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: All CCDF-eligible licensed centers must meet the standards of prevention and control of infectious disease including: proper sanitation measures for diapering (NAC 432A.411) and disinfection (NAC 432A.414, NAC 432A.415), hand washing (NAC 432A.412), toilet training (NAC 432A.413), immunization requirements must be met prior to admission to the child care facility (NRS 432A.230 and exceptions as listed in NRS 432A.235 and NRS 432A.250), bloodborne pathogen prevention and exposure (NAC 432A.308), and infectious disease outbreak control training. NAC 432A.411 Sanitary measures for changing diapers. (NRS 432A.077) 1. Each area in a facility that is used for changing diapers must: (a) Have a smooth, nonabrasive, impervious surface; (b) Be located within close proximity to a sink that is not used for the preparation of food; (c) Not be located in an area in which food is prepared; (d) Have a smooth, nonabsorbent floor covering; (e) Have nearby, for wet or soiled diapers, a washable receptacle that is lined with plastic and covered with a lid; (f) Be kept in good repair and in a safe condition; and (g) Be cleaned and disinfected after each use by removing any visible soil and applying an approved disinfectant. 2. Each soiled cloth diaper and any soiled clothing that may be contaminated with contagious matter must be stored in an individual plastic bag and be returned to the parents daily. The facility is not required to rinse or dump the contents of a diaper or the underwear of a child cared for in the facility. Each diaper used, including, without limitation, a commercial disposable diaper, must be able to contain urine and stool and minimize contamination. If cloth diapers are used on children, an absorbent inner liner and a waterproof outer covering must be provided with the diaper. 3. The staff of a facility: (a) Shall discourage children from coming near an area that is used for changing diapers; and (b) Shall not leave a child unattended in the diaper changing area. NAC 432A.414 Sanitary measures for floors, rugs, carpets and nonporous surfaces. (NRS 432A.077) 1. A carpeted floor or rug on a floor that is too large to wash in a washing machine must be vacuumed not less than one time each day or more often if necessary and cleaned not less than one time every 3 months or more often if necessary. If the carpeted floor or rug is cleaned by a member of the staff of the facility using a carpet cleaning machine, the Division may require the carpeted floor or rug to be professionally cleaned if the carpeted floor or rug does not appear to be clean. 2. Each floor of a facility that is not carpeted must be swept and mopped not less than one time each day or more often if necessary. 3. When cleaning a nonporous surface in a facility, including, without limitation, cleaning toys, cribs, tables, high chairs and surfaces used to change diapers, the staff of the facility shall: (a) Clean the surface first with soap and water to remove any dirt or debris; and (b) Disinfect the surface with a disinfecting agent. 4. The disinfecting agent used pursuant to subsection 3 must consist of: (a) One-fourth of a cup of liquid chlorine bleach added to 1 gallon of water that is prepared fresh daily and kept in a closed container; (b) One tablespoon of liquid chlorine bleach added to 1 quart of water that is prepared fresh daily; or (c) A solution that is approved by the appropriate state or local agency and is at least as effective as the solutions described in paragraphs (a) and (b). NAC 432A.415 Safety and sanitation of toys, equipment and other objects and material used for play. (NRS 432A.077) 1. Equipment and any material other than a toy that is used for play in a facility must be durable and free from characteristics that may be hazardous or injurious to a child who is less than 2 years of age, including, without limitation, such characteristics as sharp or rough edges, toxic paint or objects that are small enough for a child of that age to swallow and choke on. 2. Any object, toy or component of a toy that is accessible by a child who is less than 3 years of age at a facility must meet the federal size requirements set forth in 16 C.F.R. § 1501.4. 3. Toys with sharp points or edges, plastic bags and objects made from Styrofoam must not be accessible to a child who is less than 3 years of age. 4. A toy or any other piece of equipment that is used for play must be made of a material that is capable of being disinfected and must be cleaned and disinfected promptly after the toy or other piece of equipment has been soiled or put into the mouth of a child, or not less than one time each day. 5. The staff of a facility shall not provide a stuffed animal to any child unless the stuffed animal is laundered or disinfected not less than one time each day or more often if necessary. 6. Toys must not be placed in a crib at any time. The staff of a facility shall adhere to any requirement set forth on the label of a toy regarding the safe use of the toy. 7. Each room at a facility that is used for play and other activities for children must have: (a) Low, open shelves to store toys; (b) An adequate supply of toys that are in good condition and appropriate for the age of the children; (c) Tables and chairs that are the appropriate size for the children; and (d) Any other equipment that is necessary to meet the needs of the children. 8. Any toy that is broken or has a missing part must be repaired or replaced before the toy may be used in the facility. 9. Walkers for children that are designed to be moved across the floor must not be used in a facility. NAC 432A.412 Written procedures for washing of hands. (NRS 432A.077) 1. Each facility must have written procedures concerning the washing of hands. 2. The staff of a facility shall follow the procedures of the facility concerning the washing of hands and shall instruct, monitor and assist the children being cared for at the facility to ensure that the children follow the procedures. 3. The procedures concerning the washing of hands must require, without limitation, that: (a) The staff of the facility wash their hands with soap from a dispenser and warm water: (1) Any time that their hands come into contact with blood, mucus, vomit, feces or urine; (2) Before preparing or handling food; (3) Before engaging in any activity related to serving food, including, without limitation, setting the table; (4) Before and after eating a meal or snack; (5) After using the toilet, helping a child use the toilet or changing a diaper with or without gloves; (6) After attending to an ill child; (7) After handling an animal; (8) Before and after giving medication to a child; and (9) After cleaning a container used to store garbage or handling garbage. (b) The children being cared for in the facility wash their hands with soap from a dispenser and warm water: (1) Any time that their hands come into contact with blood, mucus, vomit, feces or urine; (2) Before handling food; (3) Before and after eating a meal or snack; (4) After handling an animal; (5) After the diaper or underwear of the child is changed; (6) After playing in water; and (7) After playing in a sandbox. (c) The staff of the facility shall ensure that: (1) Each bathroom has running water, soap and single-use or disposable towels; and (2) Any common basin or sink which is filled with standing water is not used for the washing of hands. NAC 432A.413 Written guidelines for toilet training. (NRS 432A.077) 1. Each facility shall develop written guidelines concerning the methods used by the staff of the facility for toilet training and the use of appropriate equipment and clothing for such training. 2. The guidelines concerning toilet training must be distributed to each parent of each child being cared for at the facility who is not yet toilet trained. 3. The guidelines must require the staff of the facility: (a) Not to force a child to remain on the toilet for a prolonged period of time or punish a child for wetting or soiling his or her clothing; (b) Not to leave a child unattended while the child is sitting on a potty-chair or on the toilet; (c) To instruct and assist the children in washing their hands after using the toilet; and (d) If a potty-chair is used to train a child to use the toilet, to: (1) Place the potty-chair on a washable, impervious floor; (2) Use the potty-chair in accordance with the instructions from the manufacturer; (3) Ensure that the potty-chair is stored and used in an area that is not in close proximity to an area used for the preparation of food; (4) Empty the potty-chair into a toilet immediately after each use; (5) Thoroughly clean and disinfect the potty-chair after each use; and (6) Disinfect the utility sink where the potty-chair was cleaned. NAC 432A.308 Completion by caregiver of training for recognition of signs and symptoms of illness and administration of first aid. (NRS 432A.077) 1. Whenever a child care facility is in operation, each caregiver on duty must have completed training for the recognition of signs and symptoms of illness and the administration of first aid. 2. The training for the recognition of signs and symptoms of illness must include, without limitation, the provision of information concerning health and the observation and evaluation of signs and symptoms of illness and responses to illness and emergencies and training in the prevention of exposure to bloodborne pathogens. The training for the administration of first aid must include, without limitation, the administration of first aid to victims of fire, serious injury or the ingestion of poison. Both types of training must be: (a) Provided by a licensed health care professional or a representative of a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an institution approved by The Nevada Registry or its successor organization; and (b) Approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve the training; or (2) If the training is not approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve the training, the Division or the local licensing agency. 3. A certificate or other evidence of compliance issued by a licensed health care professional, a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an approved provider of such training is adequate evidence of compliance. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All CCDF- eligible licensed centers must meet the standards of prevention and control of infectious disease including: proper sanitation measures for diapering (NAC 432A.411) and disinfection (NAC 432A.414, NAC 432A.415), hand washing (NAC 432A.412), toilet training (NAC 432A.413), immunization requirements must be met prior to admission to the child care facility (NRS 432A.230 and exceptions as listed in NRS 432A.235 and NRS 432A.250), bloodborne pathogen prevention and exposure (NAC 432A.308), and infectious disease outbreak control training. NAC 432A.411 Sanitary measures for changing diapers. (NRS 432A.077) 1. Each area in a facility that is used for changing diapers must: (a) Have a smooth, nonabrasive, impervious surface; (b) Be located within close proximity to a sink that is not used for the preparation of food; (c) Not be located in an area in which food is prepared; (d) Have a smooth, nonabsorbent floor covering; (e) Have nearby, for wet or soiled diapers, a washable receptacle that is lined with plastic and covered with a lid; (f) Be kept in good repair and in a safe condition; and (g) Be cleaned and disinfected after each use by removing any visible soil and applying an approved disinfectant. 2. Each soiled cloth diaper and any soiled clothing that may be contaminated with contagious matter must be stored in an individual plastic bag and be returned to the parents daily. The facility is not required to rinse or dump the contents of a diaper or the underwear of a child cared for in the facility. Each diaper used, including, without limitation, a commercial disposable diaper, must be able to contain urine and stool and minimize contamination. If cloth diapers are used on children, an absorbent inner liner and a waterproof outer covering must be provided with the diaper. 3. The staff of a facility: (a) Shall discourage children from coming near an area that is used for changing diapers; and (b) Shall not leave a child unattended in the diaper changing area. NAC 432A.414 Sanitary measures for floors, rugs, carpets and nonporous surfaces. (NRS 432A.077) 1. A carpeted floor or rug on a floor that is too large to wash in a washing machine must be vacuumed not less than one time each day or more often if necessary and cleaned not less than one time every 3 months or more often if necessary. If the carpeted floor or rug is cleaned by a member of the staff of the facility using a carpet cleaning machine, the Division may require the carpeted floor or rug to be professionally cleaned if the carpeted floor or rug does not appear to be clean. 2. Each floor of a facility that is not carpeted must be swept and mopped not less than one time each day or more often if necessary. 3. When cleaning a nonporous surface in a facility, including, without limitation, cleaning toys, cribs, tables, high chairs and surfaces used to change diapers, the staff of the facility shall: (a) Clean the surface first with soap and water to remove any dirt or debris; and (b) Disinfect the surface with a disinfecting agent. 4. The disinfecting agent used pursuant to subsection 3 must consist of: (a) One-fourth of a cup of liquid chlorine bleach added to 1 gallon of water that is prepared fresh daily and kept in a closed container; (b) One tablespoon of liquid chlorine bleach added to 1 quart of water that is prepared fresh daily; or (c) A solution that is approved by the appropriate state or local agency and is at least as effective as the solutions described in paragraphs (a) and (b). NAC 432A.415 Safety and sanitation of toys, equipment and other objects and material used for play. (NRS 432A.077) 1. Equipment and any material other than a toy that is used for play in a facility must be durable and free from characteristics that may be hazardous or injurious to a child who is less than 2 years of age, including, without limitation, such characteristics as sharp or rough edges, toxic paint or objects that are small enough for a child of that age to swallow and choke on. 2. Any object, toy or component of a toy that is accessible by a child who is less than 3 years of age at a facility must meet the federal size requirements set forth in 16 C.F.R. § 1501.4. 3. Toys with sharp points or edges, plastic bags and objects made from Styrofoam must not be accessible to a child who is less than 3 years of age. 4. A toy or any other piece of equipment that is used for play must be made of a material that is capable of being disinfected and must be cleaned and disinfected promptly after the toy or other piece of equipment has been soiled or put into the mouth of a child, or not less than one time each day. 5. The staff of a facility shall not provide a stuffed animal to any child unless the stuffed animal is laundered or disinfected not less than one time each day or more often if necessary. 6. Toys must not be placed in a crib at any time. The staff of a facility shall adhere to any requirement set forth on the label of a toy regarding the safe use of the toy. 7. Each room at a facility that is used for play and other activities for children must have: (a) Low, open shelves to store toys; (b) An adequate supply of toys that are in good condition and appropriate for the age of the children; (c) Tables and chairs that are the appropriate size for the children; and (d) Any other equipment that is necessary to meet the needs of the children. 8. Any toy that is broken or has a missing part must be repaired or replaced before the toy may be used in the facility. 9. Walkers for children that are designed to be moved across the floor must not be used in a facility. NAC 432A.412 Written procedures for washing of hands. (NRS 432A.077) 1. Each facility must have written procedures concerning the washing of hands. 2. The staff of a facility shall follow the procedures of the facility concerning the washing of hands and shall instruct, monitor and assist the children being cared for at the facility to ensure that the children follow the procedures. 3. The procedures concerning the washing of hands must require, without limitation, that: (a) The staff of the facility wash their hands with soap from a dispenser and warm water: (1) Any time that their hands come into contact with blood, mucus, vomit, feces or urine; (2) Before preparing or handling food; (3) Before engaging in any activity related to serving food, including, without limitation, setting the table; (4) Before and after eating a meal or snack; (5) After using the toilet, helping a child use the toilet or changing a diaper with or without gloves; (6) After attending to an ill child; (7) After handling an animal; (8) Before and after giving medication to a child; and (9) After cleaning a container used to store garbage or handling garbage. (b) The children being cared for in the facility wash their hands with soap from a dispenser and warm water: (1) Any time that their hands come into contact with blood, mucus, vomit, feces or urine; (2) Before handling food; (3) Before and after eating a meal or snack; (4) After handling an animal; (5) After the diaper or underwear of the child is changed; (6) After playing in water; and (7) After playing in a sandbox. (c) The staff of the facility shall ensure that: (1) Each bathroom has running water, soap and single-use or disposable towels; and (2) Any common basin or sink which is filled with standing water is not used for the washing of hands. NAC 432A.413 Written guidelines for toilet training. (NRS 432A.077) 1. Each facility shall develop written guidelines concerning the methods used by the staff of the facility for toilet training and the use of appropriate equipment and clothing for such training. 2. The guidelines concerning toilet training must be distributed to each parent of each child being cared for at the facility who is not yet toilet trained. 3. The guidelines must require the staff of the facility: (a) Not to force a child to remain on the toilet for a prolonged period of time or punish a child for wetting or soiling his or her clothing; (b) Not to leave a child unattended while the child is sitting on a potty-chair or on the toilet; (c) To instruct and assist the children in washing their hands after using the toilet; and (d) If a potty-chair is used to train a child to use the toilet, to: (1) Place the potty-chair on a washable, impervious floor; (2) Use the potty-chair in accordance with the instructions from the manufacturer; (3) Ensure that the potty-chair is stored and used in an area that is not in close proximity to an area used for the preparation of food; (4) Empty the potty-chair into a toilet immediately after each use; (5) Thoroughly clean and disinfect the potty-chair after each use; and (6) Disinfect the utility sink where the potty-chair was cleaned. NAC 432A.308 Completion by caregiver of training for recognition of signs and symptoms of illness and administration of first aid. (NRS 432A.077) 1. Whenever a child care facility is in operation, each caregiver on duty must have completed training for the recognition of signs and symptoms of illness and the administration of first aid. 2. The training for the recognition of signs and symptoms of illness must include, without limitation, the provision of information concerning health and the observation and evaluation of signs and symptoms of illness and responses to illness and emergencies and training in the prevention of exposure to bloodborne pathogens. The training for the administration of first aid must include, without limitation, the administration of first aid to victims of fire, serious injury or the ingestion of poison. Both types of training must be: (a) Provided by a licensed health care professional or a representative of a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an institution approved by The Nevada Registry or its successor organization; and (b) Approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve the training; or (2) If the training is not approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve the training, the Division or the local licensing agency. 3. A certificate or other evidence of compliance issued by a licensed health care professional, a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an approved provider of such training is adequate evidence of compliance. iii. All CCDF-eligible licensed in-home care. Provide the standard: The state's CCL program does not license in-home child care providers. All in-home providers receiving child care scholarship payments must take 24 hours of health and safety training prior to providing care or during an orientation period of 90 days. Training includes: prevention and control of infectious diseases, prevention of Sudden Infant Death Syndrome and safe sleeping practices, administration of medication consistent with parental consent standards, prevention and response to emergencies due to food and allergy reactions, physical premise safety, prevention of Shaken Baby Syndrome an abusive head trauma, emergency preparedness and response planning for natural disasters and human-caused events such as firearm/physical violence. [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All CCDF- eligible license-exempt center care providers receiving child care scholarship payments must take 24 hours of health and safety training prior to providing care or during an orientation period of 90 days. Training includes: prevention and control of infectious diseases, prevention of Sudden Infant Death Syndrome and safe sleeping practices, administration of medication consistent with parental consent standards, prevention and response to emergencies due to food and allergy reactions, physical premise safety, prevention of Shaken Baby Syndrome an abusive head trauma, emergency preparedness and response planning for natural disasters and human-caused events such as firearm/physical violence. