He-C 4002.31:(t) During meals and snacks, child care personnel shall: (1) Encourage children to serve themselves, when appropriate; (2) Help children with disabilities to participate in meal and snack times with their peers; iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A