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: All CCDF-eligible license-exempt family child care providers receiving child care scholarship payments must take 24 hours of health and safety training prior to providing care or during an orientation period of 90 days. Training includes: prevention and control of infectious diseases, prevention of Sudden Infant Death Syndrome and safe sleeping practices, administration of medication consistent with parental consent standards, prevention and response to emergencies due to food and allergy reactions, physical premise safety, prevention of Shaken Baby Syndrome an abusive head trauma, emergency preparedness and response planning for natural disasters and human-caused events such as firearm/physical violence. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The state's CCL program does not license in-home child care providers. All in-home providers receiving child care scholarship payments must take 24 hours of health and safety training prior to providing care or during an orientation period of 90 days. Training includes: prevention and control of infectious diseases, prevention of Sudden Infant Death Syndrome and safe sleeping practices, administration of medication consistent with parental consent standards, prevention and response to emergencies due to food and allergy reactions, physical premise safety, prevention of Shaken Baby Syndrome an abusive head trauma, emergency preparedness and response planning for natural disasters and human-caused events such as firearm/physical violence. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All CCDF-eligible out-of-school programs receiving child care scholarship payments must take 24 hours of health and safety training prior to providing care or during an orientation period of 90 days. Training includes: prevention and control of infectious diseases, prevention of Sudden Infant Death Syndrome and safe sleeping practices, administration of medication consistent with parental consent standards, prevention and response to emergencies due to food and allergy reactions, physical premise safety, prevention of Shaken Baby Syndrome an abusive head trauma, emergency preparedness and response planning for natural disasters and human-caused events such as firearm/physical violence. Outdoor youth programs (e.g., summer camps, day camps, etc.) are required to prepare a written general plan for preventing diseases and coping with emergencies including procedures to be followed in the base camp as well as in the field. The plan for the prevention and elimination of infectious and communicable diseases must be approved by the local health authority. 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: Certificate of immunization prerequisite to admission to child care facility; conditional admission; reporting. Except as otherwise provided by law and unless excused because of religious belief or medical condition, a child may not be admitted to any child care facility within this State unless the parents or guardian of the child submit to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the State Board of Health may determine. The immunization certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his or her designee or a registered nurse or his or her designee, attesting that the certificate accurately reflects the child’s record of immunization. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunization cannot be immediately confirmed by a physician in this State or a local health officer, may enter the child care facility conditionally if the parent or guardian: (a) Agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (b) Submits proof that the parent or guardian has not established a permanent residence in the county in which the facility is located. If a certificate from the physician or local health officer showing that the child has received or is receiving the required immunizations is not submitted to the operator of the child care facility within 15 days after the child was conditionally admitted, the child must be excluded from the facility. Before December 31 of each year, each child care facility shall report to the Division of Public and Behavioral Health, on a form furnished by the Division, the exact number of children who have: (a) Been admitted conditionally to the child care facility; and (b) Completed the immunizations required by this section. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Certificate of immunization prerequisite to admission to child care facility; conditional admission; reporting. Except as otherwise provided by law and unless excused because of religious belief or medical condition, a child may not be admitted to any child care facility within this State unless the parents or guardian of the child submit to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the State Board of Health may determine. The immunization certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his or her designee or a registered nurse or his or her designee, attesting that the certificate accurately reflects the child’s record of immunization. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunization cannot be immediately confirmed by a physician in this State or a local health officer, may enter the child care facility conditionally if the parent or guardian: (a) Agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (b) Submits proof that the parent or guardian has not established a permanent residence in the county in which the facility is located. If a certificate from the physician or local health officer showing that the child has received or is receiving the required immunizations is not submitted to the operator of the child care facility within 15 days after the child was conditionally admitted, the child must be excluded from the facility. Before December 31 of each year, each child care facility shall report to the Division of Public and Behavioral Health, on a form furnished by the Division, the exact number of children who have: (a) Been admitted conditionally to the child care facility; and (b) Completed the immunizations required by 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: OST and OSR standards are set using the Caring for our Children Basics: Immunization Documentation - Programs should require that all parents/guardians of enrolled children provide written documentation of receipt of immunizations appropriate for each child's age. Infants, children, and adolescents should be immunized as specified in the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years developed by the Advisory Committee on Immunization Practices of the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians. Children whose immunizations are not up-to-date or have not been administered according to the recommended schedule should receive the required immunizations, unless contraindicated or for legal exemptions. Unimmunized Children - If immunizations have not been or are not to be administered because of a medical condition, a statement from the child's primary health care provider documenting the reason why the child is temporarily or permanently medically exempt from the immunization requirements should be on file. If immunizations are not to be administered because of the parents'/guardians' religious beliefs, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian should be on file. Parents/guardians of an enrolling or enrolled infant who has not been immunized due to the child’s age should be informed if/when there are children in care who have not had routine immunizations due to exemption. The parent/guardian of a child who has not received the age-appropriate immunizations prior to enrollment and who does not have documented medical or religious, exemptions from routine childhood immunizations should provide documentation of a scheduled appointment or arrangement to receive immunizations. Children who are in foster care or experiencing homelessness as defined by the McKinney-Vento Act should receive services while parents/guardians are taking necessary actions to comply with immunization requirements of the program. An immunization plan and catch-up immunizations should be initiated upon enrollment and completed as soon as possible. If a vaccine-preventable disease to which children are susceptible occurs and potentially exposes the unimmunized children who are susceptible to that disease, the health department should be consulted to determine whether these children should be excluded for the duration of possible exposure or until the appropriate immunizations have been completed. The local or state health department will be able to provide guidelines for exclusion requirements. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: License-exempt family child care home standards are set using the Caring for our Children Basics: Immunization Documentation - Programs should require that all parents/guardians of enrolled children provide written documentation of receipt of immunizations appropriate for each child's age. Infants, children, and adolescents should be immunized as specified in the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years developed by the Advisory Committee on Immunization Practices of the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians. Children whose immunizations are not up-to-date or have not been administered according to the recommended schedule should receive the required immunizations, unless contraindicated or for legal exemptions. Unimmunized Children - If immunizations have not been or are not to be administered because of a medical condition, a statement from the child's primary health care provider documenting the reason why the child is temporarily or permanently medically exempt from the immunization requirements should be on file. If immunizations are not to be administered because of the parents'/guardians' religious beliefs, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian should be on file. Parents/guardians of an enrolling or enrolled infant who has not been immunized due to the child’s age should be informed if/when there are children in care who have not had routine immunizations due to exemption. The parent/guardian of a child who has not received the age-appropriate immunizations prior to enrollment and who does not have documented medical or religious, exemptions from routine childhood immunizations should provide documentation of a scheduled appointment or arrangement to receive immunizations. Children who are in foster care or experiencing homelessness as defined by the McKinney-Vento Act should receive services while parents/guardians are taking necessary actions to comply with immunization requirements of the program. An immunization plan and catch-up immunizations should be initiated upon enrollment and completed as soon as possible. If a vaccine-preventable disease to which children are susceptible occurs and potentially exposes the unimmunized children who are susceptible to that disease, the health department should be consulted to determine whether these children should be excluded for the duration of possible exposure or until the appropriate immunizations have been completed. The local or state health department will be able to provide guidelines for exclusion requirements. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- exempt in-home care standards are set using the Caring for our Children Basics: Immunization Documentation - Programs should require that all parents/guardians of enrolled children provide written documentation of receipt of immunizations appropriate for each child's age. Infants, children, and adolescents should be immunized as specified in the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years developed by the Advisory Committee on Immunization Practices of the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians. Children whose immunizations are not up-to-date or have not been administered according to the recommended schedule should receive the required immunizations, unless contraindicated or for legal exemptions. Unimmunized Children - If immunizations have not been or are not to be administered because of a medical condition, a statement from the child's primary health care provider documenting the reason why the child is temporarily or permanently medically exempt from the immunization requirements should be on file. If immunizations are not to be administered because of the parents'/guardians' religious beliefs, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian should be on file. Parents/guardians of an enrolling or enrolled infant who has not been immunized due to the child’s age should be informed if/when there are children in care who have not had routine immunizations due to exemption. The parent/guardian of a child who has not received the age-appropriate immunizations prior to enrollment and who does not have documented medical or religious, exemptions from routine childhood immunizations should provide documentation of a scheduled appointment or arrangement to receive immunizations. Children who are in foster care or experiencing homelessness as defined by the McKinney-Vento Act should receive services while parents/guardians are taking necessary actions to comply with immunization requirements of the program. An immunization plan and catch-up immunizations should be initiated upon enrollment and completed as soon as possible. If a vaccine-preventable disease to which children are susceptible occurs and potentially exposes the unimmunized children who are susceptible to that disease, the health department should be consulted to determine whether these children should be excluded for the duration of possible exposure or until the appropriate immunizations have been completed. The local or state health department will be able to provide guidelines for exclusion requirements. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: OST and OSR standards are set using the Caring for our Children Basics: Immunization Documentation - Programs should require that all parents/guardians of enrolled children provide written documentation of receipt of immunizations appropriate for each child's age. Infants, children, and adolescents should be immunized as specified in the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years developed by the Advisory Committee on Immunization Practices of the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians. Children whose immunizations are not up-to-date or have not been administered according to the recommended schedule should receive the required immunizations, unless contraindicated or for legal exemptions. Unimmunized Children - If immunizations have not been or are not to be administered because of a medical condition, a statement from the child's primary health care provider documenting the reason why the child is temporarily or permanently medically exempt from the immunization requirements should be on file. If immunizations are not to be administered because of the parents'/guardians' religious beliefs, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian should be on file. Parents/guardians of an enrolling or enrolled infant who has not been immunized due to the child’s age should be informed if/when there are children in care who have not had routine immunizations due to exemption. The parent/guardian of a child who has not received the age-appropriate immunizations prior to enrollment and who does not have documented medical or religious, exemptions from routine childhood immunizations should provide documentation of a scheduled appointment or arrangement to receive immunizations. Children who are in foster care or experiencing homelessness as defined by the McKinney-Vento Act should receive services while parents/guardians are taking necessary actions to comply with immunization requirements of the program. An immunization plan and catch-up immunizations should be initiated upon enrollment and completed as soon as possible. If a vaccine-preventable disease to which children are susceptible occurs and potentially exposes the unimmunized children who are susceptible to that disease, the health department should be consulted to determine whether these children should be excluded for the duration of possible exposure or until the appropriate immunizations have been completed. The local or state health department will be able to provide guidelines for exclusion requirements. 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: NAC 432A.416 Sleeping devices; napping. (NRS 432A.077) 1. Each member of the staff of a facility that is necessary to meet the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205 for napping or sleeping children must be on the same floor in the same building where the children are napping or sleeping. Members of the staff of each facility must be readily accessible and available to be summoned to ensure the safety of the children in the facility. 2. Areas provided for napping or sleeping in a facility must be sufficiently lighted to provide for visual supervision of the children at all times. 3. The staff of each facility shall: (a) Ensure that each infant under 12 months of age is placed on his or her back on a firm mattress, mat or pad manufactured for use by an infant when the infant is napping or sleeping; (b) Use a safe, sturdy, well-constructed, single-level, free-standing crib, portable crib or playpen for children to nap or sleep in; (c) Equip any such sleeping device with a waterproof, firm-fitting mattress; (d) Ensure that each crib to be used by a child who is 6 months of age or younger is constructed with vertical slats that are not more than 2 3/8 inches apart; (e) Ensure that a child who is 18 months of age or younger naps or sleeps in a crib which is appropriate for his or her age or in another sleeping device which has been approved by the Division; (f) Ensure that a child who is older than 18 months of age naps or sleeps in an appropriate crib or on a cot or mat; (g) Ensure that each sleeping device has appropriate bedding and a waterproof and washable covering; (h) Wipe clean each sleeping device with a disinfectant not less than one time each week or more often if necessary; (i) Ensure that the bedding that each child uses is used only for that particular child; (j) Replace the bedding each time it is wet or soiled by a child or when the sleeping device is to be used by another child; (k) Within 15 minutes after a child in a crib has awakened from a nap or from sleeping, take the child out of the crib and engage him or her in an appropriate activity; (l) Ensure that each child takes a nap as needed; (m) Ensure that each napping or sleeping child is in an area from which the staff can readily hear and see the child; and (n) Ensure that each napping or sleeping child is checked by a caregiver not less than one time every 15 minutes. 4. The staff of a facility shall not change the diaper of a child in a crib or other sleeping device. 5. The staff of a facility shall not use a waterbed, sofa, soft mattress, pillow or any other soft surface as a surface on which to place an infant under 12 months of age to nap or sleep. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.416 Sleeping devices; napping. (NRS 432A.077) 1. Each member of the staff of a facility that is necessary to meet the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205 for napping or sleeping children must be on the same floor in the same building where the children are napping or sleeping. Members of the staff of each facility must be readily accessible and available to be summoned to ensure the safety of the children in the facility. 2. Areas provided for napping or sleeping in a facility must be sufficiently lighted to provide for visual supervision of the children at all times. 3. The staff of each facility shall: (a) Ensure that each infant under 12 months of age is placed on his or her back on a firm mattress, mat or pad manufactured for use by an infant when the infant is napping or sleeping; (b) Use a safe, sturdy, well-constructed, single-level, free-standing crib, portable crib or playpen for children to nap or sleep in; (c) Equip any such sleeping device with a waterproof, firm-fitting mattress; (d) Ensure that each crib to be used by a child who is 6 months of age or younger is constructed with vertical slats that are not more than 2 3/8 inches apart; (e) Ensure that a child who is 18 months of age or younger naps or sleeps in a crib which is appropriate for his or her age or in another sleeping device which has been approved by the Division; (f) Ensure that a child who is older than 18 months of age naps or sleeps in an appropriate crib or on a cot or mat; (g) Ensure that each sleeping device has appropriate bedding and a waterproof and washable covering; (h) Wipe clean each sleeping device with a disinfectant not less than one time each week or more often if necessary; (i) Ensure that the bedding that each child uses is used only for that particular child; (j) Replace the bedding each time it is wet or soiled by a child or when the sleeping device is to be used by another child; (k) Within 15 minutes after a child in a crib has awakened from a nap or from sleeping, take the child out of the crib and engage him or her in an appropriate activity; (l) Ensure that each child takes a nap as needed; (m) Ensure that each napping or sleeping child is in an area from which the staff can readily hear and see the child; and (n) Ensure that each napping or sleeping child is checked by a caregiver not less than one time every 15 minutes. 4. The staff of a facility shall not change the diaper of a child in a crib or other sleeping device. 5. The staff of a facility shall not use a waterbed, sofa, soft mattress, pillow or any other soft surface as a surface on which to place an infant under 12 months of age to nap or sleep. 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: OST and OSR not required due to working with school age children only. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN standards within Caring for our Children Basics detailed below: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.1.4.1 Safe Sleep Practices and SIDS Risk Reduction (pg. 12) All staff, parents/guardians, volunteers, and others who care for infants in the early care and education setting should follow safe sleep practices as recommended by the American Academy of Pediatrics (AAP). Cribs must be in compliance with current U.S. Consumer Product Safety Commission (CPSC) and ASTM International safety standards. See Standard 5.4.5.2 for more information. 5.4.5.2 Cribs and Play Yards (pg. 20) Before purchase and use, cribs and play yards should be in compliance with current CPSC and ASTM International safety standards that include ASTM F1169-10a Standard Consumer Safety Specification for Full-Size Baby Cribs, ASTM F406-13, Standard Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards, or the CPSC 16 CFR 1219, 1220, and 1500 Safety Standards for Full-Size Baby Cribs and Non-Full-Size Baby Cribs; Final Rule. Programs should only use cribs for sleep purposes and ensure that each crib is a safe sleep environment as defined by the American Academy of Pediatrics. Each crib should be labeled and used for the infant's exclusive use. Cribs and mattresses should be thoroughly cleaned and sanitized before assignment for use by another child. Infants should not be placed in the cribs with items that could pose a strangulation or suffocation risk. Cribs should be placed away from window blinds or draperies. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN standards within Caring for our Children Basics detailed below: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.1.4.1 Safe Sleep Practices and SIDS Risk Reduction (pg. 12) All staff, parents/guardians, volunteers, and others who care for infants in the early care and education setting should follow safe sleep practices as recommended by the American Academy of Pediatrics (AAP). Cribs must be in compliance with current U.S. Consumer Product Safety Commission (CPSC) and ASTM International safety standards. See Standard 5.4.5.2 for more information. 5.4.5.2 Cribs and Play Yards (pg. 20) Before purchase and use, cribs and play yards should be in compliance with current CPSC and ASTM International safety standards that include ASTM F1169-10a Standard Consumer Safety Specification for Full-Size Baby Cribs, ASTM F406-13, Standard Consumer Safety Specification for Non-Full-Size Baby Cribs/Play Yards, or the CPSC 16 CFR 1219, 1220, and 1500 Safety Standards for Full-Size Baby Cribs and Non-Full-Size Baby Cribs; Final Rule. Programs should only use cribs for sleep purposes and ensure that each crib is a safe sleep environment as defined by the American Academy of Pediatrics. Each crib should be labeled and used for the infant's exclusive use. Cribs and mattresses should be thoroughly cleaned and sanitized before assignment for use by another child. Infants should not be placed in the cribs with items that could pose a strangulation or suffocation risk. Cribs should be placed away from window blinds or draperies. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: OST and OSR not required due to working with school age children only. 5.3.3 Administration of medication, consistent with standards for parental consent health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the administration of medication for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Licensed provider types do not administer medication without the express permission of parents/guardians. Providers can only administer prescription/non-prescription medication to children if the medication is provided to the facility by the parent/guardian with permission to administer and instructions about administration. NAC 432A.376 Medication. Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child- proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213. 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child’s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child’s parent. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Licensed provider types do not administer medication without the express permission of parents/guardians. Providers can only administer prescription/non-prescription medication to children if the medication is provided to the facility by the parent/guardian with permission to administer and instructions about administration. NAC 432A.376 Medication. Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child- proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213. 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child’s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child’s parent. 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: License- Exempt Providers use the information provided within Caring for Our Children Basics: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.2.2.1 Situations that Require Hand Hygiene (pg. 13) All staff, volunteers, and children should abide by the following procedures for hand washing, as defined by the U.S. Centers for Disease Control and Prevention (CDC): a) Upon arrival for the day, after breaks, or when moving from one group to another. b) Before and after: Giving medication or applying a medical ointment or cream in which a break in the skin (e.g., sores, cuts, or scrapes) may be encountered. 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. 4.2.0.10 Care for Children with Food Allergies (pg. 16) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. 9.4.2.1 Contents of Child Records (pg. 26) Programs should maintain a confidential file for each child in one central location on-site and should be immediately available to the child's caregivers/teachers (who should have parental/guardian consent for access to records), the child's parents/guardians, and the licensing authority upon request. The file for each child should include the following: a) Pre-admission enrollment information; b) Admission agreement signed by the parent/guardian at enrollment; c) Initial and updated health care assessments, completed and signed by the child's primary care provider, based on the child's most recent well care visit; d) Health history completed by the parent/guardian at admission; e) Medication record; f) Authorization form for emergency medical care; g) Results of developmental and behavioral screenings; h) Record of persons authorized to pick up child; i) Written informed consent forms signed by the parent/guardian allowing the facility to share the child's health records with other service providers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: License-Exempt Providers use the information provided within Caring for Our Children Basics: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.2.2.1 Situations that Require Hand Hygiene (pg. 13) All staff, volunteers, and children should abide by the following procedures for hand washing, as defined by the U.S. Centers for Disease Control and Prevention (CDC): a) Upon arrival for the day, after breaks, or when moving from one group to another. b) Before and after: Giving medication or applying a medical ointment or cream in which a break in the skin (e.g., sores, cuts, or scrapes) may be encountered. 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. 4.2.0.10 Care for Children with Food Allergies (pg. 16) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. 9.4.2.1 Contents of Child Records (pg. 26) Programs should maintain a confidential file for each child in one central location on-site and should be immediately available to the child's caregivers/teachers (who should have parental/guardian consent for access to records), the child's parents/guardians, and the licensing authority upon request. The file for each child should include the following: a) Pre-admission enrollment information; b) Admission agreement signed by the parent/guardian at enrollment; c) Initial and updated health care assessments, completed and signed by the child's primary care provider, based on the child's most recent well care visit; d) Health history completed by the parent/guardian at admission; e) Medication record; f) Authorization form for emergency medical care; g) Results of developmental and behavioral screenings; h) Record of persons authorized to pick up child; i) Written informed consent forms signed by the parent/guardian allowing the facility to share the child's health records with other service providers. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- Exempt Providers use the information provided within Caring for Our Children Basics: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.2.2.1 Situations that Require Hand Hygiene (pg. 13) All staff, volunteers, and children should abide by the following procedures for hand washing, as defined by the U.S. Centers for Disease Control and Prevention (CDC): a) Upon arrival for the day, after breaks, or when moving from one group to another. b) Before and after: Giving medication or applying a medical ointment or cream in which a break in the skin (e.g., sores, cuts, or scrapes) may be encountered. 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. 4.2.0.10 Care for Children with Food Allergies (pg. 16) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. 9.4.2.1 Contents of Child Records (pg. 26) Programs should maintain a confidential file for each child in one central location on-site and should be immediately available to the child's caregivers/teachers (who should have parental/guardian consent for access to records), the child's parents/guardians, and the licensing authority upon request. The file for each child should include the following: a) Pre-admission enrollment information; b) Admission agreement signed by the parent/guardian at enrollment; c) Initial and updated health care assessments, completed and signed by the child's primary care provider, based on the child's most recent well care visit; d) Health history completed by the parent/guardian at admission; e) Medication record; f) Authorization form for emergency medical care; g) Results of developmental and behavioral screenings; h) Record of persons authorized to pick up child; i) Written informed consent forms signed by the parent/guardian allowing the facility to share the child's health records with other service providers. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: License-Exempt Providers use the information provided within Caring for Our Children Basics: 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 3.2.2.1 Situations that Require Hand Hygiene (pg. 13) All staff, volunteers, and children should abide by the following procedures for hand washing, as defined by the U.S. Centers for Disease Control and Prevention (CDC): a) Upon arrival for the day, after breaks, or when moving from one group to another. b) Before and after: Giving medication or applying a medical ointment or cream in which a break in the skin (e.g., sores, cuts, or scrapes) may be encountered. 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. 4.2.0.10 Care for Children with Food Allergies (pg. 16) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. 9.4.2.1 Contents of Child Records (pg. 26) Programs should maintain a confidential file for each child in one central location on-site and should be immediately available to the child's caregivers/teachers (who should have parental/guardian consent for access to records), the child's parents/guardians, and the licensing authority upon request. The file for each child should include the following: a) Pre-admission enrollment information; b) Admission agreement signed by the parent/guardian at enrollment; c) Initial and updated health care assessments, completed and signed by the child's primary care provider, based on the child's most recent well care visit; d) Health history completed by the parent/guardian at admission; e) Medication record; f) Authorization form for emergency medical care; g) Results of developmental and behavioral screenings; h) Record of persons authorized to pick up child; i) Written informed consent forms signed by the parent/guardian allowing the facility to share the child's health records with other service providers. 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: In licensed facilities, children are not permitted to be administered any medications not provided by the child's parent/guardian. NAC 432A.376 Medication. Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child- proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213. 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child’s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child’s parent. ii. All CCDF-eligible licensed family child care homes. Provide the standard: In licensed facilities, children are not permitted to be administered any medications not provided by the child's parent/guardian. NAC 432A.376 Medication. Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child- proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213. 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child’s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child’s parent. 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: License- Exempt Providers utilize the information provided within Caring for Our Children Basics (detailed below): 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: License-Exempt Providers utilize the information provided within Caring for Our Children Basics (detailed below): 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: License- Exempt Providers utilize the information provided within Caring for Our Children Basics (detailed below): 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non-prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: License-Exempt Providers utilize the information provided within Caring for Our Children Basics (detailed below): 3.6.3.1/3.6.3.2 Medication Administration and Storage (pg. 15) The administration of medicines at the facility should be limited to: a) Prescription or non- prescription medication (over-the-counter) ordered by the prescribing health professional for a specific child with written permission of the parent/guardian. Prescription medication should be labeled with the child’s name; date the prescription was filled; name and contact information of the prescribing health professional; expiration date; medical need; instructions for administration, storage, and disposal; and name and strength of the medication. b) Labeled medications (over-the-counter) brought to the early care and education facility by the parent/guardian in the original container. The label should include the child's name; dosage; relevant warnings as well as specific; and legible instructions for administration, storage; and disposal. Programs should never administer a medication that is prescribed for one child to another child. Documentation that the medicine/agent is administered to the child as prescribed is required. Medication should not be used beyond the date of expiration. Unused medications should be returned to the parent/guardian for disposal. All medications, refrigerated or unrefrigerated, should have child-resistant caps; be stored away from food at the proper temperature, and be inaccessible to children. 3.6.3.3 Training of Caregivers/Teachers to Administer Medication (pg. 16) Any caregiver/teacher who administers medication should complete a standardized training course that includes skill and competency assessment in medication administration. The course should be repeated according to state and/or local regulation and taught by a trained professional. Skill and competency should be monitored whenever an administration error occurs. 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: NAC432A.385 Snacks and meals. (NRS 432A.077) 1. The staff of each facility shall: (a) Provide appropriate and adequate seating for the children at the facility during snacks and meals; (b) If a high chair is used, ensure that the chair: (1) Is in good condition; (2) Has a wide base; and (3) Has a safety belt for the child; (c) Wash with a detergent and disinfect before and after each use of any table that is used during a snack or meal; (d) Allow, encourage and assist each child to feed himself or herself, including, without limitation, encouraging a child to hold and drink from a cup, use a spoon and use his or her fingers to feed himself or herself; (e) Offer each child drinking water at times other than during his or her regular feedings; (f) Discard any food that is left in a dish after a meal; (g) Ensure that bottles and containers of food are not kept in water longer than 5 minutes, and stir, shake and test a bottle or container of food before using the bottle or container to feed an infant; (h) Not hold an infant while preparing food; (i) On a daily basis, empty, clean and sanitize any pot used to warm a bottle or food; (j) Store each bottle of formula and container of food in accordance with the instructions from the manufacturer of the formula or food; (k) Label each bottle of formula and container of food with the name of the child to whom it belongs and the date the formula or food was prepared by the facility or was prepared or purchased by the parent; (l) Immediately refrigerate and label each container of breast milk provided by a parent; (m) Return each bottle to the appropriate parent each day; (n) Return any unused, open container of food to the appropriate parent each day if the child was not fed directly from the container of food; and (o) Develop with the parents of a child a plan for feeding the child, which must include, without limitation: (1) Instructions for feeding; (2) Any special dietary restrictions, including, without limitation, any allergies to food; (3) A schedule of times for feeding; (4) Whether the child will be fed breast milk, formula or solid food; (5) If the child will be fed breast milk or formula, when to begin feeding solid food; and (6) Likes and dislikes of certain foods. 2. A child who is fed with a bottle and does not hold his or her own bottle must be held by a caregiver while being fed with a bottle. The bottle must not be propped for feeding. A child who demonstrates a preference for holding a bottle during feeding may hold his or her own bottle and need not be held by a caregiver if the caregiver is directly observing the child. 3. The staff of a facility may feed a child commercially prepared baby food directly from the jar in which it was packaged or from a separate dish. If the staff feeds the child from the jar, the staff shall discard the jar after it is used. NAC 432A.308 Completion by caregiver of training for recognition of signs and symptoms of illness and administration of first aid. (NRS 432A.077) 1. Whenever a child care facility is in operation, each caregiver on duty must have completed training for the recognition of signs and symptoms of illness and the administration of first aid. 2. The training for the recognition of signs and symptoms of illness must include, without limitation, the provision of information concerning health and the observation and evaluation of signs and symptoms of illness and responses to illness and emergencies and training in the prevention of exposure to bloodborne pathogens. The training for the administration of first aid must include, without limitation, the administration of first aid to victims of fire, serious injury or the ingestion of poison. Both types of training must be: (a) Provided by a licensed health care professional or a representative of a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an institution approved by The Nevada Registry or its successor organization; and (b) Approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve the training; or (2) If the training is not approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve the training, the Division or the local licensing agency. 3. A certificate or other evidence of compliance issued by a licensed health care professional, a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an approved provider of such training is adequate evidence of compliance. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC432A.385 Snacks and meals. (NRS 432A.077) 1. The staff of each facility shall: (a) Provide appropriate and adequate seating for the children at the facility during snacks and meals; (b) If a high chair is used, ensure that the chair: (1) Is in good condition; (2) Has a wide base; and (3) Has a safety belt for the child; (c) Wash with a detergent and disinfect before and after each use of any table that is used during a snack or meal; (d) Allow, encourage and assist each child to feed himself or herself, including, without limitation, encouraging a child to hold and drink from a cup, use a spoon and use his or her fingers to feed himself or herself; (e) Offer each child drinking water at times other than during his or her regular feedings; (f) Discard any food that is left in a dish after a meal; (g) Ensure that bottles and containers of food are not kept in water longer than 5 minutes, and stir, shake and test a bottle or container of food before using the bottle or container to feed an infant; (h) Not hold an infant while preparing food; (i) On a daily basis, empty, clean and sanitize any pot used to warm a bottle or food; (j) Store each bottle of formula and container of food in accordance with the instructions from the manufacturer of the formula or food; (k) Label each bottle of formula and container of food with the name of the child to whom it belongs and the date the formula or food was prepared by the facility or was prepared or purchased by the parent; (l) Immediately refrigerate and label each container of breast milk provided by a parent; (m) Return each bottle to the appropriate parent each day; (n) Return any unused, open container of food to the appropriate parent each day if the child was not fed directly from the container of food; and (o) Develop with the parents of a child a plan for feeding the child, which must include, without limitation: (1) Instructions for feeding; (2) Any special dietary restrictions, including, without limitation, any allergies to food; (3) A schedule of times for feeding; (4) Whether the child will be fed breast milk, formula or solid food; (5) If the child will be fed breast milk or formula, when to begin feeding solid food; and (6) Likes and dislikes of certain foods. 2. A child who is fed with a bottle and does not hold his or her own bottle must be held by a caregiver while being fed with a bottle. The bottle must not be propped for feeding. A child who demonstrates a preference for holding a bottle during feeding may hold his or her own bottle and need not be held by a caregiver if the caregiver is directly observing the child. 3. The staff of a facility may feed a child commercially prepared baby food directly from the jar in which it was packaged or from a separate dish. If the staff feeds the child from the jar, the staff shall discard the jar after it is used. NAC 432A.308 Completion by caregiver of training for recognition of signs and symptoms of illness and administration of first aid. (NRS 432A.077) 1. Whenever a child care facility is in operation, each caregiver on duty must have completed training for the recognition of signs and symptoms of illness and the administration of first aid. 2. The training for the recognition of signs and symptoms of illness must include, without limitation, the provision of information concerning health and the observation and evaluation of signs and symptoms of illness and responses to illness and emergencies and training in the prevention of exposure to bloodborne pathogens. The training for the administration of first aid must include, without limitation, the administration of first aid to victims of fire, serious injury or the ingestion of poison. Both types of training must be: (a) Provided by a licensed health care professional or a representative of a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an institution approved by The Nevada Registry or its successor organization; and (b) Approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve the training; or (2) If the training is not approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve the training, the Division or the local licensing agency. 3. A certificate or other evidence of compliance issued by a licensed health care professional, a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an approved provider of such training is adequate evidence of compliance. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 4.2.0.10 Care for Children with Food Allergies (pg. 16-17) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 4.2.0.10 Care for Children with Food Allergies (pg. 16-17) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 4.2.0.10 Care for Children with Food Allergies (pg. 16-17) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 4.2.0.10 Care for Children with Food Allergies (pg. 16-17) Each child with a food allergy should have a written care plan that includes: a) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food; b) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications. Based on the child's care plan and prior to caring for the child, caregivers/teachers should receive training for, demonstrate competence in, and implement measures for: a) Preventing exposure to the specific food(s) to which the child is allergic; b) Recognizing the symptoms of an allergic reaction; c) Treating allergic reactions. The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting. The program should notify the parents/guardians immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The program should contact the emergency medical services system immediately whenever epinephrine has been administered. Each child’s food allergies should be posted prominently in the classroom and/or wherever food is served with permission of the parent/guardian. 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: Per NAC 432A.323 providers are required to be trained in the prevention of and response to emergencies due to food and allergic reactions. This requirement is written out on the on-site inspection form that a licensing surveyor uses to monitor how this standard is maintained and implemented. Further, how a licensed facility responds to emergencies is required to be written out in their parent handbook. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Per NAC 432A.323 providers are required to be trained in the prevention of and response to emergencies due to food and allergic reactions. This requirement is written out on the on-site inspection form that a licensing surveyor uses to monitor how this standard is maintained and implemented. Further, how a licensed facility responds to emergencies is required to be written out in their parent handbook. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of 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: All CCDF- eligible providers are required to complete mandatory training which includes the prevention of and response to emergencies due to food and allergic reactions prior to providing care or during an orientation period of 90 days, and annually thereafter. The Annual Health and Safety Checklist completed during the annual monitor for license-exempt providers evaluates compliance with prevention of and response to emergencies due to food and allergic reactions. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: All CCDF-eligible providers are required to complete mandatory training which includes the prevention of and response to emergencies due to food and allergic reactions prior to providing care or during an orientation period of 90 days, and annually thereafter. The Annual Health and Safety Checklist completed during the annual monitor for license-exempt providers evaluates compliance with prevention of and response to emergencies due to food and allergic reactions. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All CCDF- eligible providers are required to complete mandatory training which includes the prevention of and response to emergencies due to food and allergic reactions prior to providing care or during an orientation period of 90 days, and annually thereafter. The Annual Health and Safety Checklist completed during the annual monitor for license-exempt providers evaluates compliance with prevention of and response to emergencies due to food and allergic reactions. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All CCDF-eligible providers are required to complete mandatory training which includes the prevention of and response to emergencies due to food and allergic reactions prior to providing care or during an orientation period of 90 days, and annually thereafter. The Annual Health and Safety Checklist completed during the annual monitor for license-exempt providers evaluates compliance with prevention of and response to emergencies due to food and allergic reactions. 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: NAC 432A.250 Building and grounds. (NRS 432A.077) 1. Except as otherwise provided in this subsection, subsection 3 and NRS 432A.078, in each facility there must be: (a) At least 35 square feet of indoor space for each child, exclusive of bathrooms, halls, kitchen, stairs, storage spaces, multipurpose rooms and gymnasiums that are not regularly used. (b) At least 37 1/2 square feet of outdoor play space for each child, as determined by the maximum number of children stated on the license for the facility. An accommodation facility need not provide outdoor play space. 2. Each facility shall: (a) Ensure that each room of the facility which is used by children is: (1) Maintained free of drafts and at a temperature that is not less than 65 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of October through March and at a temperature that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of April through September; and (2) Heated, cooled and ventilated to maintain the temperatures required in this paragraph and to avoid the accumulation of odors and fumes; (b) Ensure that electrical devices or electrical apparatuses which are accessible to children are not located near any type of water source, including, without limitation, any sink, tub, shower area or wading pool; and (c) Install nonflammable barriers, including, without limitation, permanent guards or shields to cover heating units, including, without limitation, hot water heating pipes and baseboard heaters with a surface temperature that is hotter than 100 degrees Fahrenheit, to ensure that those heating units are inaccessible to children. 3. A facility that provides care for ill children must have: (a) At least 50 square feet of indoor space for each child, as determined by the maximum number of children stated on the license for the facility, exclusive of bathrooms, halls, kitchen, stairs and storage spaces. (b) A separate ventilation system if the facility is attached to another building. 4. The play area of each facility must: (a) Be fenced or enclosed in a manner that prevents the unsupervised departure of children from the area; (b) Have an adequate drainage system; (c) Be free of hazards, debris and trash; (d) If it is an outdoor play area, provide, during the months of April through September, a shade area or shade areas that are at least equal in size to the product of 5 square feet multiplied by the total number of children in the outdoor play area; (e) Have appropriate, as determined by the Division, depths and perimeters of resilient surfacing underneath and surrounding any elevated play equipment; (f) Have adequate safety barriers around any elevated platforms; (g) Not have any dangerous or poisonous plants or other vegetative matter located within the boundaries of the play area or in an area that is accessible to children from the play area; (h) Not be in a location where any bodies of water are accessible to children; and (i) If it has playground equipment, have only equipment that is: (1) In good repair; (2) Designed and constructed to minimize injury; (3) Compatible with the age of the children in the care of the facility; (4) Spaced to reduce accidents; and (5) Securely anchored. 5. If a facility that provides care for ill children is a component of a child care center and provides outdoor play space, the play space must: (a) Be separate from the play space for well children; (b) Meet the requirements of paragraph (b) of subsection 1; and (c) Meet the requirements of subsection 4. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.250 Building and grounds. (NRS 432A.077) 1. Except as otherwise provided in this subsection, subsection 3 and NRS 432A.078, in each facility there must be: (a) At least 35 square feet of indoor space for each child, exclusive of bathrooms, halls, kitchen, stairs, storage spaces, multipurpose rooms and gymnasiums that are not regularly used. (b) At least 37 1/2 square feet of outdoor play space for each child, as determined by the maximum number of children stated on the license for the facility. An accommodation facility need not provide outdoor play space. 2. Each facility shall: (a) Ensure that each room of the facility which is used by children is: (1) Maintained free of drafts and at a temperature that is not less than 65 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of October through March and at a temperature that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of April through September; and (2) Heated, cooled and ventilated to maintain the temperatures required in this paragraph and to avoid the accumulation of odors and fumes; (b) Ensure that electrical devices or electrical apparatuses which are accessible to children are not located near any type of water source, including, without limitation, any sink, tub, shower area or wading pool; and (c) Install nonflammable barriers, including, without limitation, permanent guards or shields to cover heating units, including, without limitation, hot water heating pipes and baseboard heaters with a surface temperature that is hotter than 100 degrees Fahrenheit, to ensure that those heating units are inaccessible to children. 3. A facility that provides care for ill children must have: (a) At least 50 square feet of indoor space for each child, as determined by the maximum number of children stated on the license for the facility, exclusive of bathrooms, halls, kitchen, stairs and storage spaces. (b) A separate ventilation system if the facility is attached to another building. 4. The play area of each facility must: (a) Be fenced or enclosed in a manner that prevents the unsupervised departure of children from the area; (b) Have an adequate drainage system; (c) Be free of hazards, debris and trash; (d) If it is an outdoor play area, provide, during the months of April through September, a shade area or shade areas that are at least equal in size to the product of 5 square feet multiplied by the total number of children in the outdoor play area; (e) Have appropriate, as determined by the Division, depths and perimeters of resilient surfacing underneath and surrounding any elevated play equipment; (f) Have adequate safety barriers around any elevated platforms; (g) Not have any dangerous or poisonous plants or other vegetative matter located within the boundaries of the play area or in an area that is accessible to children from the play area; (h) Not be in a location where any bodies of water are accessible to children; and (i) If it has playground equipment, have only equipment that is: (1) In good repair; (2) Designed and constructed to minimize injury; (3) Compatible with the age of the children in the care of the facility; (4) Spaced to reduce accidents; and (5) Securely anchored. 5. If a facility that provides care for ill children is a component of a child care center and provides outdoor play space, the play space must: (a) Be separate from the play space for well children; (b) Meet the requirements of paragraph (b) of subsection 1; and (c) Meet the requirements of subsection 4. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.2 Inspection of Buildings (pg. 18) Existing and/or newly constructed, renovated, remodeled, or altered buildings should be inspected by a building inspector to ensure compliance with applicable state and local building and fire codes before the building can be used for the purpose of early care and education. 5.1.1.3 Compliance with Fire Prevention Code (pg. 18) Programs should comply with a state-approved or nationally recognized fire prevention code, such as the National Fire Protection Association (NFPA) 101: Life Safety Code. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.1.6.6 Guardrails and Protective Barriers (pg. 19) Guardrails or protective barriers, such as baby gates, should be provided at open sides of stairs, ramps, and other walking surfaces (e.g., landings, balconies, porches) from which there is more than a 30 inch vertical distance to fall. 5.2.4.2 Safety Covers and Shock Protection Devices for Electrical Outlets (pg. 19) All accessible electrical outlets should be tamper-resistant electrical outlets that contain internal shutter mechanisms to prevent children from sticking objects into receptacles. In settings that do not have tamper-resistant electrical outlets, outlets should have safety covers that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. Safety plugs may also be used if they cannot be easily removed from outlets by children and do not pose a choking risk. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 5.2.9.1 Use and Storage of Toxic Substances (pg. 19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.2.9.5 Carbon Monoxide Detectors (pg. 19) Programs should meet state or local laws regarding carbon monoxide detectors, including circumstances when detectors are necessary. Detectors should be tested monthly, and testing should be documented. Batteries should be changed at least yearly. Detectors should be replaced according to the manufacturer’s instructions. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. 5.3.1.12 Availability and Use of a Telephone of Wireless Communication Device (pg. 20) The facility should provide at all times at least one working non-pay telephone or wireless communication device for general and emergency use on the premises of the child care program, in each vehicle used when transporting children, and on field trips. While transporting children, drivers should not operate a motor vehicle while using a mobile telephone or wireless communications device when the vehicle is in motion or traffic. 5.5.0.8 Firearms (pg. 21) Center-based programs should not have firearms or any other weapon on the premises at any time. If present in a family child care home, parents should be notified and these items should be unloaded, equipped with child protective devices, and kept under lock and key with the ammunition locked separately in areas inaccessible to the children. Parents/guardians should be informed about this policy. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up- to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.2.3.1 Prohibited Surfaces for Placing Climbing Equipment (pg. 21) Equipment used for climbing should not be placed over, or immediately next to, hard surfaces not intended for use as surfacing for climbing equipment. All pieces of playground equipment should be placed over a shock-absorbing material that is either the unitary or the loose-fill type extending beyond the perimeter of the stationary equipment. Organic materials that support colonization of molds and bacteria should not be used. This standard applies whether the equipment is installed outdoors or indoors. Programs should follow CPSC guidelines and ASTM International Standards F1292-13 and F2223-10. 6.2.5.1 Inspection of Indoor and Outdoor Play Areas and Equipment (pg. 22) The indoor and outdoor play areas and equipment should be inspected daily for basic health and safety, including, but not limited to: a) Missing or broken parts; b) Protrusion of nuts and bolts; c) Rust and chipping or peeling paint; d) Sharp edges, splinters, and rough surfaces; e) Stability of handholds; f) Visible cracks; g) Stability of non-anchored large play equipment (e.g., playhouses); h) Wear and deterioration i) Vandalism or trash. Any problems should be corrected before the playground is used by children. 10.4.2.1 Frequency of Inspections for Child Care Centers and Family Child Care Homes (pg. 26) Licensing inspectors or monitoring staff should make on-site inspections to measure program compliance with health, safety, and fire standards prior to issuing an initial license and no less than one, unannounced inspection each year thereafter to ensure compliance with regulations. Additional inspections should take place if needed for the program to achieve satisfactory compliance or if the program is closed at any time. The number of inspections should not include those inspections conducted for the purpose of investigating complaints. Complaints should be investigated promptly, based on severity of the complaint. States should post results of licensing inspections, including complaints, on the internet for parent and public review. Parents/guardians should have easy access to licensing rules and made aware of how to report complaints to the licensing agency. Sufficient numbers of licensing inspectors should be qualified to inspect early care and education programs and trained in related health and safety requirements among other requirements of the State licensure. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.2 Inspection of Buildings (pg. 18) Existing and/or newly constructed, renovated, remodeled, or altered buildings should be inspected by a building inspector to ensure compliance with applicable state and local building and fire codes before the building can be used for the purpose of early care and education. 5.1.1.3 Compliance with Fire Prevention Code (pg. 18) Programs should comply with a state-approved or nationally recognized fire prevention code, such as the National Fire Protection Association (NFPA) 101: Life Safety Code. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.1.6.6 Guardrails and Protective Barriers (pg. 19) Guardrails or protective barriers, such as baby gates, should be provided at open sides of stairs, ramps, and other walking surfaces (e.g., landings, balconies, porches) from which there is more than a 30 inch vertical distance to fall. 5.2.4.2 Safety Covers and Shock Protection Devices for Electrical Outlets (pg. 19) All accessible electrical outlets should be tamper-resistant electrical outlets that contain internal shutter mechanisms to prevent children from sticking objects into receptacles. In settings that do not have tamper-resistant electrical outlets, outlets should have safety covers that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. Safety plugs may also be used if they cannot be easily removed from outlets by children and do not pose a choking risk. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 5.2.9.1 Use and Storage of Toxic Substances (pg. 19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.2.9.5 Carbon Monoxide Detectors (pg. 19) Programs should meet state or local laws regarding carbon monoxide detectors, including circumstances when detectors are necessary. Detectors should be tested monthly, and testing should be documented. Batteries should be changed at least yearly. Detectors should be replaced according to the manufacturer’s instructions. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. 5.3.1.12 Availability and Use of a Telephone of Wireless Communication Device (pg. 20) The facility should provide at all times at least one working non-pay telephone or wireless communication device for general and emergency use on the premises of the child care program, in each vehicle used when transporting children, and on field trips. While transporting children, drivers should not operate a motor vehicle while using a mobile telephone or wireless communications device when the vehicle is in motion or traffic. 5.5.0.8 Firearms (pg. 21) Center-based programs should not have firearms or any other weapon on the premises at any time. If present in a family child care home, parents should be notified and these items should be unloaded, equipped with child protective devices, and kept under lock and key with the ammunition locked separately in areas inaccessible to the children. Parents/guardians should be informed about this policy. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up- to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.2.3.1 Prohibited Surfaces for Placing Climbing Equipment (pg. 21) Equipment used for climbing should not be placed over, or immediately next to, hard surfaces not intended for use as surfacing for climbing equipment. All pieces of playground equipment should be placed over a shock-absorbing material that is either the unitary or the loose-fill type extending beyond the perimeter of the stationary equipment. Organic materials that support colonization of molds and bacteria should not be used. This standard applies whether the equipment is installed outdoors or indoors. Programs should follow CPSC guidelines and ASTM International Standards F1292-13 and F2223-10. 6.2.5.1 Inspection of Indoor and Outdoor Play Areas and Equipment (pg. 22) The indoor and outdoor play areas and equipment should be inspected daily for basic health and safety, including, but not limited to: a) Missing or broken parts; b) Protrusion of nuts and bolts; c) Rust and chipping or peeling paint; d) Sharp edges, splinters, and rough surfaces; e) Stability of handholds; f) Visible cracks; g) Stability of non-anchored large play equipment (e.g., playhouses); h) Wear and deterioration i) Vandalism or trash. Any problems should be corrected before the playground is used by children. 10.4.2.1 Frequency of Inspections for Child Care Centers and Family Child Care Homes (pg. 26) Licensing inspectors or monitoring staff should make on-site inspections to measure program compliance with health, safety, and fire standards prior to issuing an initial license and no less than one, unannounced inspection each year thereafter to ensure compliance with regulations. Additional inspections should take place if needed for the program to achieve satisfactory compliance or if the program is closed at any time. The number of inspections should not include those inspections conducted for the purpose of investigating complaints. Complaints should be investigated promptly, based on severity of the complaint. States should post results of licensing inspections, including complaints, on the internet for parent and public review. Parents/guardians should have easy access to licensing rules and made aware of how to report complaints to the licensing agency. Sufficient numbers of licensing inspectors should be qualified to inspect early care and education programs and trained in related health and safety requirements among other requirements of the State licensure. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.2 Inspection of Buildings (pg. 18) Existing and/or newly constructed, renovated, remodeled, or altered buildings should be inspected by a building inspector to ensure compliance with applicable state and local building and fire codes before the building can be used for the purpose of early care and education. 5.1.1.3 Compliance with Fire Prevention Code (pg. 18) Programs should comply with a state-approved or nationally recognized fire prevention code, such as the National Fire Protection Association (NFPA) 101: Life Safety Code. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.1.6.6 Guardrails and Protective Barriers (pg. 19) Guardrails or protective barriers, such as baby gates, should be provided at open sides of stairs, ramps, and other walking surfaces (e.g., landings, balconies, porches) from which there is more than a 30 inch vertical distance to fall. 5.2.4.2 Safety Covers and Shock Protection Devices for Electrical Outlets (pg. 19) All accessible electrical outlets should be tamper-resistant electrical outlets that contain internal shutter mechanisms to prevent children from sticking objects into receptacles. In settings that do not have tamper-resistant electrical outlets, outlets should have safety covers that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. Safety plugs may also be used if they cannot be easily removed from outlets by children and do not pose a choking risk. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 5.2.9.1 Use and Storage of Toxic Substances (pg. 19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.2.9.5 Carbon Monoxide Detectors (pg. 19) Programs should meet state or local laws regarding carbon monoxide detectors, including circumstances when detectors are necessary. Detectors should be tested monthly, and testing should be documented. Batteries should be changed at least yearly. Detectors should be replaced according to the manufacturer’s instructions. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. 5.3.1.12 Availability and Use of a Telephone of Wireless Communication Device (pg. 20) The facility should provide at all times at least one working non-pay telephone or wireless communication device for general and emergency use on the premises of the child care program, in each vehicle used when transporting children, and on field trips. While transporting children, drivers should not operate a motor vehicle while using a mobile telephone or wireless communications device when the vehicle is in motion or traffic. 5.5.0.8 Firearms (pg. 21) Center-based programs should not have firearms or any other weapon on the premises at any time. If present in a family child care home, parents should be notified and these items should be unloaded, equipped with child protective devices, and kept under lock and key with the ammunition locked separately in areas inaccessible to the children. Parents/guardians should be informed about this policy. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up- to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.2.3.1 Prohibited Surfaces for Placing Climbing Equipment (pg. 21) Equipment used for climbing should not be placed over, or immediately next to, hard surfaces not intended for use as surfacing for climbing equipment. All pieces of playground equipment should be placed over a shock-absorbing material that is either the unitary or the loose-fill type extending beyond the perimeter of the stationary equipment. Organic materials that support colonization of molds and bacteria should not be used. This standard applies whether the equipment is installed outdoors or indoors. Programs should follow CPSC guidelines and ASTM International Standards F1292-13 and F2223-10. 6.2.5.1 Inspection of Indoor and Outdoor Play Areas and Equipment (pg. 22) The indoor and outdoor play areas and equipment should be inspected daily for basic health and safety, including, but not limited to: a) Missing or broken parts; b) Protrusion of nuts and bolts; c) Rust and chipping or peeling paint; d) Sharp edges, splinters, and rough surfaces; e) Stability of handholds; f) Visible cracks; g) Stability of non-anchored large play equipment (e.g., playhouses); h) Wear and deterioration i) Vandalism or trash. Any problems should be corrected before the playground is used by children. 10.4.2.1 Frequency of Inspections for Child Care Centers and Family Child Care Homes (pg. 26) Licensing inspectors or monitoring staff should make on-site inspections to measure program compliance with health, safety, and fire standards prior to issuing an initial license and no less than one, unannounced inspection each year thereafter to ensure compliance with regulations. Additional inspections should take place if needed for the program to achieve satisfactory compliance or if the program is closed at any time. The number of inspections should not include those inspections conducted for the purpose of investigating complaints. Complaints should be investigated promptly, based on severity of the complaint. States should post results of licensing inspections, including complaints, on the internet for parent and public review. Parents/guardians should have easy access to licensing rules and made aware of how to report complaints to the licensing agency. Sufficient numbers of licensing inspectors should be qualified to inspect early care and education programs and trained in related health and safety requirements among other requirements of the State licensure. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.2 Inspection of Buildings (pg. 18) Existing and/or newly constructed, renovated, remodeled, or altered buildings should be inspected by a building inspector to ensure compliance with applicable state and local building and fire codes before the building can be used for the purpose of early care and education. 5.1.1.3 Compliance with Fire Prevention Code (pg. 18) Programs should comply with a state-approved or nationally recognized fire prevention code, such as the National Fire Protection Association (NFPA) 101: Life Safety Code. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.1.6.6 Guardrails and Protective Barriers (pg. 19) Guardrails or protective barriers, such as baby gates, should be provided at open sides of stairs, ramps, and other walking surfaces (e.g., landings, balconies, porches) from which there is more than a 30 inch vertical distance to fall. 5.2.4.2 Safety Covers and Shock Protection Devices for Electrical Outlets (pg. 19) All accessible electrical outlets should be tamper-resistant electrical outlets that contain internal shutter mechanisms to prevent children from sticking objects into receptacles. In settings that do not have tamper-resistant electrical outlets, outlets should have safety covers that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. Safety plugs may also be used if they cannot be easily removed from outlets by children and do not pose a choking risk. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 5.2.9.1 Use and Storage of Toxic Substances (pg. 19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.2.9.5 Carbon Monoxide Detectors (pg. 19) Programs should meet state or local laws regarding carbon monoxide detectors, including circumstances when detectors are necessary. Detectors should be tested monthly, and testing should be documented. Batteries should be changed at least yearly. Detectors should be replaced according to the manufacturer’s instructions. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. 5.3.1.12 Availability and Use of a Telephone of Wireless Communication Device (pg. 20) The facility should provide at all times at least one working non-pay telephone or wireless communication device for general and emergency use on the premises of the child care program, in each vehicle used when transporting children, and on field trips. While transporting children, drivers should not operate a motor vehicle while using a mobile telephone or wireless communications device when the vehicle is in motion or traffic. 5.5.0.8 Firearms (pg. 21) Center-based programs should not have firearms or any other weapon on the premises at any time. If present in a family child care home, parents should be notified and these items should be unloaded, equipped with child protective devices, and kept under lock and key with the ammunition locked separately in areas inaccessible to the children. Parents/guardians should be informed about this policy. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up- to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.2.3.1 Prohibited Surfaces for Placing Climbing Equipment (pg. 21) Equipment used for climbing should not be placed over, or immediately next to, hard surfaces not intended for use as surfacing for climbing equipment. All pieces of playground equipment should be placed over a shock-absorbing material that is either the unitary or the loose-fill type extending beyond the perimeter of the stationary equipment. Organic materials that support colonization of molds and bacteria should not be used. This standard applies whether the equipment is installed outdoors or indoors. Programs should follow CPSC guidelines and ASTM International Standards F1292-13 and F2223-10. 6.2.5.1 Inspection of Indoor and Outdoor Play Areas and Equipment (pg. 22) The indoor and outdoor play areas and equipment should be inspected daily for basic health and safety, including, but not limited to: a) Missing or broken parts; b) Protrusion of nuts and bolts; c) Rust and chipping or peeling paint; d) Sharp edges, splinters, and rough surfaces; e) Stability of handholds; f) Visible cracks; g) Stability of non-anchored large play equipment (e.g., playhouses); h) Wear and deterioration i) Vandalism or trash. Any problems should be corrected before the playground is used by children. 10.4.2.1 Frequency of Inspections for Child Care Centers and Family Child Care Homes (pg. 26) Licensing inspectors or monitoring staff should make on-site inspections to measure program compliance with health, safety, and fire standards prior to issuing an initial license and no less than one, unannounced inspection each year thereafter to ensure compliance with regulations. Additional inspections should take place if needed for the program to achieve satisfactory compliance or if the program is closed at any time. The number of inspections should not include those inspections conducted for the purpose of investigating complaints. Complaints should be investigated promptly, based on severity of the complaint. States should post results of licensing inspections, including complaints, on the internet for parent and public review. Parents/guardians should have easy access to licensing rules and made aware of how to report complaints to the licensing agency. Sufficient numbers of licensing inspectors should be qualified to inspect early care and education programs and trained in related health and safety requirements among other requirements of the State licensure. 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: Per NAC 432A.250, licensed facilities are required to ensure that children have no access to bodies of water. NAC 432A.546 provides a standard for safety if the facility offers activities in water. The onsite inspection checklist includes checking for these requirements which a licensing surveyor will monitor for during the onsite facility inspection to ensure this standard is met. NAC 432A.546 Facilities which provide activities in water. (NRS 432A.077) 1. Portable wading pools and other containers of water may be used in a facility if: (a) The depth of the water in the pool or container does not exceed 6 inches; and (b) The pool or container is emptied, cleaned and sanitized immediately after each use. 2. A facility which provides activities in water that has a depth greater than 6 inches, other than a swimming lesson which is taught at a public swimming pool, shall ensure that: (a) No child is in water with a depth that is higher than the chest of the child while the child is standing; (b) At least one caregiver is within arm’s reach of each child who is less than 3 years of age; (c) The children are not allowed to wade or swim in a moving body of water, including, without limitation, a stream, river, creek or irrigation ditch; and (d) At least one person who is currently certified as a lifeguard or water safety instructor by the American National Red Cross or an equivalent water safety program is supervising the children. A public lifeguard may satisfy the requirement of this paragraph. 3. A facility which offers an activity in the water as described in subsection 2 must offer the activity as an optional activity. 4. When children cared for in a facility are engaged in an activity in the water as described in subsection 2 and the children are: (a) Less than 3 years of age, the ratio of caregivers to children must be one caregiver for each child; (b) At least 3 years of age but less than 6 years of age, the ratio of caregivers to children must be one caregiver for every 4 children; and (c) Except as otherwise provided in subsection 5, at least 6 years of age or older, the ratio of caregivers to children must be one caregiver for every 6 children. 5. When children cared for in a facility are engaged in an activity in the water as described in subsection 2 and the children are at least 6 years of age or older, if: (a) There are more than 6 children but less than 12 children engaged in the activity, the ratio of caregivers to children must be two caregivers for each group of that size; (b) There are at least 12 children but less than 20 children engaged in the activity, the ratio of caregivers to children must be three caregivers for each group of that size; and (c) There are 20 or more children engaged in the activity, the ratio of caregivers to children must be three caregivers plus one additional caregiver for every sixth additional child in excess of 20 children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Per NAC 432A.250, licensed facilities are required to ensure that children have no access to bodies of water. NAC 432A.546 provides a standard for safety if the facility offers activities in water. The onsite inspection checklist includes checking for these requirements which a licensing surveyor will monitor for during the onsite facility inspection to ensure this standard is met. NAC 432A.546 Facilities which provide activities in water. (NRS 432A.077) 1. Portable wading pools and other containers of water may be used in a facility if: (a) The depth of the water in the pool or container does not exceed 6 inches; and (b) The pool or container is emptied, cleaned and sanitized immediately after each use. 2. A facility which provides activities in water that has a depth greater than 6 inches, other than a swimming lesson which is taught at a public swimming pool, shall ensure that: (a) No child is in water with a depth that is higher than the chest of the child while the child is standing; (b) At least one caregiver is within arm’s reach of each child who is less than 3 years of age; (c) The children are not allowed to wade or swim in a moving body of water, including, without limitation, a stream, river, creek or irrigation ditch; and (d) At least one person who is currently certified as a lifeguard or water safety instructor by the American National Red Cross or an equivalent water safety program is supervising the children. A public lifeguard may satisfy the requirement of this paragraph. 3. A facility which offers an activity in the water as described in subsection 2 must offer the activity as an optional activity. 4. When children cared for in a facility are engaged in an activity in the water as described in subsection 2 and the children are: (a) Less than 3 years of age, the ratio of caregivers to children must be one caregiver for each child; (b) At least 3 years of age but less than 6 years of age, the ratio of caregivers to children must be one caregiver for every 4 children; and (c) Except as otherwise provided in subsection 5, at least 6 years of age or older, the ratio of caregivers to children must be one caregiver for every 6 children. 5. When children cared for in a facility are engaged in an activity in the water as described in subsection 2 and the children are at least 6 years of age or older, if: (a) There are more than 6 children but less than 12 children engaged in the activity, the ratio of caregivers to children must be two caregivers for each group of that size; (b) There are at least 12 children but less than 20 children engaged in the activity, the ratio of caregivers to children must be three caregivers for each group of that size; and (c) There are 20 or more children engaged in the activity, the ratio of caregivers to children must be three caregivers plus one additional caregiver for every sixth additional child in excess of 20 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 2.2.0.4 Supervision Near Water (pg. 10) Constant and active supervision should be maintained when any child is in or around water. During swimming and/or bathing where an infant or toddler is present, the ratio should always be one adult to one infant/toddler. During wading and/or water play activities, the supervising adult should be within an arm’s length providing touch supervision. Programs should ensure that all pools have drain covers that are used in compliance with the Virginia Graeme Baker Pool and Spa Safety Act. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. 6.3.2.1 Lifesaving Equipment (pg. 22) Each swimming pool more than six feet in width, length, or diameter should be provided with a ring buoy and rope, a rescue tube, or a throwing line and a shepherd's hook that will not conduct electricity. This equipment should be long enough to reach the center of the pool from the edge of the pool, kept in good repair, and stored safely and conveniently for immediate access. Caregivers/teachers should be trained on the proper use of this equipment. Children should be familiarized with the use of the equipment based on their developmental level. 6.3.5.2 Water in Containers (pg. 22) Bathtubs, buckets, diaper pails, and other open containers of water should be emptied immediately after use. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 2.2.0.4 Supervision Near Water (pg. 10) Constant and active supervision should be maintained when any child is in or around water. During swimming and/or bathing where an infant or toddler is present, the ratio should always be one adult to one infant/toddler. During wading and/or water play activities, the supervising adult should be within an arm’s length providing touch supervision. Programs should ensure that all pools have drain covers that are used in compliance with the Virginia Graeme Baker Pool and Spa Safety Act. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. 6.3.2.1 Lifesaving Equipment (pg. 22) Each swimming pool more than six feet in width, length, or diameter should be provided with a ring buoy and rope, a rescue tube, or a throwing line and a shepherd's hook that will not conduct electricity. This equipment should be long enough to reach the center of the pool from the edge of the pool, kept in good repair, and stored safely and conveniently for immediate access. Caregivers/teachers should be trained on the proper use of this equipment. Children should be familiarized with the use of the equipment based on their developmental level. 6.3.5.2 Water in Containers (pg. 22) Bathtubs, buckets, diaper pails, and other open containers of water should be emptied immediately after use. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 2.2.0.4 Supervision Near Water (pg. 10) Constant and active supervision should be maintained when any child is in or around water. During swimming and/or bathing where an infant or toddler is present, the ratio should always be one adult to one infant/toddler. During wading and/or water play activities, the supervising adult should be within an arm’s length providing touch supervision. Programs should ensure that all pools have drain covers that are used in compliance with the Virginia Graeme Baker Pool and Spa Safety Act. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. 6.3.2.1 Lifesaving Equipment (pg. 22) Each swimming pool more than six feet in width, length, or diameter should be provided with a ring buoy and rope, a rescue tube, or a throwing line and a shepherd's hook that will not conduct electricity. This equipment should be long enough to reach the center of the pool from the edge of the pool, kept in good repair, and stored safely and conveniently for immediate access. Caregivers/teachers should be trained on the proper use of this equipment. Children should be familiarized with the use of the equipment based on their developmental level. 6.3.5.2 Water in Containers (pg. 22) Bathtubs, buckets, diaper pails, and other open containers of water should be emptied immediately after use. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 2.2.0.4 Supervision Near Water (pg. 10) Constant and active supervision should be maintained when any child is in or around water. During swimming and/or bathing where an infant or toddler is present, the ratio should always be one adult to one infant/toddler. During wading and/or water play activities, the supervising adult should be within an arm’s length providing touch supervision. Programs should ensure that all pools have drain covers that are used in compliance with the Virginia Graeme Baker Pool and Spa Safety Act. 5.2.4.4 Location of Electrical Devices Near Water (pg. 19) No electrical device or apparatus accessible to children should be located so it could be plugged into an electrical outlet while a person is in contact with a water source, such as a sink, tub, shower area, water table, or swimming pool. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. 6.3.2.1 Lifesaving Equipment (pg. 22) Each swimming pool more than six feet in width, length, or diameter should be provided with a ring buoy and rope, a rescue tube, or a throwing line and a shepherd's hook that will not conduct electricity. This equipment should be long enough to reach the center of the pool from the edge of the pool, kept in good repair, and stored safely and conveniently for immediate access. Caregivers/teachers should be trained on the proper use of this equipment. Children should be familiarized with the use of the equipment based on their developmental level. 6.3.5.2 Water in Containers (pg. 22) Bathtubs, buckets, diaper pails, and other open containers of water should be emptied immediately after use. c. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from vehicular traffic hazards for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Per NAC 432A.250, licensed facilities are required to ensure their playgrounds are fenced and secured to help ensure appropriate supervision where children are not easily accessed or able to leave with being noticed or escorted. By providing enclosed playgrounds, children are protected from vehicular traffic hazards. An onsite facility inspection is conducted using the inspection checklist to ensure this standard is met. NAC 432A.250 Building and grounds. (NRS 432A.077) 1. Except as otherwise provided in this subsection, subsection 3 and NRS 432A.078, in each facility there must be: (a) At least 35 square feet of indoor space for each child, exclusive of bathrooms, halls, kitchen, stairs, storage spaces, multipurpose rooms and gymnasiums that are not regularly used. (b) At least 37 1/2 square feet of outdoor play space for each child, as determined by the maximum number of children stated on the license for the facility. An accommodation facility need not provide outdoor play space. 2. Each facility shall: (a) Ensure that each room of the facility which is used by children is: (1) Maintained free of drafts and at a temperature that is not less than 65 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of October through March and at a temperature that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of April through September; and (2) Heated, cooled and ventilated to maintain the temperatures required in this paragraph and to avoid the accumulation of odors and fumes; (b) Ensure that electrical devices or electrical apparatuses which are accessible to children are not located near any type of water source, including, without limitation, any sink, tub, shower area or wading pool; and (c) Install nonflammable barriers, including, without limitation, permanent guards or shields to cover heating units, including, without limitation, hot water heating pipes and baseboard heaters with a surface temperature that is hotter than 100 degrees Fahrenheit, to ensure that those heating units are inaccessible to children. 3. A facility that provides care for ill children must have: (a) At least 50 square feet of indoor space for each child, as determined by the maximum number of children stated on the license for the facility, exclusive of bathrooms, halls, kitchen, stairs and storage spaces. (b) A separate ventilation system if the facility is attached to another building. 4. The play area of each facility must: (a) Be fenced or enclosed in a manner that prevents the unsupervised departure of children from the area; (b) Have an adequate drainage system; (c) Be free of hazards, debris and trash; (d) If it is an outdoor play area, provide, during the months of April through September, a shade area or shade areas that are at least equal in size to the product of 5 square feet multiplied by the total number of children in the outdoor play area; (e) Have appropriate, as determined by the Division, depths and perimeters of resilient surfacing underneath and surrounding any elevated play equipment; (f) Have adequate safety barriers around any elevated platforms; (g) Not have any dangerous or poisonous plants or other vegetative matter located within the boundaries of the play area or in an area that is accessible to children from the play area; (h) Not be in a location where any bodies of water are accessible to children; and (i) If it has playground equipment, have only equipment that is: (1) In good repair; (2) Designed and constructed to minimize injury; (3) Compatible with the age of the children in the care of the facility; (4) Spaced to reduce accidents; and (5) Securely anchored. 5. If a facility that provides care for ill children is a component of a child care center and provides outdoor play space, the play space must: (a) Be separate from the play space for well children; (b) Meet the requirements of paragraph (b) of subsection 1; and (c) Meet the requirements of subsection 4. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Per NAC 432A.250, licensed facilities are required to ensure their playgrounds are fenced and secured to help ensure appropriate supervision where children are not easily accessed or able to leave with being noticed or escorted. By providing enclosed playgrounds, children are protected from vehicular traffic hazards. An onsite facility inspection is conducted using the inspection checklist to ensure this standard is met. NAC 432A.250 Building and grounds. (NRS 432A.077) 1. Except as otherwise provided in this subsection, subsection 3 and NRS 432A.078, in each facility there must be: (a) At least 35 square feet of indoor space for each child, exclusive of bathrooms, halls, kitchen, stairs, storage spaces, multipurpose rooms and gymnasiums that are not regularly used. (b) At least 37 1/2 square feet of outdoor play space for each child, as determined by the maximum number of children stated on the license for the facility. An accommodation facility need not provide outdoor play space. 2. Each facility shall: (a) Ensure that each room of the facility which is used by children is: (1) Maintained free of drafts and at a temperature that is not less than 65 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of October through March and at a temperature that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of April through September; and (2) Heated, cooled and ventilated to maintain the temperatures required in this paragraph and to avoid the accumulation of odors and fumes; (b) Ensure that electrical devices or electrical apparatuses which are accessible to children are not located near any type of water source, including, without limitation, any sink, tub, shower area or wading pool; and (c) Install nonflammable barriers, including, without limitation, permanent guards or shields to cover heating units, including, without limitation, hot water heating pipes and baseboard heaters with a surface temperature that is hotter than 100 degrees Fahrenheit, to ensure that those heating units are inaccessible to children. 3. A facility that provides care for ill children must have: (a) At least 50 square feet of indoor space for each child, as determined by the maximum number of children stated on the license for the facility, exclusive of bathrooms, halls, kitchen, stairs and storage spaces. (b) A separate ventilation system if the facility is attached to another building. 4. The play area of each facility must: (a) Be fenced or enclosed in a manner that prevents the unsupervised departure of children from the area; (b) Have an adequate drainage system; (c) Be free of hazards, debris and trash; (d) If it is an outdoor play area, provide, during the months of April through September, a shade area or shade areas that are at least equal in size to the product of 5 square feet multiplied by the total number of children in the outdoor play area; (e) Have appropriate, as determined by the Division, depths and perimeters of resilient surfacing underneath and surrounding any elevated play equipment; (f) Have adequate safety barriers around any elevated platforms; (g) Not have any dangerous or poisonous plants or other vegetative matter located within the boundaries of the play area or in an area that is accessible to children from the play area; (h) Not be in a location where any bodies of water are accessible to children; and (i) If it has playground equipment, have only equipment that is: (1) In good repair; (2) Designed and constructed to minimize injury; (3) Compatible with the age of the children in the care of the facility; (4) Spaced to reduce accidents; and (5) Securely anchored. 5. If a facility that provides care for ill children is a component of a child care center and provides outdoor play space, the play space must: (a) Be separate from the play space for well children; (b) Meet the requirements of paragraph (b) of subsection 1; and (c) Meet the requirements of subsection 4. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 2.2.0.1 Methods of Supervision of Children (pg. 10) In center-based programs, caregivers/teachers should directly supervise children under age 6 by sight and sound at all times. In family child care settings, caregivers should directly supervise children by sight or sound. When children are sleeping, caregivers may supervise by sound with frequent visual checks. Developmentally appropriate child-to-staff ratios should be met during all hours of operation, and safety precautions for specific areas and equipment should be followed. Children under the age of 6 should never be inside or outside by themselves. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 6.1.0.6/6.1.0.8/6.3.1.1 Location of Play Areas Near Bodies of Water/Enclosures for Outdoor Play Areas/Enclosure of Bodies of Water (pg. 21) The outdoor play area should be enclosed with a fence or natural barriers. Fences and barriers should not prevent the supervision of children by caregivers/teachers. If a fence is used, it should be in good condition and conform to applicable local building codes in height and construction. These areas should have at least two exits, with at least one being remote from the buildings. Gates should be equipped with self-closing and positive self-latching closure mechanisms that are high enough or of a type such that children cannot open it. The openings in the fence and gates should be no larger than 3 ½ inches. The fence and gates should be constructed to discourage climbing. Outside play areas should be free from unsecured bodies of water. If present, all water hazards should be inaccessible to unsupervised children and enclosed with a fence that is 4 to 6 feet high or higher and comes within 3 ½ inches of the ground. 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: NAC 432A.400 Discipline. (NRS 432A.077) 1. A licensee of a facility shall enhance a child’s behavior through positive guidance, redirection of the child’s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child’s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; (g) Withhold or use physical activity as a form of punishment; (h) Confine a child as a form of punishment by any means, including, without limitation, in a car seat, high chair, infant carrier or jump seat; or (i) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child’s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.400 Discipline. (NRS 432A.077) 1. A licensee of a facility shall enhance a child’s behavior through positive guidance, redirection of the child’s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child’s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; (g) Withhold or use physical activity as a form of punishment; (h) Confine a child as a form of punishment by any means, including, without limitation, in a car seat, high chair, infant carrier or jump seat; or (i) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child’s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. 3.4.4.3 Preventing and Identifying Shaken Baby Syndrome and Abusive Head Trauma (pg. 14) All programs should have a policy and procedure to identify and prevent shaken baby syndrome and abusive head trauma. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome and abusive head trauma; recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and the development and vulnerabilities of the brain in infancy and early childhood. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. 3.4.4.3 Preventing and Identifying Shaken Baby Syndrome and Abusive Head Trauma (pg. 14) All programs should have a policy and procedure to identify and prevent shaken baby syndrome and abusive head trauma. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome and abusive head trauma; recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and the development and vulnerabilities of the brain in infancy and early childhood. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. 3.4.4.3 Preventing and Identifying Shaken Baby Syndrome and Abusive Head Trauma (pg. 14) All programs should have a policy and procedure to identify and prevent shaken baby syndrome and abusive head trauma. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome and abusive head trauma; recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and the development and vulnerabilities of the brain in infancy and early childhood. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. 3.4.4.3 Preventing and Identifying Shaken Baby Syndrome and Abusive Head Trauma (pg. 14) All programs should have a policy and procedure to identify and prevent shaken baby syndrome and abusive head trauma. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome and abusive head trauma; recognition of potential signs and symptoms of shaken baby syndrome and abusive head trauma; strategies for coping with a crying, fussing, or distraught child; and the development and vulnerabilities of the brain in infancy and early childhood. 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: Per NAC 432A.323, licensed facilities are required to be trained in the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment. Further, this standard is noted on the facility on-site inspection checklist to help ensure compliance and appropriate implementation. Additionally, NAC 432A.400 establishes what is considered inappropriate discipline and constitutes maltreatment of a child. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. NAC 432A.400 Discipline. (NRS 432A.077) 1. A licensee of a facility shall enhance a child’s behavior through positive guidance, redirection of the child’s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child’s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; (g) Withhold or use physical activity as a form of punishment; (h) Confine a child as a form of punishment by any means, including, without limitation, in a car seat, high chair, infant carrier or jump seat; or (i) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child’s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Per NAC 432A.323, licensed facilities are required to be trained in the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment. Further, this standard is noted on the facility on-site inspection checklist to help ensure compliance and appropriate implementation. Additionally, NAC 432A.400 establishes what is considered inappropriate discipline and constitutes maltreatment of a child. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. NAC 432A.400 Discipline. (NRS 432A.077) 1. A licensee of a facility shall enhance a child’s behavior through positive guidance, redirection of the child’s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child’s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; (g) Withhold or use physical activity as a form of punishment; (h) Confine a child as a form of punishment by any means, including, without limitation, in a car seat, high chair, infant carrier or jump seat; or (i) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child’s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below). For FFNs, the standards apply to children birth through age 13 (or 19 if a child with special needs). For OST and OSR providers, the standards apply to school-aged children (e.g., 6 years and older). 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below). For FFNs, the standards apply to children birth through age 13 (or 19 if a child with special needs). For OST and OSR providers, the standards apply to school-aged children (e.g., 6 years and older). 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below). For FFNs, the standards apply to children birth through age 13 (or 19 if a child with special needs). For OST and OSR providers, the standards apply to school-aged children (e.g., 6 years and older). 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below). For FFNs, the standards apply to children birth through age 13 (or 19 if a child with special needs). For OST and OSR providers, the standards apply to school-aged children (e.g., 6 years and older). 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 2.2.0.9 Prohibited Caregiver/Teacher Behaviors (pg. 11) The following behaviors should be prohibited in all early care and education settings: a) The use of corporal punishment, including, but not limited to: i. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting; ii. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures; iii. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances; iv. Exposing a child to extremes of temperature. b) Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; c) Binding, tying to restrict movement, or taping the mouth; d) Using or withholding food or beverages as a punishment; e) Toilet learning/training methods that punish, demean, or humiliate a child; f) Any form of emotional abuse, including rejecting, terrorizing, extended ignoring, isolating, or corrupting a child; g) Any abuse or maltreatment of a child;; h) Abusive, profane, or sarcastic language or verbal abuse, threats, or derogatory remarks about the child or child’s family; i) Any form of public or private humiliation, including threats of physical punishment; j) Physical activity/outdoor time taken away as punishment; k) Placing a child in a crib for a time-out or for disciplinary reasons. 5.3.7 Emergency preparedness and response planning standard Identify by checking below that the emergency preparedness and response planning due to natural disasters and human-caused events standard includes procedures in the following areas: i. [x] Evacuation ii. [x] Relocation iii. [x] Shelter-in-place iv. [x] Lock down v. Staff emergency preparedness [x] Training [x] Practice drills vi. Volunteer emergency preparedness [x] Training [x] Practice drills vii. [x] Communication with families viii. [x] Reunification with families ix. [x] Continuity of operations x. Accommodation of [x] Infants [x] Toddlers [x] Children with disabilities [x] Children with chronic medical conditions xi. If any of the above are not checked, describe: N/A 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: 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." NAC 432A.190.2 Inspections; investigations. (NRS 432A.077, 432A.170, 432A.180, 439.150) In conducting inspections and investigations, the Division may call upon political subdivisions and governmental agencies for assistance. The licensee or applicant shall cooperate with the person conducting the investigation by providing access to the buildings, records required to be maintained pursuant to this chapter and staff of the facility. Failure to provide such access is a ground for revocation of a license or denial of an application for a license. NAC 432A.200.6 The license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. A report of inspection by the State Fire Marshal or the Division, finding satisfactory conditions, may be accepted by the Administrator as proof of compliance with the applicable regulations. NAC 432A.260 Health standards; inspection reports. (NRS 432A.077) 1. To maintain his or her license, the licensee must ensure that his or her facility meets all standards for environmental health which are established by the Division. 2. Reports of inspections concerning the sanitation of a facility must be maintained in a physical file at the facility and available for review at the facility by a parent of a child who attends the facility or a parent who is considering enrolling a child at the facility for at least 2 years after the date of the inspection. ii. All CCDF-eligible licensed family child care homes. Provide the standard: 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." NAC 432A.190.2 Inspections; investigations. (NRS 432A.077, 432A.170, 432A.180, 439.150) In conducting inspections and investigations, the Division may call upon political subdivisions and governmental agencies for assistance. The licensee or applicant shall cooperate with the person conducting the investigation by providing access to the buildings, records required to be maintained pursuant to this chapter and staff of the facility. Failure to provide such access is a ground for revocation of a license or denial of an application for a license. NAC 432A.200.6 The license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. A report of inspection by the State Fire Marshal or the Division, finding satisfactory conditions, may be accepted by the Administrator as proof of compliance with the applicable regulations. NAC 432A.260 Health standards; inspection reports. (NRS 432A.077) 1. To maintain his or her license, the licensee must ensure that his or her facility meets all standards for environmental health which are established by the Division. 2. Reports of inspections concerning the sanitation of a facility must be maintained in a physical file at the facility and available for review at the facility by a parent of a child who attends the facility or a parent who is considering enrolling a child at the facility for at least 2 years after the date of the inspection. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." 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: Licensing does not conduct environmental health inspections. Licensing utilizes a designee. Per NRS 432A.180 (NRS: CHAPTER 432A - SERVICES AND FACILITIES FOR CARE OF CHILDREN (state.nv.us)) a designee of the Administrator shall enter and inspect at least annually, every building or premises of a childcare facility and area of operation of an outdoor youth program to secure compliance with laws and regulations concerning the health, safety and welfare of children in the care of the facility or program. NAC432A.200. 6 (NAC: CHAPTER 432A - SERVICES AND FACILITIES FOR CARE OF CHILDREN (state.nv.us)) states the license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. CCL utilizes our local health agencies to address hazardous materials and bio contaminants. Per NAC432A.323 caregivers are required to be trained in the handling and storage of hazardous materials. All facilities are annually inspection by the Health Department (NAC432A.260) and Child Care Licensing (listed on the on-site inspection conducted biannually) to ensure compliance and implementation. 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." NAC 432A.190.2 Inspections; investigations. (NRS 432A.077, 432A.170, 432A.180, 439.150) In conducting inspections and investigations, the Division may call upon political subdivisions and governmental agencies for assistance. The licensee or applicant shall cooperate with the person conducting the investigation by providing access to the buildings, records required to be maintained pursuant to this chapter and staff of the facility. Failure to provide such access is a ground for revocation of a license or denial of an application for a license. NAC 432A.200.6 The license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. A report of inspection by the State Fire Marshal or the Division, finding satisfactory conditions, may be accepted by the Administrator as proof of compliance with the applicable regulations. NAC 432A.260 Health standards; inspection reports. (NRS 432A.077) 1. To maintain his or her license, the licensee must ensure that his or her facility meets all standards for environmental health which are established by the Division. 2. Reports of inspections concerning the sanitation of a facility must be maintained in a physical file at the facility and available for review at the facility by a parent of a child who attends the facility or a parent who is considering enrolling a child at the facility for at least 2 years after the date of the inspection. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Licensing does not conduct environmental health inspections. Licensing utilizes a designee. Per NRS 432A.180 (NRS: CHAPTER 432A - SERVICES AND FACILITIES FOR CARE OF CHILDREN (state.nv.us)) a designee of the Administrator shall enter and inspect at least annually, every building or premises of a childcare facility and area of operation of an outdoor youth program to secure compliance with laws and regulations concerning the health, safety and welfare of children in the care of the facility or program. NAC432A.200. 6 (NAC: CHAPTER 432A - SERVICES AND FACILITIES FOR CARE OF CHILDREN (state.nv.us)) states the license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. CCL utilizes our local health agencies to address hazardous materials and bio contaminants. Per NAC432A.323 caregivers are required to be trained in the handling and storage of hazardous materials. All facilities are annually inspection by the Health Department (NAC432A.260) and Child Care Licensing (listed on the on-site inspection conducted biannually) to ensure compliance and implementation.5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." NAC 432A.190.2 Inspections; investigations. (NRS 432A.077, 432A.170, 432A.180, 439.150) In conducting inspections and investigations, the Division may call upon political subdivisions and governmental agencies for assistance. The licensee or applicant shall cooperate with the person conducting the investigation by providing access to the buildings, records required to be maintained pursuant to this chapter and staff of the facility. Failure to provide such access is a ground for revocation of a license or denial of an application for a license. NAC 432A.200.6 The license must not be issued until the Administrator of the Division is satisfied that the proposed facility will be in compliance with the applicable codes concerning safety of human life, environmental health, and building and zoning, as established respectively by the State Fire Marshal, the State Board of Health and the appropriate local government. A report of inspection by the State Fire Marshal or the Division, finding satisfactory conditions, may be accepted by the Administrator as proof of compliance with the applicable regulations. NAC 432A.260 Health standards; inspection reports. (NRS 432A.077) 1. To maintain his or her license, the licensee must ensure that his or her facility meets all standards for environmental health which are established by the Division. 2. Reports of inspections concerning the sanitation of a facility must be maintained in a physical file at the facility and available for review at the facility by a parent of a child who attends the facility or a parent who is considering enrolling a child at the facility for at least 2 years after the date of the inspection. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 5.1.1.5 Environmental Audit of Site Location (pg. 18) An environmental audit should be conducted before construction of a new building; renovation or occupation of an older building; or after a natural disaster to properly evaluate and, where necessary, remediate or avoid sites where children's health could be compromised. A written report that includes any remedial action taken should be kept on file. The audit should include assessments of: a) Potential air, soil, and water contamination on program sites and outdoor play spaces; b) Potential toxic or hazardous materials in building construction, such as lead and asbestos; and c) Potential safety hazards in the community surrounding the site. 5.2.9.1 Use and Storage of Toxic Substances (pg.19) All toxic substances should be inaccessible to children and should not be used when children are present. Toxic substances should be used as recommended by the manufacturer and stored in the original labeled containers. The telephone number for the poison control center should be posted and readily accessible in emergency situations. 5.3.1.1/5.5.0.6/5.5.0.7 Safety of Equipment, Materials, and Furnishings (pg. 19) Equipment, materials, furnishings, and play areas should be sturdy, safe, in good repair, and meet the recommendations of the CPSC. Programs should attend to, including, but not limited to, the following safety hazards: a) Openings that could entrap a child's head or limbs; b) Elevated surfaces that are inadequately guarded; c) Lack of specified surfacing and fall zones under and around climbable equipment; d) Mismatched size and design of equipment for the intended users; e) Insufficient spacing between equipment; f) Tripping hazards; g) Components that can pinch, sheer, or crush body tissues; h) Equipment that is known to be of a hazardous type; i) Sharp points or corners; j) Splinters; k) Protruding nails, bolts, or other parts that could entangle clothing or snag skin; l) Loose, rusty parts; m) Hazardous small parts that may become detached during normal use or reasonably foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to a child; n) Strangulation hazards (e.g., straps, strings, etc.); o) Flaking paint; p) Paint that contains lead or other hazardous materials; and q) Tip-over hazards, such as chests, bookshelves, and televisions. r) Plastic bags that are large enough to pose a suffocation risk as well as matches, candles, and lighters should not be accessible to children. NV Registry Class: They must complete the NV Registry approved class entitled "Building and Physical Premises Safety including Storage of Bio-Contaminants and Hazardous Materials." 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: Per NAC 432A.323 caregivers are required to be trained in how to safely transport children. Further, NAC 432A.290 very clearly lists out standards of how transportation is to be handled by licensed facilities. These standards are checked during annual/biannual inspections using the inspection checklist. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. NAC 432A.290 Telephones; insurance for protection against liability to third persons; transportation. (NRS 432A.077) 1. Each licensee of a facility shall have a working telephone listed in a local telephone directory. A current list of emergency telephone numbers, including health agencies, fire and police departments and ambulance services must be posted adjacent to the telephone. 2. Each licensee of a facility shall have a policy of insurance for protection against liability to third persons. A certificate of insurance must be furnished by the licensee of a facility to the Division as evidence that the policy is in force. Each policy must contain a provision which requires the insurer to notify the Division before cancellation or nonrenewal of the policy. The licensee shall notify the Division if there is a lapse in the insurance coverage required by this subsection. The policy of insurance must be maintained at the facility. Any government, governmental agency or political subdivision of a government which operates a child care facility and is self-insured is not required to furnish a certificate of insurance to the Division. 3. If transportation is provided by the licensee of a facility, all children must be protected by adequate supervision by the staff, safety precautions and adequate insurance which covers liability for health or injury, medical expenses and damages caused by uninsured motorists. The licensee of a facility shall require that each child is instructed in the conduct required for safe transportation. A driver of a vehicle used by the licensee of a facility shall: (a) Possess an appropriate driver’s license and adequate insurance; (b) Not leave an unattended child in the vehicle at any time; (c) Ensure that a parent, or a person designated in writing by the parent, is present to take charge of a child upon delivery of the child to his or her home or the facility; (d) Ensure that each child boards or departs the vehicle on the side of the vehicle adjacent to a curb and that the child is safely conducted across any street encountered immediately before boarding or after departing; and (e) Ensure that the doors and windows of the vehicle are secure before proceeding. 4. Except as otherwise provided in this section, when transporting children, the licensee of a facility shall ensure that the ratio of caregivers to children in the vehicle satisfies the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205. When transporting children who are 2 years of age or older, a licensee of a special needs facility shall ensure that the ratio of caregivers to children in the vehicle satisfies the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205. 5. If, during the time school is in operation, the licensee of a facility provides transportation for children of school age to and from a public or private school, the ratio of staff to children in the vehicle must be not less than one member of the staff for every 15 children. 6. The licensee of a facility shall maintain a log for transportation provided by the licensee of the facility. The log must be maintained at the facility for at least 4 months after the transportation is provided. The log must include: (a) The name of each child who was transported; (b) The date the transportation was provided by the licensee of the facility; (c) The time of departure of the vehicle and the time the vehicle arrived at its destination; (d) The signature of the driver of the vehicle; (e) The name of each adult who was transported in the vehicle, including, without limitation, the driver of the vehicle; and (f) The signed verification required by subsection 7. 7. Upon arrival at the destination, one member of the staff of the facility shall mark each child off the log as the child departs the vehicle, conduct a physical inspection and visually and physically sweep the vehicle to ensure a child is not left behind in the vehicle, and include in the log signed verification that each child who was transported in the vehicle is accounted for and that the visual and physical sweeps were conducted. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Per NAC 432A.323 caregivers are required to be trained in how to safely transport children. Further, NAC 432A.290 very clearly lists out standards of how transportation is to be handled by licensed facilities. These standards are checked during annual/biannual inspections using the inspection checklist. NAC 432A.323 Initial courses of training in child care. (NRS 432A.077, 432A.177) 1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 90 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. NAC 432A.290 Telephones; insurance for protection against liability to third persons; transportation. (NRS 432A.077) 1. Each licensee of a facility shall have a working telephone listed in a local telephone directory. A current list of emergency telephone numbers, including health agencies, fire and police departments and ambulance services must be posted adjacent to the telephone. 2. Each licensee of a facility shall have a policy of insurance for protection against liability to third persons. A certificate of insurance must be furnished by the licensee of a facility to the Division as evidence that the policy is in force. Each policy must contain a provision which requires the insurer to notify the Division before cancellation or nonrenewal of the policy. The licensee shall notify the Division if there is a lapse in the insurance coverage required by this subsection. The policy of insurance must be maintained at the facility. Any government, governmental agency or political subdivision of a government which operates a child care facility and is self-insured is not required to furnish a certificate of insurance to the Division. 3. If transportation is provided by the licensee of a facility, all children must be protected by adequate supervision by the staff, safety precautions and adequate insurance which covers liability for health or injury, medical expenses and damages caused by uninsured motorists. The licensee of a facility shall require that each child is instructed in the conduct required for safe transportation. A driver of a vehicle used by the licensee of a facility shall: (a) Possess an appropriate driver’s license and adequate insurance; (b) Not leave an unattended child in the vehicle at any time; (c) Ensure that a parent, or a person designated in writing by the parent, is present to take charge of a child upon delivery of the child to his or her home or the facility; (d) Ensure that each child boards or departs the vehicle on the side of the vehicle adjacent to a curb and that the child is safely conducted across any street encountered immediately before boarding or after departing; and (e) Ensure that the doors and windows of the vehicle are secure before proceeding. 4. Except as otherwise provided in this section, when transporting children, the licensee of a facility shall ensure that the ratio of caregivers to children in the vehicle satisfies the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205. When transporting children who are 2 years of age or older, a licensee of a special needs facility shall ensure that the ratio of caregivers to children in the vehicle satisfies the applicable requirement for the ratio of caregivers to children set forth in NAC 432A.5205. 5. If, during the time school is in operation, the licensee of a facility provides transportation for children of school age to and from a public or private school, the ratio of staff to children in the vehicle must be not less than one member of the staff for every 15 children. 6. The licensee of a facility shall maintain a log for transportation provided by the licensee of the facility. The log must be maintained at the facility for at least 4 months after the transportation is provided. The log must include: (a) The name of each child who was transported; (b) The date the transportation was provided by the licensee of the facility; (c) The time of departure of the vehicle and the time the vehicle arrived at its destination; (d) The signature of the driver of the vehicle; (e) The name of each adult who was transported in the vehicle, including, without limitation, the driver of the vehicle; and (f) The signed verification required by subsection 7. 7. Upon arrival at the destination, one member of the staff of the facility shall mark each child off the log as the child departs the vehicle, conduct a physical inspection and visually and physically sweep the vehicle to ensure a child is not left behind in the vehicle, and include in the log signed verification that each child who was transported in the vehicle is accounted for and that the visual and physical sweeps were conducted. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 6.5.2.2 Child Passenger Safety (pg. 23) When children are driven in a motor vehicle other than a bus, all children should be transported only if they are restrained in a developmentally appropriate car safety seat, booster seat, seat belt, or harness that is suited to the child's weight and age in accordance with state and federal laws and regulations. The child should be securely fastened, according to the manufacturer's instructions. The child passenger restraint system should meet the federal motor vehicle safety standards contained in 49 CFR 571.213 and carry notice of compliance. Child passenger restraint systems should be installed and used in accordance with the manufacturer's instructions and should be secured in back seats only. Car safety seats should be replaced if they have been recalled, are past the manufacturer's date of use, expiration date, or have been involved in a crash that meets the U.S. Department of Transportation crash severity criteria or the manufacturer's criteria for replacement of seats after a crash. If the program uses a vehicle that meets the definition of a school bus and the school bus has safety restraints, the following should apply: a) The school bus should accommodate the placement of wheelchairs with four tie-downs affixed according to the manufactures’ instructions in a forward-facing direction; b) The wheelchair occupant should be secured by a three-point tie restraint during transport; c) At all times, school buses should be ready to transport children who must ride in wheelchairs; d) Manufacturers’ specifications should be followed to assure that safety requirements are met. 6.5.2.4 Interior Temperature of Vehicles (pg. 23) The interior of vehicles used to transport children for field trips and out-of- program activities should be maintained at a temperature comfortable to children. All vehicles should be locked when not in use, head counts of children should be taken before and after transporting to prevent a child from being left in a vehicle, and children should never be left in a vehicle unattended. 6.5.3.1 Passenger Vans (pg. 23) Early care and education programs that provide transportation for any purpose to children, parents/guardians, staff, and others should not use 15-passenger vans when avoidable. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 6.5.2.2 Child Passenger Safety (pg. 23) When children are driven in a motor vehicle other than a bus, all children should be transported only if they are restrained in a developmentally appropriate car safety seat, booster seat, seat belt, or harness that is suited to the child's weight and age in accordance with state and federal laws and regulations. The child should be securely fastened, according to the manufacturer's instructions. The child passenger restraint system should meet the federal motor vehicle safety standards contained in 49 CFR 571.213 and carry notice of compliance. Child passenger restraint systems should be installed and used in accordance with the manufacturer's instructions and should be secured in back seats only. Car safety seats should be replaced if they have been recalled, are past the manufacturer's date of use, expiration date, or have been involved in a crash that meets the U.S. Department of Transportation crash severity criteria or the manufacturer's criteria for replacement of seats after a crash. If the program uses a vehicle that meets the definition of a school bus and the school bus has safety restraints, the following should apply: a) The school bus should accommodate the placement of wheelchairs with four tie-downs affixed according to the manufactures’ instructions in a forward-facing direction; b) The wheelchair occupant should be secured by a three-point tie restraint during transport; c) At all times, school buses should be ready to transport children who must ride in wheelchairs; d) Manufacturers’ specifications should be followed to assure that safety requirements are met. 6.5.2.4 Interior Temperature of Vehicles (pg. 23) The interior of vehicles used to transport children for field trips and out-of- program activities should be maintained at a temperature comfortable to children. All vehicles should be locked when not in use, head counts of children should be taken before and after transporting to prevent a child from being left in a vehicle, and children should never be left in a vehicle unattended. 6.5.3.1 Passenger Vans (pg. 23) Early care and education programs that provide transportation for any purpose to children, parents/guardians, staff, and others should not use 15-passenger vans when avoidable. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 6.5.2.2 Child Passenger Safety (pg. 23) When children are driven in a motor vehicle other than a bus, all children should be transported only if they are restrained in a developmentally appropriate car safety seat, booster seat, seat belt, or harness that is suited to the child's weight and age in accordance with state and federal laws and regulations. The child should be securely fastened, according to the manufacturer's instructions. The child passenger restraint system should meet the federal motor vehicle safety standards contained in 49 CFR 571.213 and carry notice of compliance. Child passenger restraint systems should be installed and used in accordance with the manufacturer's instructions and should be secured in back seats only. Car safety seats should be replaced if they have been recalled, are past the manufacturer's date of use, expiration date, or have been involved in a crash that meets the U.S. Department of Transportation crash severity criteria or the manufacturer's criteria for replacement of seats after a crash. If the program uses a vehicle that meets the definition of a school bus and the school bus has safety restraints, the following should apply: a) The school bus should accommodate the placement of wheelchairs with four tie-downs affixed according to the manufactures’ instructions in a forward-facing direction; b) The wheelchair occupant should be secured by a three-point tie restraint during transport; c) At all times, school buses should be ready to transport children who must ride in wheelchairs; d) Manufacturers’ specifications should be followed to assure that safety requirements are met. 6.5.2.4 Interior Temperature of Vehicles (pg. 23) The interior of vehicles used to transport children for field trips and out-of- program activities should be maintained at a temperature comfortable to children. All vehicles should be locked when not in use, head counts of children should be taken before and after transporting to prevent a child from being left in a vehicle, and children should never be left in a vehicle unattended. 6.5.3.1 Passenger Vans (pg. 23) Early care and education programs that provide transportation for any purpose to children, parents/guardians, staff, and others should not use 15-passenger vans when avoidable. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 6.5.2.2 Child Passenger Safety (pg. 23) When children are driven in a motor vehicle other than a bus, all children should be transported only if they are restrained in a developmentally appropriate car safety seat, booster seat, seat belt, or harness that is suited to the child's weight and age in accordance with state and federal laws and regulations. The child should be securely fastened, according to the manufacturer's instructions. The child passenger restraint system should meet the federal motor vehicle safety standards contained in 49 CFR 571.213 and carry notice of compliance. Child passenger restraint systems should be installed and used in accordance with the manufacturer's instructions and should be secured in back seats only. Car safety seats should be replaced if they have been recalled, are past the manufacturer's date of use, expiration date, or have been involved in a crash that meets the U.S. Department of Transportation crash severity criteria or the manufacturer's criteria for replacement of seats after a crash. If the program uses a vehicle that meets the definition of a school bus and the school bus has safety restraints, the following should apply: a) The school bus should accommodate the placement of wheelchairs with four tie-downs affixed according to the manufactures’ instructions in a forward-facing direction; b) The wheelchair occupant should be secured by a three-point tie restraint during transport; c) At all times, school buses should be ready to transport children who must ride in wheelchairs; d) Manufacturers’ specifications should be followed to assure that safety requirements are met. 6.5.2.4 Interior Temperature of Vehicles (pg. 23) The interior of vehicles used to transport children for field trips and out-of- program activities should be maintained at a temperature comfortable to children. All vehicles should be locked when not in use, head counts of children should be taken before and after transporting to prevent a child from being left in a vehicle, and children should never be left in a vehicle unattended. 6.5.3.1 Passenger Vans (pg. 23) Early care and education programs that provide transportation for any purpose to children, parents/guardians, staff, and others should not use 15-passenger vans when avoidable. 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: NAC 432A.322 Certification in administration of cardiopulmonary resuscitation. (NRS 432A.077) 1. Each person who is employed in a child care facility shall: (a) Except as otherwise provided in subsection 2 and NAC 432A.560 and 432A.570, obtain certification in the administration of cardiopulmonary resuscitation within 90 days after the person commences employment in the facility; and (b) Maintain current certification in the administration of cardiopulmonary resuscitation. 2. A person is not required to obtain the certification required pursuant to subsection 1 if, on the date that he or she commences employment in the facility, the person is certified in the administration of cardiopulmonary resuscitation and that certification satisfies the requirements set forth in this section. 3. The certification required pursuant to subsection 1 must include certification in administering cardiopulmonary resuscitation to children and: (a) To infants, if care is provided to infants at the facility; and (b) To adults, if necessary to ensure that the person is certified to administer cardiopulmonary resuscitation to children of all ages for which care is provided at the facility. 4. Each course completed to obtain and maintain the certification required pursuant to subsection 1 must be taught by a certified instructor who meets the standards of a nationally or internationally recognized provider of training in cardiopulmonary resuscitation, including, without limitation, the American Heart Association, the American National Red Cross, MEDIC FIRST AID International, EMS Safety Services, or the American Safety and Health Institute. 5. Evidence that an employee has obtained and maintained current certification in the administration of cardiopulmonary resuscitation as required pursuant to this section must be included in his or her personnel file and must be kept at the facility. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.322 Certification in administration of cardiopulmonary resuscitation. (NRS 432A.077) 1. Each person who is employed in a child care facility shall: (a) Except as otherwise provided in subsection 2 and NAC 432A.560 and 432A.570, obtain certification in the administration of cardiopulmonary resuscitation within 90 days after the person commences employment in the facility; and (b) Maintain current certification in the administration of cardiopulmonary resuscitation. 2. A person is not required to obtain the certification required pursuant to subsection 1 if, on the date that he or she commences employment in the facility, the person is certified in the administration of cardiopulmonary resuscitation and that certification satisfies the requirements set forth in this section. 3. The certification required pursuant to subsection 1 must include certification in administering cardiopulmonary resuscitation to children and: (a) To infants, if care is provided to infants at the facility; and (b) To adults, if necessary to ensure that the person is certified to administer cardiopulmonary resuscitation to children of all ages for which care is provided at the facility. 4. Each course completed to obtain and maintain the certification required pursuant to subsection 1 must be taught by a certified instructor who meets the standards of a nationally or internationally recognized provider of training in cardiopulmonary resuscitation, including, without limitation, the American Heart Association, the American National Red Cross, MEDIC FIRST AID International, EMS Safety Services, or the American Safety and Health Institute. 5. Evidence that an employee has obtained and maintained current certification in the administration of cardiopulmonary resuscitation as required pursuant to this section must be included in his or her personnel file and must be kept at the facility. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 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: NAC 432A.322 Certification in administration of cardiopulmonary resuscitation. (NRS 432A.077) 1. Each person who is employed in a child care facility shall: (a) Except as otherwise provided in subsection 2 and NAC 432A.560 and 432A.570, obtain certification in the administration of cardiopulmonary resuscitation within 90 days after the person commences employment in the facility; and (b) Maintain current certification in the administration of cardiopulmonary resuscitation. 2. A person is not required to obtain the certification required pursuant to subsection 1 if, on the date that he or she commences employment in the facility, the person is certified in the administration of cardiopulmonary resuscitation and that certification satisfies the requirements set forth in this section. 3. The certification required pursuant to subsection 1 must include certification in administering cardiopulmonary resuscitation to children and: (a) To infants, if care is provided to infants at the facility; and (b) To adults, if necessary to ensure that the person is certified to administer cardiopulmonary resuscitation to children of all ages for which care is provided at the facility. 4. Each course completed to obtain and maintain the certification required pursuant to subsection 1 must be taught by a certified instructor who meets the standards of a nationally or internationally recognized provider of training in cardiopulmonary resuscitation, including, without limitation, the American Heart Association, the American National Red Cross, MEDIC FIRST AID International, EMS Safety Services, or the American Safety and Health Institute. 5. Evidence that an employee has obtained and maintained current certification in the administration of cardiopulmonary resuscitation as required pursuant to this section must be included in his or her personnel file and must be kept at the facility. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.322 Certification in administration of cardiopulmonary resuscitation. (NRS 432A.077) 1. Each person who is employed in a child care facility shall: (a) Except as otherwise provided in subsection 2 and NAC 432A.560 and 432A.570, obtain certification in the administration of cardiopulmonary resuscitation within 90 days after the person commences employment in the facility; and (b) Maintain current certification in the administration of cardiopulmonary resuscitation. 2. A person is not required to obtain the certification required pursuant to subsection 1 if, on the date that he or she commences employment in the facility, the person is certified in the administration of cardiopulmonary resuscitation and that certification satisfies the requirements set forth in this section. 3. The certification required pursuant to subsection 1 must include certification in administering cardiopulmonary resuscitation to children and: (a) To infants, if care is provided to infants at the facility; and (b) To adults, if necessary to ensure that the person is certified to administer cardiopulmonary resuscitation to children of all ages for which care is provided at the facility. 4. Each course completed to obtain and maintain the certification required pursuant to subsection 1 must be taught by a certified instructor who meets the standards of a nationally or internationally recognized provider of training in cardiopulmonary resuscitation, including, without limitation, the American Heart Association, the American National Red Cross, MEDIC FIRST AID International, EMS Safety Services, or the American Safety and Health Institute. 5. Evidence that an employee has obtained and maintained current certification in the administration of cardiopulmonary resuscitation as required pursuant to this section must be included in his or her personnel file and must be kept at the facility. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.1.1/1.4.2.3 Pre-Service Training/Orientation (pg. 10) Before or during the first three months of employment, training and orientation should detail health and safety issues for early care and education settings including, but not limited to, typical and atypical child development; pediatric first aid and CPR; safe sleep practices, including risk reduction of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID); poison prevention; shaken baby syndrome and abusive head trauma; standard precautions; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs. Caregivers/teachers should complete training before administering medication to children. All directors or program administrators and caregivers/teachers should document receipt of training. Providers should not care for children unsupervised until they have completed training in pediatric first aid and CPR; safe sleep practices, including risk reduction of sudden infant death syndrome/Sudden Unexplained Infant Death (SIDS/SUID); standard precautions for the prevention of communicable disease; poison prevention; and shaken baby syndrome/abusive head trauma. 1.4.3.1 First Aid and CPR Training for Staff (pg. 9) All staff members involved in providing direct care to children should have up-to- date documentation of satisfactory completion of training in pediatric first aid and current certification in pediatric CPR. Records of successful completion of training in pediatric first aid and CPR should be maintained in the personnel files of the facility. 1.4.4.1/1.4.4.2 Continuing Education for Directors, Caregivers/Teachers in Centers, and Family Child Care Homes (pg. 9) Directors and caregivers/teachers should successfully complete intentional and sequential education/professional development in child development programming and child health, safety, and staff health based on individual competency and any special needs of the children in their care. 3.5.0.1 Care Plan for Children with Special Health Care Needs (pg. 14) Children with special health care needs are defined as . . . those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Any child who meets these criteria in an early care and education setting should have an up-to-date Routine and Emergent Care Plan, completed by their primary health care provider with input from parents/guardians, included in their on-site health record and readily accessible to those caring for the child. Community resources should be used to ensure adequate information, training, and monitoring is available for early care and education staff. Caregivers should undergo training in pediatric first aid and CPR that includes responding to an emergency for any child with a special health care need. 5.6.0.1 First Aid and Emergency Supplies (pg. 21) The facility should maintain up-to-date first aid and emergency supplies in each location in which children are cared. The first aid kit or supplies should be kept in a closed container, cabinet, or drawer that is labeled and stored in a location known to all staff, accessible to staff at all times, but locked or otherwise inaccessible to children. When children leave the facility for a walk or to be transported, a designated staff member should bring a transportable first aid kit. In addition, a transportable first aid kit should be in each vehicle that is used to transport children to and from the program. First aid kits or supplies should be restocked after each use. 6.5.1.2 Qualifications for Drivers (pg. 22) In addition to meeting the general staff background check standards, any driver or transportation staff member who transports children for any purpose should have: a) A valid driver's license that authorizes the driver to operate the type of vehicle being driven; b) A safe driving record for more than 5 years, with no crashes where a citation was issued, as evidenced by the state Department of Motor Vehicles records; c) No use of alcohol, drugs, or any substance that could impair abilities before or while driving; d) No tobacco use while driving; e) No medical condition that would compromise driving, supervision, or evacuation capability; f) Valid pediatric CPR and first aid certificate if transporting children alone. g) The driver's license number and date of expiration, vehicle insurance information, and verification of current state vehicle inspection should be on file in the facility. 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: If any person suspects that child abuse or neglect is occurring in a facility, the person may immediately report such suspicions to the Division. Every licensee or employee of a facility who has reason to believe child abuse or neglect is occurring in the facility, in the child’s home or elsewhere shall report such beliefs to the appropriate authority as required in NRS 432B.220. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.410 Reports of child abuse or neglect. (NRS 432A.077) If any person suspects that child abuse or neglect is occurring in a facility, the person may immediately report such suspicions to the Division. Every licensee or employee of a facility who has reason to believe child abuse or neglect is occurring in the facility, in the child’s home or elsewhere shall report such beliefs to the appropriate authority as required in NRS 432B.220. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. 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: NAC 432A.410 Reports of child abuse or neglect. (NRS 432A.077) If any person suspects that child abuse or neglect is occurring in a facility, the person may immediately report such suspicions to the Division. Every licensee or employee of a facility who has reason to believe child abuse or neglect is occurring in the facility, in the child’s home or elsewhere shall report such beliefs to the appropriate authority as required in NRS 432B.220. ii. All CCDF-eligible licensed family child care homes. Provide the standard: NAC 432A.410 Reports of child abuse or neglect. (NRS 432A.077) If any person suspects that child abuse or neglect is occurring in a facility, the person may immediately report such suspicions to the Division. Every licensee or employee of a facility who has reason to believe child abuse or neglect is occurring in the facility, in the child’s home or elsewhere shall report such beliefs to the appropriate authority as required in NRS 432B.220. 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: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: FFN, OST, and OSR standards within Caring for our Children Basics (detailed below): 1.4.5.2 Child Abuse and Neglect Education (pg. 9) Caregivers/teachers should be educated on child abuse and neglect to establish child abuse and neglect prevention and recognition strategies for children, caregivers/teachers, and parents/guardians. The education should address physical, sexual, and psychological or emotional abuse and neglect. Caregivers/teachers are mandatory reporters of child abuse or neglect. Caregivers/teachers should be trained in compliance with their state's child abuse reporting laws. 3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation (pg. 15) Because caregivers/teachers are mandated reporters of child abuse and neglect, each program should have a written policy for reporting child abuse and neglect. The written policy should specify that in any instance where there is reasonable cause to believe that child abuse or neglect has occurred, the individual who suspects child abuse or neglect should report directly to the child abuse reporting hotline, child protective services, or the police, as required by state and local laws. 9.2.4.1 Written Plan and Training for handling Urgent Medical Care or Threatening Incidents (pg. 25) The program should have a written plan for reporting and managing any incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. Caregiver/teacher and staff training procedures should also be included. The management, documentation, and reporting of the following types of incidents should be addressed: a) Lost or missing child; b) Suspected maltreatment of a child (also see state's mandates for reporting); c) Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program; d) Injuries to children requiring medical or dental care; e) Illness or injuries requiring hospitalization or emergency treatment; f) Mental health emergencies; g) Health and safety emergencies involving parents/guardians and visitors to the program; h) Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the early care and education program, even if the death occurred outside of early care and education hours; i) The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility. 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? [ ] Yes. [x] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: ii. Access to physical activity. Describe: iii. Caring for children with special needs. Describe: iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: