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: A written agreement is required between the center and the parent that (i) the center will notify the parent when the child becomes ill and the parent will arrange to have the child picked up as soon as possible if requested by the center, and (ii) the parent will inform the center within 24 hours or the next business day after his child or any member of the immediate household has developed any reportable communicable disease, except for life threatening diseases, which must be reported immediately. (8VAC20-780-90) Each child must have a physical examination before the child’s attendance or within 30 days after the first day of attendance. (8VAC20-780-140) Each staff member must submit documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with children that has been completed within the last 30 calendar days of the date of employment. TB results are due every two years thereafter. (8VAC20-780-160) When there is evidence that the safety of children may be jeopardized by contact with a staff member because of their physical health, the employee is to be prohibited from engaging in contact with children or participating in the food service program until a physician confirms any risk has been eliminated or can be reduced to an acceptable level by reasonable accommodations. (8VAC20-780-170) Staff are required to complete the Department’s sponsored orientation course (i.e., preservice training) within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses procedures for ill children; and prevention and control of disease. (8VAC20-780-240 and 8VAC20-790-600) There must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes: components of daily health check for children; inclusion and exclusion of a child when the child is exhibiting symptoms that indicate possible illness; description of how diseases are spread and procedures and methods for reducing the spread of disease; information concerning the Department of Health’s notification of reportable diseases; and staff occupational health and safety practices in accordance with OSHA. (8VAC20-780-245) Before issuance of a license and annually thereafter, approval from the local health department is required for meeting requirements of water supply, sewage disposal system, and food service, if applicable. (8VAC20-780-250 and 8VAC20- 780-260) If combs, toothbrushes or other personal articles are used, they must be individually assigned. Disposable products shall be used once and discarded (8VAC20-780-430) Cribs, cots, rest mats and beds shall be identified for use by a specific child. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. If rest mats are used, they must be sanitized on all sides weekly or before use by another child. (8VAC20-780-440) Linens are to be assigned for individual use, clean, and washed at least weekly. Crib sheets are to be clean and washed daily. Pillows shall be individually assigned and covered with pillow cases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-780-450) If portable wading pools without integral filter systems are used, they must be emptied after the use of each group of children, rinsed, and filled with clean water, or more frequently as necessary. Children who are not potty trained may not use portable wading pools. After each day’s use, portable wading pools must be emptied, sanitized and stored to keep them clean and dry. (8VAC20-780-470) A child is not allowed to attend the center if he has a temperature over 101°F, recurrent vomiting or diarrhea, or a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the center as soon as possible after the signs or symptoms are noticed; and the child shall remain in the designated quiet area until leaving the center. When children at the center have been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the center's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-780-490) Handwashing procedures for children include washing with soap and running water or disposable wipes before and after eating meals or snacks, and with soap and running water after toileting or any contact with blood, feces or urine. Handwashing procedures for staff include washing with soap and running water before and after helping a child use the toilet; before and after a diaper change; after the staff member uses the toilet; after any contact with body fluids; before feeding or helping children with feeding; and before preparing or serving food or beverages. Diapering areas must have a sink with running warm water; soap, disposable towels and single use gloves; a nonabsorbent surface that is only used for diapering or cleaning a child; a leakproof or plastic-line storage system that is either foot-operated or used in such a way that neither the staff member’s hand nor the soiled diaper touches an exterior surface of the storage system during disposal; and a leakproof covered receptable for soiled linens. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. The diapering surface must be cleaned with soap and at least room temperature water and sanitized after each use. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20-780-500) Contaminated or spoiled food shall not be served to children. Tables and highchairs must be sanitized before and after each use for feeding and cleaned at least daily. (8VAC20-780-560) Prepared infant formula is to be refrigerated and dated. Prepared baby food not consumed during a feeding by an infant may only be used by the same infant later in the same day if the food is not served out of the baby jar and is dated and stored in the refrigerator. Formula and breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-780- 570) If perishable food is taken on field trips, the food shall be stored in insulated containers with ice packs to keep the food cold. (8VAC20-780-580) Animals kept on the premises shall be vaccinated, if applicable. Animals which are, or are suspected of being, ill or infested with external lice, fleas and ticks or internal worms shall be removed from contact with children. If a child is bitten by an animal, the site of the bite shall be washed with soap and water immediately, and the child's physician or local health department shall be contacted as soon as possible for medical advice. Manure shall be removed from barns, stables and corrals at least once a day. (8VAC20-780-600) During evening care, if bath towels are used, they shall be assigned for individual use. (8VAC20-780-610) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Before the child’s first day of attendance, parents are provided in writing certain information that is signed to acknowledge receipt. The information includes the requirement for (i) the home to notify the parent when the child becomes ill and the parent will arrange to have the child picked up as soon as possible if requested by the home, and (ii) the parent will inform the home within 24 hours or the next business day after his child or any member of the immediate household has developed any reportable communicable disease, except for life threatening diseases, which must be reported immediately. (8VAC20-800-70) Each child must have a physical examination before the child’s attendance or within 30 days after the first day of attendance. (8VAC20-800-100) Each caregiver and each adult household member must submit documentation of a negative tuberculosis screening prior to coming into contact with children that has been completed within the last 30 calendar days. TB results for caregivers and adult household members are due every two years thereafter. (8VAC20-800-170 and 8VAC20-800-180) If a physician determines that the health, safety or well-being of children in care may be jeopardized by contact with a caregiver or household member because of their physical health, the individual is to be immediately removed from contact with children and food service until the condition is cleared. (8VAC20-800-190) Caregivers in homes that are CCDF vendors are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Caregivers in homes that are CCDF vendors are also required to complete orientation training prior to working alone with children and within seven days of employment that includes procedures for action in the case of an ill child. (8VAC20-790-250) If portable wading pools without integral filter systems are used, they must be emptied after the use of each group of children, rinsed, and filled with clean water, or more frequently as necessary. Children who are not potty trained may not use portable wading pools. When not in use, portable wading pools must be emptied, sanitized and stored to keep them clean and dry. (8VAC20-800-260) Any surface that has been contaminated with body fluids must be cleaned and sanitized. (8VAC20-800-300) When water is not obtained from a municipal supply, and the house is not connected to a municipal sewer line, the water supply and septic system of the family day home shall be inspected and approved by the local health official or a private laboratory if there are open and obvious symptoms of water or sewage system problems, such as evidence of cloudy, murky, or muddy water, or sewage back up. Homes connected to a municipal water supply and sewer line that have open and obvious symptoms of water or sewage system problems shall have the problems corrected within a time frame established by the local public utility department. (8VAC20-800-350) Garbage is to be removed on a daily basis from rooms occupied by children and removed from the premises at least once a week or more often if needed. (8VAC20-800-360) The home shall be kept free from rodents and insect infestation. (8VAC20-800- 370) Family pets are not allowed on any surfaces where food is prepared or served and must be in good health and show no evidence of carrying any disease. Dogs or cats must be vaccinated for rabies and shall be treated for fleas, ticks, or worms as needed. Monkeys, ferrets, reptiles, psittacine birds (birds of the parrot family), or wild or dangerous animals may not be in areas accessible to children during the hours children are in care. Animal litter boxes, toys, food dishes, and water dishes must be inaccessible to children. All animal excrement must be removed promptly, disposed of properly, and, if indoors, the soiled area cleaned. (8VAC20- 800-460) Toys mouthed by children shall be cleaned and sanitized daily. (8VAC20-800-480) A child is to be provided with an individual crib, cot, rest mat or bed. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. Rest mats must be cleaned and sanitized on all sides at least weekly or as needed. (8VAC20-800-510) Linens are to be assigned for individual use, clean, and washed at least weekly or when soiled. Clean linens are to be used each time a child rests on the bed of a family member. Pillows shall be assigned for individual use and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-800-530) Play pens shall be cleaned and sanitized each day of use or more often as needed. (8VAC20-800-550) When a child has been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the home's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. (8VAC20-800-650) A child is to be excluded from the home if he has both a fever over 101°F (oral) or over 100°F (armpit) and behavior change; diarrhea; recurrent vomiting; or symptoms of a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the home as soon as possible; and the child shall remain in a quiet, designated quiet area until leaving the home. (8VAC20-800-670) Handwashing procedures for children include washing with liquid soap and running water when their hands are dirty; before eating; after toileting or diapering; after handing or caring for animals; and after contact with body fluids. Handwashing procedures for caregivers include washing with liquid soap and running water when their hands are dirty; after toileting; before preparing and serving food or beverages; before feeding or helping children with feeding; after contact with any body fluids; after handling or caring for animals; after handling raw eggs or meat; and before and after diapering a child or assisting a child with toileting. (8VAC20-800-680 and 8VAC20-790-390) The diapering surface shall be separate from the kitchen, food preparation areas, or surfaces used for children’s activities; nonabsorbent and washable; and cleaned and sanitized after each use. Soiled diapers and wipes must be disposed of in a leak-proof or plastic-line storage system that is either foot-operated or used in such a way that neither the caregiver’s hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. A leakproof storage system is required for cloth diapers. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20- 800-690) The provider must immediately make a report of an outbreak of disease to the local health department or the Commissioner of the Virginia Department of Health. (8VAC20-800-860) Tables and highchairs must be cleaned and sanitized daily and before and after each use for feeding. (8VAC20-800-870 and 8VAC20-790-440) Clean individual drinking cups must be provided daily. Children are not allowed to share common drinking cups. (8VAC20-800-910) Eating utensils and dishes shall be properly cleaned by prerinsing, washing, and air drying, or using a dishwasher; and shall be stored in a clean dry place and protected from contamination. Disposable utensils and dishes shall be used once and discarded. (8VAC20-800-930) Temperatures shall be maintained at or below 40°F in refrigerator compartments and at or below 0°F in the freezer compartments. All perishable foods and drinks used for children in care, except when being prepared and served, shall be kept in the refrigerator. (8VAC20-800-940) All milk and milk products shall be pasteurized. (8VAC20-800-950) Infant bottles shall be refrigerated and dated and shall be discarded after 48 hours if not used. Prepared baby food shall not be served out of the container, and leftovers shall be dated and stored in the refrigerator. Opened containers shall be discarded if not consumed within 24 hours of storage. Formula or breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-800-960 and 8VAC20-790-450) Nighttime care requires that each child have a toothbrush, and a comb or hairbrush assigned for individual use, and that bath towels and washcloths, if used, are assigned for individual use and laundered as needed but at least weekly. (8VAC20-800-1020) iii. All CCDF-eligible licensed in-home care. Provide the standard: Before the child’s first day of attendance, parents are provided in writing certain information that is signed to acknowledge receipt. The information includes the requirement for (i) the home to notify the parent when the child becomes ill and the parent will arrange to have the child picked up as soon as possible if requested by the home, and (ii) the parent will inform the home within 24 hours or the next business day after his child or any member of the immediate household has developed any reportable communicable disease, except for life threatening diseases, which must be reported immediately. (8VAC20-800-70) Each child must have a physical examination before the child’s attendance or within 30 days after the first day of attendance. (8VAC20-800-100) Each caregiver and each adult household member must submit documentation of a negative tuberculosis screening prior to coming into contact with children that has been completed within the last 30 calendar days. TB results for caregivers and adult household members are due every two years thereafter. (8VAC20-800-170 and 8VAC20-800-180) If a physician determines that the health, safety or well-being of children in care may be jeopardized by contact with a caregiver or household member because of their physical health, the individual is to be immediately removed from contact with children and food service until the condition is cleared. (8VAC20-800-190) Caregivers in homes that are CCDF vendors are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Caregivers in homes that are CCDF vendors are also required to complete orientation training prior to working alone with children and within seven days of employment that includes procedures for action in the case of an ill child. (8VAC20-790-250). If portable wading pools without integral filter systems are used, they must be emptied after the use of each group of children, rinsed, and filled with clean water, or more frequently as necessary. Children who are not potty trained may not use portable wading pools. When not in use, portable wading pools must be emptied, sanitized and stored to keep them clean and dry. (8VAC20-800-260) Any surface that has been contaminated with body fluids must be cleaned and sanitized. (8VAC20-800-300) When water is not obtained from a municipal supply, and the house is not connected to a municipal sewer line, the water supply and septic system of the family day home shall be inspected and approved by the local health official or a private laboratory if there are open and obvious symptoms of water or sewage system problems, such as evidence of cloudy, murky, or muddy water, or sewage back up. Homes connected to a municipal water supply and sewer line that have open and obvious symptoms of water or sewage system problems shall have the problems corrected within a time frame established by the local public utility department. (8VAC20-800-350) Garbage is to be removed on a daily basis from rooms occupied by children and removed from the premises at least once a week or more often if needed. (8VAC20-800-360) The home shall be kept free from rodents and insect infestation. (8VAC20-800- 370) Family pets are not allowed on any surfaces where food is prepared or served and must be in good health and show no evidence of carrying any disease. Dogs or cats must be vaccinated for rabies and shall be treated for fleas, ticks, or worms as needed. Monkeys, ferrets, reptiles, psittacine birds (birds of the parrot family), or wild or dangerous animals may not be in areas accessible to children during the hours children are in care. Animal litter boxes, toys, food dishes, and water dishes must be inaccessible to children. All animal excrement must be removed promptly, disposed of properly, and, if indoors, the soiled area cleaned. (8VAC20- 800-460) Toys mouthed by children shall be cleaned and sanitized daily. (8VAC20-800-480) A child is to be provided with an individual crib, cot, rest mat or bed. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. Rest mats must be cleaned and sanitized on all sides at least weekly or as needed. (8VAC20-800-510) Linens are to be assigned for individual use, clean, and washed at least weekly or when soiled. Clean linens are to be used each time a child rests on the bed of a family member. Pillows shall be assigned for individual use and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-800-530) Play pens shall be cleaned and sanitized each day of use or more often as needed. (8VAC20-800-550) When a child has been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the home's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. (8VAC20-800-650) A child is to be excluded from the home if he has both a fever over 101°F (oral) or over 100°F (armpit) and behavior change; diarrhea; recurrent vomiting; or symptoms of a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the home as soon as possible; and the child shall remain in a quiet, designated quiet area until leaving the home. (8VAC20-800-670) Handwashing procedures for children include washing with liquid soap and running water when their hands are dirty; before eating; after toileting or diapering; after handing or caring for animals; and after contact with body fluids. Handwashing procedures for caregivers include washing with liquid soap and running water when their hands are dirty; after toileting; before preparing and serving food or beverages; before feeding or helping children with feeding; after contact with any body fluids; after handling or caring for animals; after handling raw eggs or meat; and before and after diapering a child or assisting a child with toileting. (8VAC20-800-680 and 8VAC20-790-390) The diapering surface shall be separate from the kitchen, food preparation areas, or surfaces used for children’s activities; nonabsorbent and washable; and cleaned and sanitized after each use. Soiled diapers and wipes must be disposed of in a leak-proof or plastic-line storage system that is either foot-operated or used in such a way that neither the caregiver’s hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. A leakproof storage system is required for cloth diapers. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20- 800-690) The provider must immediately make a report of an outbreak of disease to the local health department or the Commissioner of the Virginia Department of Health. (8VAC20-800-860) Tables and highchairs must be cleaned and sanitized daily and before and after each use for feeding. (8VAC20-800-870 and 8VAC20-790-440) Clean individual drinking cups must be provided daily. Children are not allowed to share common drinking cups. (8VAC20-800-910) Eating utensils and dishes shall be properly cleaned by prerinsing, washing, and air drying, or using a dishwasher; and shall be stored in a clean dry place and protected from contamination. Disposable utensils and dishes shall be used once and discarded. (8VAC20-800-930) Temperatures shall be maintained at or below 40°F in refrigerator compartments and at or below 0°F in the freezer compartments. All perishable foods and drinks used for children in care, except when being prepared and served, shall be kept in the refrigerator. (8VAC20-800-940) All milk and milk products shall be pasteurized. (8VAC20-800-950) Infant bottles shall be refrigerated and dated and shall be discarded after 48 hours if not used. Prepared baby food shall not be served out of the container, and leftovers shall be dated and stored in the refrigerator. Opened containers shall be discarded if not consumed within 24 hours of storage. Formula or breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-800-960 and 8VAC20-790-450) Nighttime care requires that each child have a toothbrush, and a comb or hairbrush assigned for individual use, and that bath towels and washcloths, if used, are assigned for individual use and laundered as needed but at least weekly. (8VAC20-800-1020) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: A written statement is required that the vendor will notify the parent when the child becomes ill, and the parent will arrange to have the child picked up as soon as possible if requested by the vendor. (8VAC20-790-540) Each staff member must submit documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with children that has been completed within the last 30 calendar days of the date of employment. TB results are due every two years thereafter. (8VAC20-790-560) Staff are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses procedures for ill children. Additionally, there must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes: components of daily health check for children; inclusion and exclusion of a child when the child is exhibiting symptoms that indicate possible illness; description of how diseases are spread and procedures and methods for reducing the spread of disease; information concerning the Department of Health’s notification of reportable diseases; and staff occupational health and safety practices in accordance with OSHA. (8VAC20- 790-600) Before approval of a vendor agreement and annually thereafter, approval from the local health department is required for meeting requirements of water supply, sewage disposal system, and food service, if applicable. (8VAC20-790-610 and 8VAC20-790-620) When children at the center have been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the center's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790- 720) If combs, toothbrushes or other personal articles are used, they must be individually assigned. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. Disposable products shall be used once and discarded. (8VAC20-790-730) Linens are to be assigned for individual use. Pillows shall be individually assigned and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-790-740) A child is not allowed to attend the center if he has a temperature over 101°F, recurrent vomiting or diarrhea, or symptoms a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the center as soon as possible after the signs or symptoms are noticed; and the child shall remain in a designated quiet area until leaving the center. When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790-750) Handwashing procedures for children include washing with soap and running water or disposable wipes before and after eating meals or snacks, and with soap and running water after toileting or any contact with blood, feces or urine. Handwashing procedures for staff include washing with soap and running water before and after helping a child use the toilet or changing a diaper; after the staff member uses the toilet; after any contact with body fluids; before feeding or helping children with feeding; and before preparing or serving food or beverages. Diapering areas must have a sink with running warm water; soap, disposable towels and single use gloves; a nonabsorbent surface that is only used for diapering or cleaning a child; a leakproof or plastic-line storage system that is either foot-operated or used in such a way that neither the staff member’s hand nor the soiled diaper touches an exterior surface of the storage system during disposal; and a leakproof covered receptable for soiled linens. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. The diapering surface must be cleaned with soap and at least room temperature water and sanitized after each use. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20-790-760) Tables and highchairs must be sanitized before and after each use for feeding and cleaned at least daily. (8VAC20-790-810) Prepared infant formula is to be refrigerated and dated. Prepared baby food not consumed during a feeding by an infant may only be used by the same infant later in the same day if the food is not served out of the baby jar and is dated and stored in the refrigerator. Formula and breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-790- 820) Animals kept on the premises shall be vaccinated, if applicable. (8VAC20-790-840) During evening and overnight care, if bath towels are used, they shall be assigned for individual use. (8VAC20-790-850) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Before the child’s first day of attendance, parents are provided a written statement that the vendor will notify the parent when the child becomes ill, and the parent will arrange to have the child picked up as soon as possible if requested by the vendor. (8VAC20-790-190) \ Each caregiver must submit documentation of a negative tuberculosis screening prior to coming into contact with children that has been completed within the last 30 calendar days. TB results for caregivers are due every two years thereafter. If a physician determines that the health, safety or well-being of children in care may be jeopardized by contact with a caregiver or household member because of their physical health, the individual is to be immediately removed from contact with children and food service until the condition is cleared. (8VAC20-790-210) Caregivers in homes that are CCDF vendors are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Caregivers in homes that are CCDF vendors are also required to complete orientation training prior to working alone with children and within seven days of employment that includes procedures for action in the case of an ill child. (8VAC20-790-250). If portable wading pools without integral filter systems are used, they must be emptied after the use of each group of children, rinsed, and filled with clean water, or more frequently as necessary. Children who are not potty trained may not use portable wading pools. When not in use, portable wading pools must be emptied, sanitized and stored to keep them clean and dry. (8VAC20-790-310) When a child has been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the vendor's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. (8VAC20-790-350) If combs, toothbrushes, or other personal articles are used, they shall be individually assigned. Disposable products are used once and discarded. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. (8VAC20-790-360) Linens are to be assigned for individual use. Pillows shall be assigned for individual use and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-790-370) A child is to be excluded from the home if he has a fever over 101°F; recurrent vomiting or diarrhea; or symptoms of a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the home as soon as possible; and the child shall remain in a quiet, designated quiet area until leaving the home. Any surface that has been contaminated with body fluids must be cleaned and sanitized. (8VAC20-790-380) Handwashing procedures for children include washing with liquid soap and running water or disposable wipes before and after eating; and with soap and running water after toileting and any contact with blood, feces or urine. Handwashing procedures for caregivers include washing with soap and running water before and after helping a child use the toilet or changing a diaper, after using the toilet, after any contact with body fluids, before feeding or helping children with feeding, and before preparing or serving food or beverages. The diapering surface shall be separate from the kitchen, food preparation areas, or surfaces used for children’s activities; nonabsorbent and washable; and cleaned and sanitized after each use. Soiled diapers and wipes must be disposed of in a leak-proof or plastic-line storage system that is either foot-operated or used in such a way that neither the caregiver’s hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. A leakproof storage system is required for cloth diapers. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20- 790-390) Tables and highchairs must be cleaned and sanitized daily and before and after each use for feeding. (8VAC20-790-440) Prepared infant formula shall be refrigerated and dated. Prepared baby food not consumed during that feeding by an infant may be used by that same infant later in the same day, provided that the food is not served out of the baby food jar and is labeled with the child's name, dated, and stored in the refrigerator; otherwise, it shall be discarded or returned to the parent at the end of the day. Formula or breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-790-450) Animals are not allowed on any surfaces where food is prepared or served and must be in good health and show no evidence of carrying any disease. Dogs or cats must be vaccinated for rabies and shall be treated for fleas, ticks, or worms as needed. Monkeys, ferrets, reptiles, psittacine birds (birds of the parrot family), or wild or dangerous animals may not be in areas accessible to children during the hours children are in care. Animal litter boxes, toys, food dishes, and water dishes must be inaccessible to children. (8VAC20-790-470) Evening and nighttime care requires that bath towels, if used, are assigned for individual use. (8VAC20-790-480) For voluntarily registered family day home vendors, each adult household member must also obtain initial TB results and updated results every two years thereafter. (8VAC20-850-30) For voluntarily registered family day home vendors, each child must have a physical examination before the child’s attendance or within 30 days after the first day of attendance. Voluntarily registered family day home vendors must also ensure their home is free from insect and rodent infestation. (8VAC20-850-110) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Before the child’s first day of attendance, parents are provided a written statement that the vendor will notify the parent when the child becomes ill, and the parent will arrange to have the child picked up as soon as possible if requested by the vendor. (8VAC20-790-190) Each caregiver must submit documentation of a negative tuberculosis screening prior to coming into contact with children that has been completed within the last 30 calendar days. TB results for caregivers are due every two years thereafter. If a physician determines that the health, safety or well-being of children in care may be jeopardized by contact with a caregiver or household member because of their physical health, the individual is to be immediately removed from contact with children and food service until the condition is cleared. (8VAC20-790-210) Caregivers in homes that are CCDF vendors are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Caregivers in homes that are CCDF vendors are also required to complete orientation training prior to working alone with children and within seven days of employment that includes procedures for action in the case of an ill child. (8VAC20-790-250). If portable wading pools without integral filter systems are used, they must be emptied after the use of each group of children, rinsed, and filled with clean water, or more frequently as necessary. Children who are not potty trained may not use portable wading pools. When not in use, portable wading pools must be emptied, sanitized and stored to keep them clean and dry. (8VAC20-790-310) When a child has been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the vendor's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. (8VAC20-790-350) If combs, toothbrushes, or other personal articles are used, they shall be individually assigned. Disposable products are used once and discarded. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. (8VAC20-790-360) Linens are to be assigned for individual use. Pillows shall be assigned for individual use and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-790-370) A child is to be excluded from the home if he has a fever over 101°F; recurrent vomiting or diarrhea; or symptoms of a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the home as soon as possible; and the child shall remain in a quiet, designated quiet area until leaving the home. Any surface that has been contaminated with body fluids must be cleaned and sanitized. (8VAC20-790-380) Handwashing procedures for children include washing with liquid soap and running water or disposable wipes before and after eating; and with soap and running water after toileting and any contact with blood, feces or urine. Handwashing procedures for caregivers include washing with soap and running water before and after helping a child use the toilet or changing a diaper, after using the toilet, after any contact with body fluids, before feeding or helping children with feeding, and before preparing or serving food or beverages. The diapering surface shall be separate from the kitchen, food preparation areas, or surfaces used for children’s activities; nonabsorbent and washable; and cleaned and sanitized after each use. Soiled diapers and wipes must be disposed of in a leak-proof or plastic-line storage system that is either foot-operated or used in such a way that neither the caregiver’s hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. A leakproof storage system is required for cloth diapers. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20- 790-390) Tables and highchairs must be cleaned and sanitized daily and before and after each use for feeding. (8VAC20-790-440) Prepared infant formula shall be refrigerated and dated. Prepared baby food not consumed during that feeding by an infant may be used by that same infant later in the same day, provided that the food is not served out of the baby food jar and is labeled with the child's name, dated, and stored in the refrigerator; otherwise, it shall be discarded or returned to the parent at the end of the day. Formula or breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-790-450) Animals are not allowed on any surfaces where food is prepared or served and must be in good health and show no evidence of carrying any disease. Dogs or cats must be vaccinated for rabies and shall be treated for fleas, ticks, or worms as needed. Monkeys, ferrets, reptiles, psittacine birds (birds of the parrot family), or wild or dangerous animals may not be in areas accessible to children during the hours children are in care. Animal litter boxes, toys, food dishes, and water dishes must be inaccessible to children. (8VAC20-790-470) Evening and nighttime care requires that bath towels, if used, are assigned for individual use. (8VAC20-790-480) For voluntarily registered in-home vendors, each adult household member must also obtain initial TB results and updated results every two years thereafter. (8VAC20-850-30) For voluntarily registered in-home vendors, each child must have a physical examination before the child’s attendance or within 30 days after the first day of attendance. Voluntarily registered family day home vendors must also ensure their home is free from insect and rodent infestation. (8VAC20-850-110) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.1.a.i. CCDF eligible out-of-school programs that are license exempt must meet the following standards: A written statement is required that the vendor will notify the parent when the child becomes ill, and the parent will arrange to have the child picked up as soon as possible if requested by the vendor. (8VAC20-790-540) Each staff member must submit documentation of a negative tuberculosis screening at the time of employment and prior to coming into contact with children that has been completed within the last 30 calendar days of the date of employment. TB results are due every two years thereafter. (8VAC20-790-560) Staff are required to complete the Virginia Preservice Training within 90 calendar days of employment, which includes preventing the spread of disease, including immunization requirements; and handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluid. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses procedures for ill children. Additionally, there must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes: components of daily health check for children; inclusion and exclusion of a child when the child is exhibiting symptoms that indicate possible illness; description of how diseases are spread and procedures and methods for reducing the spread of disease; information concerning the Department of Health’s notification of reportable diseases; and staff occupational health and safety practices in accordance with OSHA. (8VAC20- 790-600) Before approval of a vendor agreement and annually thereafter, approval from the local health department is required for meeting requirements of water supply, sewage disposal system, and food service, if applicable. (8VAC20-790-610 and 8VAC20-790-620) When children at the center have been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the center's having been informed unless forbidden by law, except for life threatening diseases, which must be reported to parents immediately. When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790- 720) If combs, toothbrushes or other personal articles are used, they must be individually assigned. There is to be at least 12 inches of space between occupied cribs, cots, beds and rest mats to reduce the transfer of airborne diseases. Disposable products shall be used once and discarded. (8VAC20-790-730) Linens are to be assigned for individual use. Pillows shall be individually assigned and covered with pillowcases. Mattresses, when used, are to be covered with a waterproof material that can be cleaned and sanitized. (8VAC20-790-740) A child is not allowed to attend the center if he has a temperature over 101°F, recurrent vomiting or diarrhea, or symptoms a communicable disease. If a child needs to be excluded, arrangements shall be made for the child to leave the center as soon as possible after the signs or symptoms are noticed; and the child shall remain in a designated quiet area until leaving the center. When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790-750) Handwashing procedures for children include washing with soap and running water or disposable wipes before and after eating meals or snacks, and with soap and running water after toileting or any contact with blood, feces or urine. Handwashing procedures for staff include washing with soap and running water before and after helping a child use the toilet or changing a diaper; after the staff member uses the toilet; after any contact with body fluids; before feeding or helping children with feeding; and before preparing or serving food or beverages. Diapering areas must have a sink with running warm water; soap, disposable towels and single use gloves; a nonabsorbent surface that is only used for diapering or cleaning a child; a leakproof or plastic-line storage system that is either foot-operated or used in such a way that neither the staff member’s hand nor the soiled diaper touches an exterior surface of the storage system during disposal; and a leakproof covered receptable for soiled linens. When a child’s closing becomes wet or soiled, they shall be cleaned and changed immediately. The diapering surface must be cleaned with soap and at least room temperature water and sanitized after each use. Additionally, toilet chairs must be emptied promptly and cleaned and sanitized after each use. (8VAC20-790-760) Tables and highchairs must be sanitized before and after each use for feeding and cleaned at least daily. (8VAC20-790-810) Prepared infant formula is to be refrigerated and dated. Prepared baby food not consumed during a feeding by an infant may only be used by the same infant later in the same day if the food is not served out of the baby jar and is dated and stored in the refrigerator. Formula and breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. (8VAC20-790- 820) Animals kept on the premises shall be vaccinated, if applicable. (8VAC20-790-840) During evening and overnight care, if bath towels are used, they shall be assigned for individual use. (8VAC20-790-850) 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: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. Documentation of additional immunizations once every six months for children under the age of two years, and once between each child’s fourth and sixth birthdays is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the center on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or 2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. (8VAC20-780-130) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the home on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or 2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. Documentation of additional immunizations once every six months for children under the age of two years, and once between each child’s fourth and sixth birthdays is required. (8VAC20-800-90) A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. (8VAC20-790-230) iii. All CCDF-eligible licensed in-home care. Provide the standard: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the home on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or 2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. Documentation of additional immunizations once every six months for children under the age of two years, and once between each child’s fourth and sixth birthdays is required. (8VAC20-800-90) A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. (8VAC20-790-230) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. Documentation of additional immunizations once every six months for children under the age of two years is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the vendor on the form entitled "Certification of Religious Exemption," stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices, or 2. A physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. (8VAC20-790-580) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. Documentation of additional immunizations once every six months for children under the age of two years is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the vendor on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or 2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. (8VAC20-790-230) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. Documentation of additional immunizations once every six months for children under the age of two years is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the vendor on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or 2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. (8VAC20-790-230) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.1.b.i. CCDF eligible out-of-school programs that are license exempt must meet the following standards: Documentation that each child has received the immunizations required by the State Board of Health before the child can attend the center is required. A child may be conditionally enrolled for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his/her immunizations requirements within the ensuing 90 calendar days. There is an exception to extend the conditional period, for the hepatitis B vaccine only, to 180 days if the child requires more than two doses of the hepatitis B vaccine. A child experiencing homelessness who does not have documentation of the required immunizations is allowed a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required immunizations. Documentation of additional immunizations once every six months for children under the age of two years is required. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose: 1. Parent submits an affidavit to the vendor on the form entitled "Certification of Religious Exemption," stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices, or 2. A physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization. (8VAC20-790-580) 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: The center shall develop written procedures for safe sleep practices, and sudden infant death syndrome awareness. (8VAC20-780-40) Staff are required to complete the Department’s sponsored orientation course (i.e. Preservice training) within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20- 780-240) Smoking and the use of electronic smoking devices are prohibited in the interior of a center, in vehicles when children are transported, and if permitted outside, it is prohibited in the presence of children. (8VAC20-780-280 and 8VAC20-790-640) Sight and sound supervision is required for children in care. (8VAC20-780-340) Infants shall be placed on their backs in a supine position when placed in a crib, allowing an infant who is able to easily turn over in the crib to adopt whatever position she/he prefers. Resting or sleeping infants must be individually checked every 15-20 minutes. Infants who cannot turn themselves over and are awake are to be placed on their stomachs a total of 30 minutes each day to facilitate upper body strength. (8VAC20-780-370) Play yards may not be used for the designated sleeping area and cannot be occupied by more than one child at a time. (8VAC20-780-430) Cribs cannot be occupied by more than one child at a time, and double decker cribs are not permitted. Cribs must be used for children under 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards at the time they were manufactured; shall not have been recalled; shall have no more than six centimeters or 2-3/8 inches of space between slats; shall not have more than one inch between the mattress and the crib; and end panel cut outs in cribs shall be a size not to cause head entrapment. Cribs shall be placed where objects outside the crib such as cords from blinds or curtains are not within reach of infants or toddlers. Crib sides must be up and the fastenings secured when the child is in the crib. Pillows and filled comforters may not be used by children less than two years, and the use of crib bumper pads is prohibited. Toys or objects hung over an infant in a crib and crib gyms that are strung across a crib may not be used by infants over five months of age or infants who are able to push up on their hands and knees. (8VAC-20-780-440) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-780-570) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers in CCDF licensed family day homes are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20-790-250) Items tied across the top or corner of a crib or playpen or toys hung from the sides with strings or cords shall be removed when the child begins to push up on hands and knees or is five months of age, whichever comes first. (8VAC20-800-250) Smoking and the use of electronic smoking devices are prohibited indoors while children are in care, in a vehicle when children are transported, or outdoors in areas occupied by children. (8VAC20-800-470 and 8VAC20-790-270) A child shall be provided an individual crib for resting or napping. (8VAC20-800- 510) Cribs must be used for children birth through 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards at the time they were manufactured; shall not have been recalled; shall have no more than six centimeters or 2-3/8 inches of space between slats; shall have mattresses that fit snugly next to the crib so that no more than two fingers can be inserted between the mattress and the crib; shall not have end panel cutouts of a size to cause head entrapment; and shall not have mesh sides. Double-deck cribs are prohibited. Crib sides must be up and the fastenings secured when the child is in the crib. The use of crib bumper pads is prohibited. (8VAC-20-800-520) Cribs when used by infants shall have a tight-fitting bottom cover. No soft bedding of any kind shall be used under or around infants including, but not limited to, pillows, quilts, comforters, sheepskins, or stuffed toys. (8VAC20-800-530) Play pens may not be used for the designated sleeping area, cannot be occupied by more than one child at a time, and shall not contain any pillows or filled comforters. (8VAC20-800-550) A caregiver must be physically present on site and provide direct care and supervision at all times, to include awareness of and responsibility for each child in care, including being near enough to intervene if needed; and monitoring of each sleeping infant in one of the following ways: a. By placing each infant for sleep in a location where the infant is within sight and hearing of a caregiver; b. By in-person observation of each sleeping infant at least once every 15 minutes; or c. By using a baby monitor. (8VAC20-800-560) Infants shall be placed on their backs when sleeping or napping. An infant, toddler, or preschool child who falls asleep in a play space other than his own crib, cot, mat, or bed shall be moved promptly to his designated sleeping space if the safety or comfort of the infant, toddler, or preschool child is in question. (8VAC20- 800-590) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-800-960 and 8VAC20-790-450) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers in CCDF licensed family day homes are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20- 790-250) Items tied across the top or corner of a crib or playpen or toys hung from the sides with strings or cords shall be removed when the child begins to push up on hands and knees or is five months of age, whichever comes first. (8VAC20-800-250) Smoking and the use of electronic smoking devices are prohibited indoors while children are in care, in a vehicle when children are transported, or outdoors in areas occupied by children. (8VAC20-800-470 and 8VAC20-790-270) A child shall be provided an individual crib for resting or napping. (8VAC20-800- 510) Cribs may not be occupied by more than one child at a time and must be used for children birth through 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards at the time they were manufactured; shall not have been recalled; shall have no more than six centimeters or 2-3/8 inches of space between slats; shall have mattresses that fit snugly next to the crib so that no more than two fingers can be inserted between the mattress and the crib; shall not have end panel cutouts of a size to cause head entrapment; and shall not have mesh sides. Double-deck cribs are prohibited. Crib sides must be up and the fastenings secured when the child is in the crib. The use of crib bumper pads is prohibited. (8VAC-20-800-520 and 8VAC20-790-360) Cribs when used by infants shall have a tight-fitting bottom cover. Pillows and filled comforters cannot be used by children less than two years of age while sleeping or resting, including quilts, sheepskins, or stuffed toys. (8VAC20-800-530 and 8VAC20-790-360) Play pens may not be used for the designated sleeping area, cannot be occupied by more than one child at a time, and shall not contain any pillows or filled comforters. (8VAC20-800-550) A caregiver must be physically present on site and provide direct care and supervision at all times, to include awareness of and responsibility for each child in care, including being near enough to intervene if needed; and monitoring of each sleeping infant in one of the following ways: a. By placing each infant for sleep in a location where the infant is within sight and hearing of a caregiver; b. By in-person observation of each sleeping infant at least once every 15 minutes; or c. By using a baby monitor. (8VAC20-800-560) Infants shall be placed on their backs when sleeping or napping. An infant, toddler, or preschool child who falls asleep in a play space other than his own crib, cot, mat, or bed shall be moved promptly to his designated sleeping space if the safety or comfort of the infant, toddler, or preschool child is in question. (8VAC20- 800-590) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-800-960 and 8VAC20-790-450) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20-790-600) Smoking and the use of electronic smoking devices are prohibited in the interior of a center, in vehicles when children are transported, and if permitted outside, it is prohibited in the presence of children. (8VAC20-790-640) Sight and sound supervision is required for children in care. (8VAC20-790-680) Infants are to be placed on their backs in a supine position when placed in a crib, allowing an infant who is able to easily turn over in the crib to adopt whatever position she/he prefers. Resting or sleeping infants must be individually checked every 15-20 minutes. Infants who cannot turn themselves over and are awake are to be placed on their stomachs a total of 30 minutes each day to facilitate upper body strength. (8VAC20-790-690) Play yards and portable cribs where used shall meet the Juvenile Products Manufacturers Association and the American Society for Testing and Materials requirements and cannot be used after recall. Cribs cannot be occupied by more than one child at a time. Cribs must be used for children under 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards and have mattresses that fit snugly next to the crib so no more than two fingers can be inserted between the mattress and crib. Cribs shall be placed where objects outside the crib such as electrical cords or cords from blinds or curtains are not within reach of infants or toddlers. Crib sides must be up and the fastenings secured when the child is in the crib. Pillows and filled comforters may not be used by children less than 12 months of age while sleeping or resting including quilts, sheepskins or stuffed toys. The use of crib bumper pads is prohibited. Toys or objects hung over an infant in a crib and crib gyms that are strung across a crib may not be used by infants over five months of age or infants who are able to push up on their hands and knees. Double decker cribs are not permitted. (8VAC-20-790-730) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-790-820) Religiously exempt child day centers must be in compliance with all safe sleep guidelines recommended by the American Academy of Pediatrics. (§ 22.1- 289.031) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20-790-250) Smoking and the use of electronic smoking devices are prohibited indoors while children are in care, in a vehicle when children are transported, or outdoors in areas occupied by children. (8VAC20-790-270) A caregiver must be physically present on site and provide direct care and supervision at all times, to include awareness of and responsibility for each child in care, including being near enough to intervene if needed; and monitoring of each sleeping infant in one of the following ways: a. By placing each infant for sleep in a location where the infant is within sight and hearing of a caregiver; b. By in-person observation of each sleeping infant at least once every 15 minutes; or c. By using a baby monitor. (8VAC20-790-300) Infants shall be placed on their backs when sleeping or napping. An infant, toddler, or preschool child who falls asleep in a play space other than his own crib, cot, mat, or bed shall be moved promptly to his designated sleeping space if the safety or comfort of the infant, toddler, or preschool child is in question. (8VAC20- 790-320) If play yards, portable cribs, or mesh-sided cribs are used for sleeping or napping, they shall meet Consumer Product Safety Commission Standards and have mattresses that fit snugly so that no more than two fingers can be inserted between the mattress and side of the play yard, portable crib, or mesh-sided crib. Cribs shall not be occupied by more than one child at a time and must be used for children birth through 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards and have mattresses that fit snugly next to the crib so that no more than two fingers can be inserted between the mattress and the crib. Pillows and filled comforters cannot be used by children less than two years of age while sleeping or resting, including quilts, sheepskins, or stuffed toys. Double-deck cribs are prohibited. Crib sides must be up and the fastenings secured when the child is in the crib. The use of crib bumper pads is prohibited. Cribs shall be placed where objects outside the crib such as electrical cords or cords from blinds, curtains, etc. are not within reach of infants or toddlers. Toys or objects hung over an infant in a crib and crib gyms that are strung across the crib may not be used for infants older than five months of age or infants who are able to push up on their hands and knees. (8VAC20-790-360) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-790-450) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20-790-250) Smoking and the use of electronic smoking devices are prohibited indoors while children are in care, in a vehicle when children are transported, or outdoors in areas occupied by children. (8VAC20-790-270) A caregiver must be physically present on site and provide direct care and supervision at all times, to include awareness of and responsibility for each child in care, including being near enough to intervene if needed; and monitoring of each sleeping infant in one of the following ways: a. By placing each infant for sleep in a location where the infant is within sight and hearing of a caregiver; b. By in-person observation of each sleeping infant at least once every 15 minutes; or c. By using a baby monitor. (8VAC20-790-300) Infants shall be placed on their backs when sleeping or napping. An infant, toddler, or preschool child who falls asleep in a play space other than his own crib, cot, mat, or bed shall be moved promptly to his designated sleeping space if the safety or comfort of the infant, toddler, or preschool child is in question. (8VAC20- 790-320) If play yards, portable cribs, or mesh-sided cribs are used for sleeping or napping, they shall meet Consumer Product Safety Commission Standards and have mattresses that fit snugly so that no more than two fingers can be inserted between the mattress and side of the play yard, portable crib, or mesh-sided crib. Cribs shall not be occupied by more than one child at a time and must be used for children birth through 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards and have mattresses that fit snugly next to the crib so that no more than two fingers can be inserted between the mattress and the crib. Pillows and filled comforters cannot be used by children less than two years of age while sleeping or resting, including quilts, sheepskins, or stuffed toys. Double-deck cribs are prohibited. Crib sides must be up and the fastenings secured when the child is in the crib. The use of crib bumper pads is prohibited. Cribs shall be placed where objects outside the crib such as electrical cords or cords from blinds, curtains, etc. are not within reach of infants or toddlers. Toys or objects hung over an infant in a crib and crib gyms that are strung across the crib may not be used for infants older than five months of age or infants who are able to push up on their hands and knees. (8VAC20-790-360) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-790-450) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.2.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of sudden infant death syndrome and safe sleep practices. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention of sudden infant death syndrome and safe sleep practices. (8VAC20-790-600) Smoking and the use of electronic smoking devices are prohibited in the interior of a center, in vehicles when children are transported, and if permitted outside, it is prohibited in the presence of children. (8VAC20-790-640) Sight and sound supervision is required for children in care. (8VAC20-790-680) Infants are to be allowed to sleep as needed and shall be placed on their backs in a supine position when placed in a crib, allowing an infant who is able to easily turn over in the crib to adopt whatever position she/he prefers. Resting or sleeping infants must be individually checked every 15-20 minutes. Infant who cannot turn themselves over and are awake are to be placed on their stomachs at total of 30 minutes each day to facilitate upper body strength. (8VAC20-790-690) Play yards and portable cribs where used shall meet the Juvenile Products Manufacturers Association and the American Society for Testing and Materials requirements and cannot be used after recall. Cribs cannot be occupied by more than one child at a time. Cribs must be used for children under 12 months of age and for children over 12 months of age who are not developmentally ready to sleep on a cot or mat. Cribs must meet the Consumer Product Safety Commission standards and have mattresses that fit snugly next to the crib so no more than two fingers can be inserted between the mattress and crib. Cribs shall be placed where objects outside the crib such as electrical cords or cords from blinds or curtains are not within reach of infants or toddlers. Crib sides must be up and the fastenings secured when the child is in the crib. Pillows and filled comforters may not be used by children less than 12 months of age while sleeping or resting including quilts, sheepskins or stuffed toys. The use of crib bumper pads is prohibited. Toys or objects hung over an infant in a crib and crib gyms that are strung across a crib may not be used by infants over five months of age or infants who are able to push up on their hands and knees. Double decker cribs are not permitted. (8VAC-20-790-730) Bottles shall not be propped or used while the child is in his designated sleeping location. (8VAC20-790-820) 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: Staff are required to complete the Department’s sponsored orientation (i.e. Virginia Preservice training) within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. (8VAC20- 780-240 and 8VAC20-790-600) To administer prescription and nonprescription medication, a staff member or independent contractor is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Staff required to have the training must complete the training every three years. A child who has prescribed emergency medications must always be in the care of a staff or independent contractor who has completed medication administration training. (8VAC20-780-245) Before the child’s first day of attending, parents must be provided in writing the center’s policy regarding any medication that will be given and the center’s policy regarding the application of sunscreen, diaper ointment and insect repellent. (8VAC20-780-420) Medication administration for prescription and nonprescription medications is performed according to the written medication policies, which must include general restrictions of the center; that nonprescription medications are administered in accordance with the manufacturer's instructions, for age, duration and dosage; that the duration of a parent’s authorization expires or must be renewed after 10 working days unless written authorization from the child’s physician is also provided; and methods of preventing the use of outdated medication. Medication can only be administered by a staff who is 18 years of age or older and who has completed medication administration training. Medication shall be labeled with the child's name, the name of the medication, the dosage amount, and the time or times to be given. Nonprescription medication shall be in the original container with the direction label attached. Prescription medication must be in the original container with the child's name and the manufacturer's label must be attached, and the center may only administer the medication to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. Documentation of administration must be completed and maintained that includes the child to whom medication was administered; amount and type of medication administered to the child; the day and time the medication was administered to the child; the staff member administering the medication; any adverse reactions; and any medication error. Staff shall inform parents immediately of any adverse reactions to medication administered and any medication error. Medication must be kept in a locked place and shall be refrigerated as needed. When an authorization for medication expires, the parent shall be notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. Medications that are not picked up by the parent within 14 days shall be disposed of. (8VAC20-780-510) All nonprescription drugs and over-the-counter skin products must be used in accordance with the manufacturer's recommendations. Nonprescription drugs and over-the-counter skin products shall not be kept or used beyond the expiration date of the product. If sunscreen is used, it must be in the original container and labeled with the child's name; it shall be inaccessible to children under five years of age; it may be self administered by children nine and older if supervised; and if provided by the center, must be hypo-allergenic and have a minimum SPF of 15. If diaper ointment is used, it must be in the original container and labeled with the child's name; it must be inaccessible to children; and a record shall be kept that includes the child's name, date of use, frequency of application and any adverse reactions. If insect repellent is used, it must be in the original container and labeled with the child's name; it must be inaccessible to children; the manufacturer's instructions for age, duration and dosage shall be followed; and a record shall be kept that includes the child's name, date of use, frequency of application and any adverse reactions. Staff members without medication administration training may apply sunscreen, diaper ointment and insect repellent, unless it is prescription, in which case the storing and application of the skin product must meet medication-related requirements. (8VAC20-780- 520) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Before the child’s first day of attending, parents must be provided in writing the home’s policies for the administration of medications. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the vendor's policies and procedures on the administration of medication. (8VAC20-790-250) To administer prescription and nonprescription medication, a caregiver is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Caregivers required to have the training must complete the training every three years. (8VAC20-800- 220) Medication administration for prescription and nonprescription medications is performed according to the written medication policies. Parent’s written authorization for medication expires or must be renewed after 10 working days unless written authorization from the child’s physician is also provided. When an authorization expires, the parent shall be notified that the medication must be picked up in 14 days or the parent must renew the authorizations. Medications that are not picked up within 14 days shall be taken to a pharmacy for proper disposal. (8VAC20-800-700) Prescription medication may only be given by a caregiver trained in medication administration, must be in the original, labeled container, and only administered to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. (8VAC20-800-710) Nonprescription medication may only be administered by a caregiver that is 18 years of age or older and trained in medication administration. The medication must not be used beyond the date of expiration of the product, must be labeled with the child’s name, and given only at the dose, duration and method of administration specified on the manufacturer’s label for the age or weight of the child needing the medication. (8VAC20-800-720) Medications for children must be stored separately from medications of household members and caregivers and shall be kept in a locked place. (8VAC20- 800-730) Documentation of administration must be completed and maintained that includes the child to whom medication was administered; amount and type of medication administered to the child; the day and time the medication was administered to the child; the caregiver administering the medication; any adverse reactions; and any medication error. (8VAC20-800-740) Topical skin products such as sunscreen, diaper ointment, oral teething medicine, and insect repellent shall not be used beyond the expiration date of the product. Such products shall be in the original container and labeled with the child's name; and shall be inaccessible to children; applied according to manufacturer’s instructions. Parents must be informed immediately of any adverse reaction. If sunscreen is provided by the vendor, it must have a minimum SPF of 15. Caregivers without medication administration training may apply the product, unless it is prescription medication, in which case the storing and application of the skin product must meet medication-related requirements. (8VAC20-800-750) iii. All CCDF-eligible licensed in-home care. Provide the standard: Before the child’s first day of attending, parents must be provided in writing the home’s policies for the administration of medications. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the vendor's policies and procedures on the administration of medication. (8VAC20-790-250) To administer prescription and nonprescription medication, a caregiver is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Caregivers required to have the training must complete the training every three years. (8VAC20-800- 220) Medication administration for prescription and nonprescription medications is performed according to the written medication policies. Parent’s written authorization for medication expires or must be renewed after 10 working days unless written authorization from the child’s physician is also provided. When an authorization expires, the parent shall be notified that the medication must be picked up in 14 days or the parent must renew the authorizations. Medications that are not picked up within 14 days shall be taken to a pharmacy for proper disposal. (8VAC20-800-700) Prescription medication may only be given by a caregiver trained in medication administration, must be in the original, labeled container, and only administered to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. (8VAC20-800-710) Nonprescription medication may only be administered by a caregiver that is 18 years of age or older and trained in medication administration. The medication must not be used beyond the date of expiration of the product, must be labeled with the child’s name, and given only at the dose, duration and method of administration specified on the manufacturer’s label for the age or weight of the child needing the medication. (8VAC20-800-720) Medications for children must be stored separately from medications of household members and caregivers and shall be kept in a locked place. (8VAC20- 800-730) Documentation of administration must be completed and maintained that includes the child to whom medication was administered; amount and type of medication administered to the child; the day and time the medication was administered to the child; the caregiver administering the medication; any adverse reactions; and any medication error. (8VAC20-800-740) Topical skin products such as sunscreen, diaper ointment, oral teething medicine, and insect repellent shall not be used beyond the expiration date of the product. Such products shall be in the original container and labeled with the child's name; and shall be inaccessible to children; applied according to manufacturer’s instructions. Parents must be informed immediately of any adverse reaction. If sunscreen is provided by the vendor, it must have a minimum SPF of 15. Caregivers without medication administration training may apply the product, unless it is prescription medication, in which case the storing and application of the skin product must meet medication-related requirements. (8VAC20-800-750) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. To administer prescription medication, a staff member is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Staff required to have the training must complete the training every three years. (8VAC20-790-600) The vendor may administer prescription medication to a child if the medication is administered by a staff trained in medication administration; the staff administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and the staff administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. The vendor may administer over-the-counter or nonprescription medication to a child if the medication is administered by a staff 18 years of age or older; labeled with the child's name; in the original container with the manufacturer's direction label attached; and given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication. Medication shall be refrigerated as needed and shall be kept in a locked place. Written record of prescription and nonprescription medication given to children must be completed and maintained including the name of the child to whom medication was administered; the amount and name of medication administered to the child; the day and time the medication was administered to the child; the name of staff administering the medication; any adverse reaction; and any medication error. (8VAC20-790-770) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the vendor's policies and procedures on the administration of medication. To administer prescription medication, a caregiver is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Caregivers required to have the training must complete the training every three years. (8VAC20-790-250) Prescription and nonprescription medications shall be given to a child according to the home's written medication policies. The vendor may administer prescription medication that would normally be administered by a parent or guardian to a child provided the medication is administered by a caregiver trained in medication administration; the caregiver administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and the caregiver administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. The vendor may administer nonprescription medication provided the medication is administered by a caregiver 18 years of age or older; labeled with the child's name; in the original container with the manufacturer's direction label attached; and given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication. Nonprescription medication shall not be used beyond the expiration date of the product. Medications for children in care shall be stored separately from medications for household members and caregivers. Medication must be stored in a locked place, and when needed, medication shall be refrigerated. The vendor shall keep a record of prescription and nonprescription medication given children, which shall include the following the name of the child to whom medication was administered; the amount and type of medication administered to the child; the day and time the medication was administered to the child; the name of the caregiver administering the medication; any adverse reactions; and any medication error. (8VAC20-790-400) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the vendor's policies and procedures on the administration of medication. To administer prescription medication, a caregiver is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Caregivers required to have the training must complete the training every three years. (8VAC20-790-250) Prescription and nonprescription medications shall be given to a child according to the home's written medication policies. The vendor may administer prescription medication that would normally be administered by a parent or guardian to a child provided the medication is administered by a caregiver trained in medication administration; the caregiver administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and the caregiver administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. The vendor may administer nonprescription medication provided the medication is administered by a caregiver 18 years of age or older; labeled with the child's name; in the original container with the manufacturer's direction label attached; and given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication. Nonprescription medication shall not be used beyond the expiration date of the product. Medications for children in care shall be stored separately from medications for household members and caregivers. Medication must be stored in a locked place, and when needed, medication shall be refrigerated. The vendor shall keep a record of prescription and nonprescription medication given children, which shall include the following the name of the child to whom medication was administered; the amount and type of medication administered to the child; the day and time the medication was administered to the child; the name of the caregiver administering the medication; any adverse reactions; and any medication error. (8VAC20-790-400) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.3.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. To administer prescription medication, a staff member is required to have satisfactorily completed a training program for this purpose before administering medications or to be licensed by the Commonwealth of Virginia to administer medications. Medication Administration Training (MAT) is approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist. Staff required to have the training must complete the training every three years. (8VAC20-790-600) The vendor may administer prescription medication to a child if the medication is administered by a staff trained in medication administration; the staff administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and the staff administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration. The vendor may administer over-the-counter or nonprescription medication to a child if the medication is administered by a staff 18 years of age or older; labeled with the child's name; in the original container with the manufacturer's direction label attached; and given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication. Medication shall be refrigerated as needed and shall be kept in a locked place. Written record of prescription and nonprescription medication given to children must be completed and maintained including the name of the child to whom medication was administered; the amount and name of medication administered to the child; the day and time the medication was administered to the child; the name of staff administering the medication; any adverse reaction; and any medication error. (8VAC20-790-770) 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: Staff are required to complete the Department’s sponsored orientation (i.e. Virginia Preservice training) within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. (8VAC20- 780-240 and 8VAC20-790-600) Medication administration for prescription and nonprescription medications is only permitted with written authorization from the parent. Parent’s written authorization is only good for 10 work days unless written authorization from the child’s physician is also obtained for long term use. The medication authorization must be available to staff during the entire time it is effective. When an authorization for medication expires, the parent shall be notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. (8VAC20-780-510) Written parent authorization noting any known adverse reactions is required for the center to administer sunscreen, diaper ointment, and insect repellent. (8VAC20-780-520) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the medication administration procedures. (8VAC20-790-250) Medication administration for prescription and nonprescription medications is only permitted with written authorization from the parent. Parent’s written authorization is only good for 10 work days unless written authorization from the child’s physician is also obtained for long term use. When an authorization for medication expires, the parent shall be notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. (8VAC20- 800-700) Written parent authorization noting any known adverse reactions is required to administer sunscreen, diaper ointment, oral teething medicine, and insect repellent. The authorization is required annually. (8VAC20-800-750) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the medication administration procedures. (8VAC20-790-250) Medication administration for prescription and nonprescription medications is only permitted with written authorization from the parent. Parent’s written authorization is only good for 10 work days unless written authorization from the child’s physician is also obtained for long term use. When an authorization for medication expires, the parent shall be notified that the medication needs to be picked up within 14 days or the parent must renew the authorization. (8VAC20- 800-700) Written parent authorization noting any known adverse reactions is required to administer sunscreen, diaper ointment, oral teething medicine, and insect repellent. The authorization is required annually. (8VAC20-800-750) [ ]Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. (8VAC20-790-600) Medication administration for prescription and nonprescription medication is only permitted with written authorization from the parent. (8VAC20-790-770) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the medication administration procedures. (8VAC20-790-250) Medication administration for prescription and nonprescription medication is only permitted with written authorization from the parent. (8VAC20-790-400) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Caregivers must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the medication administration procedures. (8VAC20-790-250) Medication administration for prescription and nonprescription medication is only permitted with written authorization from the parent. (8VAC20-790-400) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.3.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes administration of medication, consistent with standards of parental consent. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes the center's policies and procedures on the administration of medication. (8VAC20-790-600) Medication administration for prescription and nonprescription medication is only permitted with written authorization from the parent. (8VAC20-790-770) 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: The center shall inform all staff who work with children of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all staff who work with children, and kept confidential in each room or area where children are present. (8VAC20-780-40) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-780-60 and 8VAC20-790-540) Staff are required to complete the Department sponsored orientation (i.e. Virginia Preservice training) within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-780-240 and 8VAC20-790-600) Any center provided sunscreen shall be hypo-allergenic. (8VAC20-780-520) The emergency preparedness plan for evaluation and sheltering-in-place shall include securing information on allergies or food intolerances. (8VAC20-780-550) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-780-560) Children’s allergy care plans and information on allergies and intolerances to medication or any other substances and actions to take in an emergency situation must be in transportation vehicles. (8VAC20-780-580) ii. All CCDF-eligible licensed family child care homes. Provide the standard: The vendor shall inform all caregivers who work with children of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all caregivers, and kept confidential. (8VAC20-790-170) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-800-60 and 8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-440) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) iii. All CCDF-eligible licensed in-home care. Provide the standard: The vendor shall inform all caregivers who work with children of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all caregivers, and kept confidential. (8VAC20-790-170) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-800-60 and 8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-440) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The vendor shall inform all staff who work with children of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all staff who work with children, and kept confidential in each room or area where children are present. (8VAC20-790-520) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-540) Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff who work with children that have food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-600) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-810) Children’s allergy care plans must be available during transportation. (8VAC20- 790-830) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The vendor shall inform all caregivers of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all caregivers, and kept confidential in each room or area where children are present. (8VAC20-790-170) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-190) Caregivers are required to complete Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-440) Children’s allergy care plans must be accessible during transportation. (8VAC20- 790-460) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The vendor shall inform all caregivers of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all caregivers, and kept confidential in each room or area where children are present. (8VAC20-790-170) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-190) Caregivers are required to complete Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-440) Children’s allergy care plans must be accessible during transportation. (8VAC20- 790-460) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.4.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: The vendor shall inform all staff who work with children of children’s allergies, sensitivities, and dietary restrictions. A current list of allergies, sensitivities and dietary restrictions must be dated, accessible to all staff who work with children, and kept confidential in each room or area where children are present. (8VAC20- 790-520) Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-540) Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff who work with children that have food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-600) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-720) When food is prepared that a child in care is allergic to, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. A child with a diagnosed food allergy shall not be served any food identified in the written care plan. (8VAC20-790-810) Children’s allergy care plans must be available during transportation. (8VAC20- 790-830) 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: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-780-60 and 8VAC20-790-540) Staff are required to complete the Department sponsored orientation (i.e. Virginia Preservice training) within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-800-240 and 8VAC20-790-600) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-780-550) Children’s allergy care plans and information on allergies and intolerances to medication or any other substances and actions to take in an emergency situation must be in transportation vehicles. (8VAC20-780-580) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-800-60 and 8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-350) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) iii. All CCDF-eligible licensed in-home care. Provide the standard:: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-800-60 and 8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-350) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-540) Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff who work with children that have food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-600) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-720) Children’s allergy care plans must be available during transportation. (8VAC20- 790-830) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-350) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-190) Caregivers are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Caregivers who work with children with food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-250) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-350) Children’s allergy care plans must be available during transportation. (8VAC20- 790-460) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.4.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Children's records must include information on allergies, including food allergies; intolerances to food, medication or other substances; and actions to be taken in an emergency situation. Also required is a written allergy care plan for each child with a diagnosed food allergy, with instructions from a physician regarding the food allergy and steps to be taken in the event of a suspected or confirmed allergic reaction. (8VAC20-790-540) Staff are required to complete the Virginia Preservice training within 90 calendar days of employment, which includes prevention of and response to emergencies due to food and allergic reactions. Staff who work with children that have food allergies must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that includes prevention of and response to emergencies due to food and other allergic reactions including: recognizing the symptoms of an allergic reaction; responding to allergic reactions; preventing exposure to the specific food and other substances to which the child is allergic; and preventing cross contamination. (8VAC20-790-600) Parents shall be informed immediately of any confirmed or suspected allergic reaction and ingestion of or contact with food identified in the written care plan, even if a reaction did not occur. (8VAC20-790-720) Children’s allergy care plans must be available during transportation. (8VAC20- 790-830) 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: Staff must complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of beginning employment, that includes building and physical premises safety. Additionally, staff must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the center’s playground safety procedures. (8VAC20-780-240 and 8VAC20-790-600) Prior to licensure, written documentation is required indicating that the building meets building and fire codes. The only exception is for any building currently approved for school occupancy that houses a public or private school during the school year when housing a center serving children two and a half years of age or older because schools already have to meet building and fire codes. Centers must also receive approval from the local health department, or an approved plan of correction for meeting requirements for water, sewage disposal, and food service, if applicable. Additionally, centers built before 1978 must submit results of an asbestos inspection and if asbestos is found, a management plan is also required, and the center must post a notice regarding the presence and location of the asbestos. (8VAC20-780-250) Annual fire and health inspections are required after initial approval, and notices related to the presence and location of asbestos must remain posted. (8VAC20- 780-260) Areas and equipment of the center, inside and outside, must be maintained in a clean, safe, and operable condition. Heat must be supplied from an approved heating system in accordance with the Uniform Statewide Building Code (USBC). Inside areas must be maintained no lower than 68°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. Outside lighting is required at entrances and exits used by children before sunrise and after sundown. (8VAC20-780-270) No center shall be located where conditions exist that would be hazardous to the health and safety of children. (8VAC20-780-280) Areas used by children of preschool age or younger must have covered electrical outlets, guardrails and handrails that meet USBC requirements, and if fans are used, they must be out of reach of children and cords must be secured. (8VAC20- 780-290) There must be 35 square feet of indoor space per child available, which does not include spaces not routinely used by children. There must be 75 square feet of space per child in outdoor play areas. Centers licensed for the care of infants and toddlers shall provide a separate playground area for these children that has at least 25 square feet of unpaved surface per infant/toddler on the outdoor area at any one time. A separate space must be designated for children who are ill or injured. (8VAC20-780-310) Centers must have at least two toilets and two sinks, and there must be at least one toilet and one sink per 20 preschool children and at least one standard size toilet and one sink per 30 school age children. The toilets must be flushable, and restrooms must have sinks near toilets that are supplied with running warm water that does not exceed 120°F. (8VAC20-780-320) Playgrounds shall be located and designed to protect children from hazards. Where playground equipment is provided, resilient surfacing shall comply with minimum safety standards when tested in accordance with the procedures described in the American Society for Testing and Materials standard F1292-99 and shall be under equipment with moving parts or climbing apparatus to create a fall zone free of hazardous obstacles. Ground supports shall be covered with materials that protect children from injury. Sandboxes with bottoms which prevent drainage shall be covered when not in use. A shady area shall be provided on playgrounds during the months of June, July, and August. Exceptions include that child day programs providing care for school-age children at a location that is currently approved by the Department of Education or recognized as a private school by the State Board of Education for school occupancy and that houses a public or private school during the school year from permitting school- age children may use outdoor play equipment and areas approved for use by students of the school during school hours. (8VAC20-780-330) Furnishings, equipment, and materials shall be of an appropriate size for the child using it. Play equipment used by children shall ensure that openings above the ground or floor which allow a 3-1/2 inch by 6-1/4 inch rectangle to fit through shall also allow a nine-inch circle to fit through, S-hooks where provided may not be open more than the thickness of a penny, and the equipment shall have no protrusions, sharp points, shearing points, or pinch points. Unenclosed climbing portion of slides and climbing equipment used by toddlers and preschool children shall not be more than seven feet high and must be located over resilient surfacing where outdoors and shall not be more than five feet high where indoors. Centers may not install any slide or climbing equipment to be used by preschoolers or toddlers when the climbing portion of the equipment is more than six feet in height. The climbing portions of indoor slides and climbing equipment over 18 inches shall not be over bare flooring, and the climbing portions of indoor slides and climbing equipment 36 inches or more shall be located over a resilient surface. Trampolines may not be used. (8VAC20-780-430) Licensed centers are required to develop and implement a plan to test potable water and submit the results of each test to the Virginia Department of Health (VDH). If the results of any test indicate a level of lead in the potable water at or above 15 parts per billion, the program shall remediate the level of lead in the water and submit the retesting results to VDH. In lieu of developing a plan and testing, centers may use bottled water for human consumption, and notify the VDH and parents of this choice. (§ 22.1-289.057) Licensed centers must be equipped with at least one carbon monoxide detector in each building built before 2015. (§ 22.1-289.058) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, caregivers must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the facility’s playground safety procedures. (8VAC20-790-250) Areas, furnishings and equipment of the home, inside and outside, must be maintained in a clean, safe, and operable condition. No equipment, materials or furnishings shall be used if recalled or identified by the Consumer Product Safety Commission as being hazardous. (8VAC20-800-240 and 8VAC20-790-260) Firearms must be stored unloaded in a locked container, compartment or cabinet and apart from ammunition. Ammunition must be stored in a locked container, compartment or cabinet. (8VAC20-800-270) Sharp kitchen utensils and other sharp objects are inaccessible to children unless being used by a caregiver or with children under supervision. (8VAC20-800-290) Machinery in operation must be inaccessible to children in care. (8VAC20-800- 310) Small electrical appliances shall be unplugged unless being used by the caregiver or with children under close supervision. Unused electrical outlets and surge protectors accessible to children under five years of age must be covered. Electrical cords and electrical appliances and equipment with cords that are frayed and have exposed wires shall not be used. Radiators, oil and wood burning stoves, floor furnaces, fireplaces, portable electric heaters, and similar heating devices located in areas accessible to children shall have barriers or screens and be located at least three feet from combustible materials. Unvented fuel burning heaters shall not be used when children are in care. Wood burning stoves and fireplaces and associated chimneys shall be inspected annually by a knowledgeable inspector to verify that the devices are properly installed, maintained, and cleaned as needed. All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. Providers must comply with the requirements or recommendations made by fire prevention or building officials to eliminate fire hazards. (8VAC20-800-320) Homes shall have an indoor bathroom with a working toilet and sink. (8VAC20- 800-340) Homes shall have indoor running water. Hot water at taps available to children must be maintained within a range of 105°F to 120°F. When water is not obtained from a municipal supply, and the house is not connected to a municipal sewer line, the water supply and septic system of the family day home shall be inspected and approved by the local health official or a private laboratory if there are open and obvious symptoms of water or sewage system problems, such as evidence of cloudy, murky, or muddy water, or sewage back up. (8VAC20-800-350) Garbage must be removed daily from rooms occupied by children and removed from the premises at least once a week or more often as needed. (8VAC20-800- 360) The home shall be kept free from rodents and insect infestation. No home shall maintain any receptacle or pool, whether natural or artificial, containing water in such condition that insects breeding therein may become a menace to public health. (8VAC20-370) Inside areas must be maintained no lower than 65°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. (8VAC20-800-400) Rooms, halls, and stairways used by children in care shall be lighted with natural or electric lighting for the children's safety and comfort. Entrance and exit ways shall be unobstructed and be lighted with natural or electric lighting. (8VAC20- 800-420) Accordion expansion gates and pressure mounted gates shall not be used as protective barriers at stair openings. Protective barriers or guardrails are required for stairs with three or more risers that children have access to. Protective barriers or guardrails on sides of stairs shall be constructed to prevent a child from climbing over, crawling or falling through, or becoming entrapped. (8VAC20-800- 430) Children shall not have access to decks, porches, lofts, or balconies that do not have protective barriers or guardrails, and the barriers or guardrails shall be constructed to prevent a child from climbing over, crawling or falling through, or becoming entrapped. (8VAC20-800-440) Windows and doors used for ventilation shall be securely screened. (8VAC20-800- 450) The climbing portions of indoor slides and climbing equipment over 18 inches high shall not be over bare floor. (8VAC20-800-490) Stationary outdoor playground equipment shall not be installed over concrete, asphalt, or any other hard surface; shall be placed at least six feet from the perimeter of other play structures or obstacles; and shall be firmly anchored with ground supports that are covered with materials to protect children from injury. The highest climbing rung or platform on outdoor climbing equipment or top of a slide shall not exceed six feet for school age children and four feet for preschool children. "S" hooks must be tightly closed; swings must have flexible seats of rubber, canvas, or nylon; and nonflexible-molded seats shall be used only when a caregiver stays within arm's length of any hard-molded swing in use and is positioned to see and protect other children who might walk into the path of the swing. Openings above the ground that are closed on all sides shall be smaller than 3-1/2 inches or larger than nine inches to prevent head entrapment hazards; ropes, loops, or any hanging apparatus that might entrap, close, or tighten upon a child shall not be used; equipment with moving parts that might pinch or crush children's hands or fingers shall not be used unless they have guards or covers; and equipment with platforms and ramps over 30 inches high shall have been designed with guardrails or barriers to prevent falls. Sandboxes shall be covered when not in use. Trampolines shall not be used during the hours children are in care. (8VAC20-800-500) Licensed homes are required to develop and implement a plan to test potable water and submit the results of each test to the Virginia Department of Health (VDH). If the results of any test indicate a level of lead in the potable water at or above 15 parts per billion, the program shall remediate the level of lead in the water and submit the retesting results to VDH. In lieu of developing a plan and testing, homes may use bottled water for human consumption, and notify the VDH and parents of this choice. (§ 22.1-289.057) Licensed homes must be equipped with at least one carbon monoxide detector in each building built before 2015. (§ 22.1-289.058) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, caregivers must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the facility’s playground safety procedures. (8VAC20-790-250) Areas, furnishings and equipment of the home, inside and outside, must be maintained in a clean, safe, and operable condition. No equipment, materials or furnishings shall be used if recalled or identified by the Consumer Product Safety Commission as being hazardous. (8VAC20-800-240 and 8VAC20-790-260) Firearms must be stored unloaded in a locked container, compartment or cabinet and apart from ammunition. Ammunition must be stored in a locked container, compartment or cabinet. (8VAC20-800-270) Sharp kitchen utensils and other sharp objects are inaccessible to children unless being used by a caregiver or with children under supervision. (8VAC20-800-290) Machinery in operation must be inaccessible to children in care. (8VAC20-800- 310) Small electrical appliances shall be unplugged unless being used by the caregiver or with children under close supervision. Unused electrical outlets and surge protectors accessible to children under five years of age must be covered. Electrical cords and electrical appliances and equipment with cords that are frayed and have exposed wires shall not be used. Radiators, oil and wood burning stoves, floor furnaces, fireplaces, portable electric heaters, and similar heating devices located in areas accessible to children shall have barriers or screens and be located at least three feet from combustible materials. Unvented fuel burning heaters shall not be used when children are in care. Wood burning stoves and fireplaces and associated chimneys shall be inspected annually by a knowledgeable inspector to verify that the devices are properly installed, maintained, and cleaned as needed. All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. Providers must comply with the requirements or recommendations made by fire prevention or building officials to eliminate fire hazards. (8VAC20-800-320) Homes shall have an indoor bathroom with a working toilet and sink. (8VAC20- 800-340) Homes shall have indoor running water. Hot water at taps available to children must be maintained within a range of 105°F to 120°F. When water is not obtained from a municipal supply, and the house is not connected to a municipal sewer line, the water supply and septic system of the family day home shall be inspected and approved by the local health official or a private laboratory if there are open and obvious symptoms of water or sewage system problems, such as evidence of cloudy, murky, or muddy water, or sewage back up. (8VAC20-800-350) Garbage must be removed daily from rooms occupied by children and removed from the premises at least once a week or more often as needed. (8VAC20-800- 360) The home shall be kept free from rodents and insect infestation. No home shall maintain any receptacle or pool, whether natural or artificial, containing water in such condition that insects breeding therein may become a menace to public health. (8VAC20-370) Inside areas must be maintained no lower than 65°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. (8VAC20-800-400) Rooms, halls, and stairways used by children in care shall be lighted with natural or electric lighting for the children's safety and comfort. Entrance and exit ways shall be unobstructed and be lighted with natural or electric lighting. (8VAC20- 800-420) Accordion expansion gates and pressure mounted gates shall not be used as protective barriers at stair openings. Protective barriers or guardrails are required for stairs with three or more risers that children have access to. Protective barriers or guardrails on sides of stairs shall be constructed to prevent a child from climbing over, crawling or falling through, or becoming entrapped. (8VAC20-800- 430) Children shall not have access to decks, porches, lofts, or balconies that do not have protective barriers or guardrails, and the barriers or guardrails shall be constructed to prevent a child from climbing over, crawling or falling through, or becoming entrapped. (8VAC20-800-440) Windows and doors used for ventilation shall be securely screened. (8VAC20-800- 450) The climbing portions of indoor slides and climbing equipment over 18 inches high shall not be over bare floor. (8VAC20-800-490) Stationary outdoor playground equipment shall not be installed over concrete, asphalt, or any other hard surface; shall be placed at least six feet from the perimeter of other play structures or obstacles; and shall be firmly anchored with ground supports that are covered with materials to protect children from injury. The highest climbing rung or platform on outdoor climbing equipment or top of a slide shall not exceed six feet for school age children and four feet for preschool children. "S" hooks must be tightly closed; swings must have flexible seats of rubber, canvas, or nylon; and nonflexible-molded seats shall be used only when a caregiver stays within arm's length of any hard-molded swing in use and is positioned to see and protect other children who might walk into the path of the swing. Openings above the ground that are closed on all sides shall be smaller than 3-1/2 inches or larger than nine inches to prevent head entrapment hazards; ropes, loops, or any hanging apparatus that might entrap, close, or tighten upon a child shall not be used; equipment with moving parts that might pinch or crush children's hands or fingers shall not be used unless they have guards or covers; and equipment with platforms and ramps over 30 inches high shall have been designed with guardrails or barriers to prevent falls. Sandboxes shall be covered when not in use. Trampolines shall not be used during the hours children are in care. (8VAC20-800-500) Licensed homes are required to develop and implement a plan to test potable water and submit the results of each test to the Virginia Department of Health (VDH). If the results of any test indicate a level of lead in the potable water at or above 15 parts per billion, the program shall remediate the level of lead in the water and submit the retesting results to VDH. In lieu of developing a plan and testing, homes may use bottled water for human consumption, and notify the VDH and parents of this choice. (§ 22.1-289.057) Licensed homes must be equipped with at least one carbon monoxide detector in each building built before 2015. (§ 22.1-289.058) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, staff must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the center’s playground safety procedures. (8VAC20-790-600) Prior to licensure, written documentation is required indicating that the building meets building and fire codes. The only exception is for any building currently approved for school occupancy that houses a public or private school during the school year when housing a center serving children two and a half years of age or older because schools already have to meet building and fire codes. Centers must also receive approval from the local health department, or an approved plan of correction for meeting requirements for water, sewage disposal, and food service, if applicable. (8VAC20-790-610) Annual fire and health inspections are required after initial approval. (8VAC20- 790-620) Areas and equipment of the center, inside and outside, must be maintained in a clean, safe, and operable condition. Inside areas must be maintained no lower than 68°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. (8VAC20-790-630) Centers must have at least two toilets and two sinks, and there must be at least one toilet and one sink for every 30 children. The toilets must be flushable, and restrooms must have sinks near toilets that are supplied with running warm water that does not exceed 120°F. (8VAC20-790-650) All areas of the premises that are accessible to children shall be free of obvious injury hazards, including providing and maintaining sand or other cushioning material under playground equipment. Exceptions include that child day programs providing care for school-age children at a location that is currently approved by the Department of Education or recognized as a private school by the State Board of Education for school occupancy and that houses a public or private school during the school year from permitting school-age children may use outdoor play equipment and areas approved for use by students of the school during school hours. (8VAC20-790-660) Furnishings, materials and equipment shall be age and stage appropriate size for the children. (8VAC20-730) Religious exempt child day centers and certified preschools serving preschool age children are required to develop and implement a plan to test potable water and submit the results of each test to the Virginia Department of Health (VDH). If the results of any test indicate a level of lead in the potable water at or above 15 parts per billion, the program shall remediate the level of lead in the water and submit the retesting results to VDH. In lieu of developing a plan and testing, centers may use bottled water for human consumption, and notify the VDH and parents of this choice. (§ 22.1-289.057) Religious exempt child day centers and certified preschools serving preschool age children must be equipped with at least one carbon monoxide detector in each building built before 2015. (§ 22.1-289.058) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, caregivers must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the facility’s playground safety procedures. (8VAC20-790-250) Areas and equipment of the home, inside and outside, must be maintained in a clean, safe, and operable condition. No equipment, materials or furnishings shall be used if recalled or identified by the Consumer Product Safety Commission as being hazardous. Inside areas must be maintained no lower than 65°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. Unused electrical outlets accessible to preschool age or younger children must be covered. Sharp kitchen utensils and other sharp objects are inaccessible to children unless being used by a caregiver or with children under supervision. Radiators, oil and wood burning stoves, floor furnaces, fireplaces, portable electric heaters, and similar heating devices located in areas accessible to children shall have barriers or screens and be located at least three feet from combustible materials. Unvented fuel burning heaters shall not be used when children are in care. Wood burning stoves and fireplaces and associated chimneys shall be inspected annually by a knowledgeable inspector to verify that the devices are properly installed, maintained, and cleaned as needed. All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. Protective barriers or guardrails are required for stairs with three or more risers that children have access to. Windows and doors used for ventilation shall be securely screened. Machinery in operation must be inaccessible to children in care. (8VAC20-790-260) Homes shall have an indoor bathroom with a working toilet and sink with running water that does not exceed 120°F. (8VAC20790-280) All areas on the premises accessible to children are free of obvious injury. Stationary outdoor playground equipment shall not be installed over concrete, asphalt, or any other hard surface. Trampolines shall not be used during the hours children are in care. (8VAC20-790-290) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, caregivers must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the facility’s playground safety procedures. (8VAC20-790-250) Areas and equipment of the home, inside and outside, must be maintained in a clean, safe, and operable condition. No equipment, materials or furnishings shall be used if recalled or identified by the Consumer Product Safety Commission as being hazardous. Inside areas must be maintained no lower than 65°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. Unused electrical outlets accessible to preschool age or younger children must be covered. Sharp kitchen utensils and other sharp objects are inaccessible to children unless being used by a caregiver or with children under supervision. Radiators, oil and wood burning stoves, floor furnaces, fireplaces, portable electric heaters, and similar heating devices located in areas accessible to children shall have barriers or screens and be located at least three feet from combustible materials. Unvented fuel burning heaters shall not be used when children are in care. Wood burning stoves and fireplaces and associated chimneys shall be inspected annually by a knowledgeable inspector to verify that the devices are properly installed, maintained, and cleaned as needed. All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. Protective barriers or guardrails are required for stairs with three or more risers that children have access to. Windows and doors used for ventilation shall be securely screened. Machinery in operation must be inaccessible to children in care. (8VAC20-790-260) Homes shall have an indoor bathroom with a working toilet and sink with running water that does not exceed 120°F. (8VAC20790-280) All areas on the premises accessible to children are free of obvious injury. Stationary outdoor playground equipment shall not be installed over concrete, asphalt, or any other hard surface. Trampolines shall not be used during the hours children are in care. (8VAC20-790-290) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.5.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff must complete the Virginia Preservice Training within 90 days of beginning employment, that includes building and physical premises safety. Additionally, staff must complete facility specific orientation prior to working alone with children and within seven days of beginning employment that includes the center’s playground safety procedures. (8VAC20-790-600) Prior to licensure, written documentation is required indicating that the building meets building and fire codes. The only exception is for any building currently approved for school occupancy that houses a public or private school during the school year when housing a center serving children two and a half years of age or older because schools already have to meet building and fire codes. Centers must also receive approval from the local health department, or an approved plan of correction for meeting requirements for water, sewage disposal, and food service, if applicable. (8VAC20-790-610) Annual fire and health inspections are required after initial approval. (8VAC20- 790-620) Areas and equipment of the center, inside and outside, must be maintained in a clean, safe, and operable condition. Inside areas must be maintained no lower than 68°F, and if the temperature exceeds 80°F, fans or other cooling systems are required. (8VAC20-790-630) Centers must have at least two toilets and two sinks, and there must be at least one toilet and one sink for every 30 children. The toilets must be flushable, and restrooms must have sinks near toilets that are supplied with running warm water that does not exceed 120°F. (8VAC20-790-650) All areas of the premises that are accessible to children shall be free of obvious injury hazards, including providing and maintaining sand or other cushioning material under playground equipment. Exceptions include that child day programs providing care for school-age children at a location that is currently approved by the Department of Education or recognized as a private school by the State Board of Education for school occupancy and that houses a public or private school during the school year from permitting school-age children may use outdoor play equipment and areas approved for use by students of the school during school hours. (8VAC20-790-660) Furnishings, materials and equipment shall be age and stage appropriate size for the children. (8VAC20-730) Religious exempt child day centers and certified preschools serving preschool age children are required to develop and implement a plan to test potable water and submit the results of each test to the Virginia Department of Health (VDH). If the results of any test indicate a level of lead in the potable water at or above 15 parts per billion, the program shall remediate the level of lead in the water and submit the retesting results to VDH. In lieu of developing a plan and testing, centers may use bottled water for human consumption, and notify the VDH and parents of this choice. (§ 22.1-289.057) Religious exempt child day centers and certified preschools serving preschool age children must be equipped with at least one carbon monoxide detector in each building built before 2015. (§ 22.1-289.058) 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: When permanent swimming or wading pools are located on the premises of the center, the manufacturer's specifications for operating the pool shall be followed as well as any local ordinances and any Department of Health requirements for swimming pools; pools constructed, renovated, or remodeled after April 1, 1986, shall have a statement in writing of their inspection and approval from the local building official when such approval is required; outdoor swimming pools shall be enclosed by safety fences and gates which are in compliance with the applicable edition of the Virginia USBC and shall be kept locked when the pool is not in use; and entrances to indoor swimming pools shall be locked when the pool is not in use. If children are allowed to swim in a lake or other place other than a pool, safe swimming areas shall be clearly marked and there shall be appropriate water safety equipment. Piers, floats, and platforms shall be in good repair and where used for diving, the minimum water depth shall be stated on the deck or planking. (8VAC20-780-470) Notwithstanding the staff-to-children ratios, at no time shall there be fewer than two staff members supervising swimming or wading activity. If a pool, lake, or other swimming area has a water depth of more than two feet, a certified lifeguard holding a current certificate shall be on duty supervising the children participating in swimming or wading activities at all times when one or more children are in the water, and the lifeguard cannot be counted in the staff-to- children ratios. (8VAC20-780-460) The center shall have emergency procedures and written safety rules for swimming or wading or follow the posted rules of public pools that are posted in the swimming area when the pool is located on the premises of the center; and explained to children participating in swimming or wading activities. Underwater and deck lighting is required if outdoor swimming activities take place outside of daylight hours. (8VAC20-780-480) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Access to the water in aboveground swimming pools shall be prevented by locking and securing the ladder in place or storing the ladder in a place inaccessible to children. A non-climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of drowning hazards such as, but not limited to, inground swimming or wading pools, ponds, or fountains not enclosed by safety fences. When not in use during the family day home's hours of operation, portable wading pools shall be emptied, sanitized, and stored in a position to keep them clean and dry. Bathtubs, buckets, and other containers of liquid accessible to children shall be emptied immediately after use. Hot tubs, spas, and whirlpools shall not be used by children in care, and covered with safety covers while children are in care. (8VAC20-800-260) The point system (i.e., staff-to-child ratio) shall be maintained while the children are participating in swimming or wading activities. Outdoor swimming activities shall occur only during daylight hours. When one or more children are in water that is more than two feet deep in a pool, lake, or other swimming area on or off the premises of the family day home, a minimum of least two caregivers shall be present and able to supervise the children; and an individual currently certified in basic water rescue, community water safety, water safety instruction, or lifeguarding shall be on duty supervising the children participating in swimming or wading activities at all times. (8VAC20-800-660) iii. All CCDF-eligible licensed in-home care. Provide the standard: Access to the water in aboveground swimming pools shall be prevented by locking and securing the ladder in place or storing the ladder in a place inaccessible to children. A non- climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of drowning hazards such as, but not limited to, inground swimming or wading pools, ponds, or fountains not enclosed by safety fences. When not in use during the family day home's hours of operation, portable wading pools shall be emptied, sanitized, and stored in a position to keep them clean and dry. Bathtubs, buckets, and other containers of liquid accessible to children shall be emptied immediately after use. Hot tubs, spas, and whirlpools shall not be used by children in care, and covered with safety covers while children are in care. (8VAC20-800-260) The point system (i.e., staff-to-child ratio) shall be maintained while the children are participating in swimming or wading activities. Outdoor swimming activities shall occur only during daylight hours. When one or more children are in water that is more than two feet deep in a pool, lake, or other swimming area on or off the premises of the family day home, a minimum of least two caregivers shall be present and able to supervise the children; and an individual currently certified in basic water rescue, community water safety, water safety instruction, or lifeguarding shall be on duty supervising the children participating in swimming or wading activities at all times. (8VAC20-800-660) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Indoor swimming pools on the center premises shall be kept locked when the pool is not in use. Outdoor swimming pools located on the center premises shall be enclosed by safety fences and gates that are in compliance with the applicable edition of the Virginia Uniform Statewide Building Code and shall be kept locked when the pool is not in use. Notwithstanding the staff-to-children ratios already indicated, at no time shall there be fewer than two staff members supervising the activity. If a pool, lake, or other swimming area has a water depth of more than two feet, a certified lifeguard holding a current certificate shall be on duty supervising the children participating in swimming or wading activities at all times when one or more children are in the water, and the lifeguard may not be counted in the staff- to-children ratio. The vendor shall have emergency procedures and written safety rules for swimming or wading or follow the posted rules of public pools that are posted in the swimming area when the pool is located on the premises of the center; and explained to children participating in swimming or wading activities. (8VAC20-790-680 v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Access to the water in aboveground swimming pools shall be prevented by locking and securing the ladder in place or storing the ladder in a place inaccessible to children. A non-climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of drowning hazards such as, but not limited to, inground swimming or wading pools, ponds, or fountains not enclosed by safety fences. When not in use during the family day home's hours of operation, portable wading pools shall be emptied, sanitized, and stored in a position to keep them clean and dry. Hot tubs, spas, and whirlpools shall not be used by children in care, and covered with safety covers while children are in care. The point system (i.e., staff-to-child ratio) shall be maintained while the children are participating in swimming or wading activities. Outdoor swimming activities shall occur only during daylight hours. When one or more children are in water that is more than two feet deep in a pool, lake, or other swimming area on or off the premises of the family day home, a minimum of least two caregivers shall be present and able to supervise the children; and an individual currently certified in basic water rescue, community water safety, water safety instruction, or lifeguarding shall be on duty supervising the children participating in swimming or wading activities at all times. (8VAC20- 790-310) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Access to the water in aboveground swimming pools shall be prevented by locking and securing the ladder in place or storing the ladder in a place inaccessible to children. A non- climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of drowning hazards such as, but not limited to, inground swimming or wading pools, ponds, or fountains not enclosed by safety fences. When not in use during the family day home's hours of operation, portable wading pools shall be emptied, sanitized, and stored in a position to keep them clean and dry. Hot tubs, spas, and whirlpools shall not be used by children in care, and covered with safety covers while children are in care. The point system (i.e., staff-to-child ratio) shall be maintained while the children are participating in swimming or wading activities. Outdoor swimming activities shall occur only during daylight hours. When one or more children are in water that is more than two feet deep in a pool, lake, or other swimming area on or off the premises of the family day home, a minimum of least two caregivers shall be present and able to supervise the children; and an individual currently certified in basic water rescue, community water safety, water safety instruction, or lifeguarding shall be on duty supervising the children participating in swimming or wading activities at all times. (8VAC20-790-310) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.5.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Indoor swimming pools on the center premises shall be kept locked when the pool is not in use. Outdoor swimming pools located on the center premises shall be enclosed by safety fences and gates that are in compliance with the applicable edition of the Virginia Uniform Statewide Building Code and shall be kept locked when the pool is not in use. Notwithstanding the staff-to-children ratios already indicated, at no time shall there be fewer than two staff members supervising the activity. If a pool, lake, or other swimming area has a water depth of more than two feet, a certified lifeguard holding a current certificate shall be on duty supervising the children participating in swimming or wading activities at all times when one or more children are in the water, and the lifeguard may not be counted in the staff-to-children ratio. The vendor shall have emergency procedures and written safety rules for swimming or wading or follow the posted rules of public pools that are posted in the swimming area when the pool is located on the premises of the center; and explained to children participating in swimming or wading activities. (8VAC20-790-680) 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: During transportation, the center shall ensure that doors are closed properly and locked. When entering and leaving vehicles, children must enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Children must cross streets at corners or other designated safe crossing point if no corner or crosswalk is available. (8VAC20-780-580) ii. All CCDF-eligible licensed family child care homes. Provide the standard: A non- climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of hazards such as, but not limited to, streets with speed limits in excess of 25 miles per hour or with heavy traffic, or railroad tracks. (8VAC20-800-500) During transportation, the provider shall ensure that doors are closed properly and locked, and that each child boards and leaves the vehicle from the curb side of the vehicle or in a protected parking area or driveway. (8VAC20-800-1010 and 8VAC20-790-460) iii. All CCDF-eligible licensed in-home care. Provide the standard: A non-climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of hazards such as, but not limited to, streets with speed limits in excess of 25 miles per hour or with heavy traffic, or railroad tracks. (8VAC20-800-500) During transportation, the provider shall ensure that doors are closed properly and locked, and that each child boards and leaves the vehicle from the curb side of the vehicle or in a protected parking area or driveway. (8VAC20-800-1010 and 8VAC20-790-460) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: During transportation, the vendor shall ensure that doors are closed properly and locked. When entering and leaving vehicles, children must enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Children must cross streets at corners or other designated safe crossing point if no corner or crosswalk is available. (8VAC20-790-830) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: A non-climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of hazards such as, but not limited to, streets with speed limits in excess of 25 miles per hour or with heavy traffic. (8VAC20-790-290) During transportation, the provider shall ensure that doors are closed properly and locked, and that each child boards and leaves the vehicle from the curb side of the vehicle or in a protected parking area or driveway. (8VAC20-790-460) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: A non- climbable barrier at least four feet high such as, but not limited to, a fence or impenetrable hedge shall surround outdoor play areas located within 30 feet of hazards such as, but not limited to, streets with speed limits in excess of 25 miles per hour or with heavy traffic. (8VAC20-790-290) During transportation, the provider shall ensure that doors are closed properly and locked, and that each child boards and leaves the vehicle from the curb side of the vehicle or in a protected parking area or driveway. (8VAC20-790-460) 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, licensed and license-exempt, must meet the same standards: During transportation, the vendor shall ensure that doors are closed properly and locked. When entering and leaving vehicles, children must enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Children must cross streets at corners or other designated safe crossing point if no corner or crosswalk is available. (8VAC20-790-830) 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: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-780-10) The center shall develop written procedures for prevention of shaken baby syndrome or abusive head trauma, including copying with crying babies. (8VAC20- 780-40) Staff are required to complete the Department’s sponsored orientation (i.e. Virginia Preservice Training) within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-780-240 and 8VAC20-790-600) When supervising children, staff must always ensure children’s care, protection and guidance. (8VAC20-780-340) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 780-410) ii. All CCDF-eligible licensed family child care homes. Provide the standard: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-140) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-250) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-340) iii. All CCDF-eligible licensed in-home care. Provide the standard: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-140) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-250) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-340) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-490) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-600) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-710) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-140) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-250) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-340) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-140) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-250) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-340) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.6.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: "Shaken Baby Syndrome" or "Abusive Head Trauma" is defined in the standards as a traumatic injury that has been inflicted upon the brain of an infant or young child. The injury can occur during violent shaking causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear. (8VAC20-790-490) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes prevention of shaken baby syndrome and abusive head trauma. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include prevention of shaken baby syndrome and abusive head trauma, including procedures to cope with crying babies or distraught children. (8VAC20-790-600) Physical punishment, or threats thereof, are forbidden. Physical punishment of a child includes striking a child, roughly handling a child, or shaking a child. (8VAC20- 790-710) 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: Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2- 1509 of the Code of Virginia. (8VAC20-780-80 and 8VAC20-790-570) Staff are required to complete the Department’s sponsored orientation (i.e. Virginia Preservice Training) within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include recognizing and reporting child abuse and neglect. (8VAC20-780-240 and 8VAC20-790-600) Staff who do not work with a group of children are required to complete annual training on child abuse and neglect. (8VAC20-780-245) When supervising children, staff must always ensure children’s care, protection and guidance. (8VAC20-780-340) When time out is used as a behavior guidance technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall be appropriate to the child's developmental level and individual needs; 3. It shall not be used with infants or toddlers; 4. The child shall be in a safe, lighted, well-ventilated place, and within actual sight and sound of a staff member; and 5. The child shall not be left alone inside or outside the center. (8VAC20-780-400) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Separation from the group so that the child is away from the hearing and vision of a staff member; 5. Withholding or forcing of food, water or rest; 6. Verbal remarks which are demeaning to the child; 7. Punishment for toileting accidents; and 8. Punishment by applying unpleasant or harmful substances. (8VAC20-780-410 and 8VAC20-790-710) Before the child’s first day of attending, parents must be provided in writing, the center’s policy for reporting suspected child abuse. (8VAC20-780-420) The center must obtain eligible background checks for each staff to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§ 22.1-289.035) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Before the child’s first day of attendance, parents must be provided in writing, the requirement for paid caregivers to report suspected child abuse or neglect. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment to include recognizing and reporting child abuse and neglect. (8VAC20-800-200 and 8VAC20- 790-250) When time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall be appropriate to the child’s developmental level and circumstances; 3. It shall not be used with infants or toddlers; 4. The child shall be in a safe, lighted, well- ventilated place, and within actual sight and sound of a staff member; and 5. The child shall not be left alone inside or outside the home. (8VAC20-800-630) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-800-640) Caregivers shall immediately report any suspected incident of child abuse or neglect by any person. (8VAC20-800-860) The home must obtain eligible background checks for each staff and adult household member to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§§ 22.1-289.035 and 22.1289.036) The home must obtain an eligible Viriginia Child Abuse and Neglect Registry search for each household member 14 years of age and older. (8VAC20-770-40) iii. All CCDF-eligible licensed in-home care. Provide the standard: Before the child’s first day of attendance, parents must be provided in writing, the requirement for paid caregivers to report suspected child abuse or neglect. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment to include recognizing and reporting child abuse and neglect. (8VAC20-800-200 and 8VAC20- 790-250) When time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall be appropriate to the child’s developmental level and circumstances; 3. It shall not be used with infants or toddlers; 4. The child shall be in a safe, lighted, well- ventilated place, and within actual sight and sound of a staff member; and 5. The child shall not be left alone inside or outside the home. (8VAC20-800-630) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-800-640) Caregivers shall immediately report any suspected incident of child abuse or neglect by any person. (8VAC20-800-860) The home must obtain eligible background checks for each staff and adult household member to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§§ 22.1-289.035 and 22.1289.036) The home must obtain an eligible Viriginia Child Abuse and Neglect Registry search for each household member 14 years of age and older. (8VAC20-770-40) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2- 1509 of the Code of Virginia. (8VAC20-790-570) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include recognizing and reporting child abuse and neglect. (8VAC20-790-600) If time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall not be used with infants or toddlers; 3. The child shall be in a safe, lighted, well-ventilated place, and within actual sight and sound of a staff member; and 4. The child shall not be left alone inside or outside the center. (8VAC20-790-700) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-790-710) The center must obtain eligible background checks for each staff to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§ 22.1-289.035) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The vendor shall immediately report any suspected incident of child abuse or neglect. (8VAC20-790-220) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment to include reporting child abuse and neglect. (8VAC20-790-250) If time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall not be used with infants or toddlers; 3. The child shall be in a safe, lighted, well-ventilated place, and within actual sight and sound of a staff member; and 4. The child shall not be left alone inside or outside the home. (8VAC20-790-330) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-790-340) The home must obtain eligible background checks for each staff and adult household member to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§§ 22.1-289.035 and 22.1289.036) Voluntarily registered family day homes exempt from licensure must obtain an eligible Viriginia Child Abuse and Neglect Registry search for each household member 14 years of age and older. (8VAC20-770-40) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The vendor shall immediately report any suspected incident of child abuse or neglect. (8VAC20-790-220) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment to include reporting child abuse and neglect. (8VAC20-790-250) If time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall not be used with infants or toddlers; 3. The child shall be in a safe, lighted, well-ventilated place, and within actual sight and sound of a staff member; and 4. The child shall not be left alone inside or outside the home. (8VAC20-790-330) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-790-340) The home must obtain eligible background checks for each staff and adult household member to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§§ 22.1-289.035 and 22.1289.036) Voluntarily registered family day homes exempt from licensure must obtain an eligible Viriginia Child Abuse and Neglect Registry search for each household member 14 years of age and older. (8VAC20-770-40) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.6.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-790-570) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing and reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment to include recognizing and reporting child abuse and neglect. (8VAC20-790-600) If time out is used as a discipline technique: 1. It shall be used sparingly and shall not exceed one minute for each year of the child's age; 2. It shall not be used with infants or toddlers; 3. The child shall be in a safe, lighted, well-ventilated place, and within actual sight and sound of a staff member; and 4. The child shall not be left alone inside or outside the center. (8VAC20-790-700) The following actions or threats thereof are forbidden: 1. Physical punishment, striking a child, roughly handling or shaking a child, restricting movement through binding or tying, forcing a child to assume an uncomfortable position, or exercise as punishment; 2. Enclosure in a small confined space or any space that the child cannot freely exit himself; however, this does not apply to the use of equipment such as cribs, play yards, high chairs, and safety gates when used with children preschool age or younger for their intended purpose; 3. Punishment by another child; 4. Withholding or forcing of food, water or rest; 5. Verbal remarks which are demeaning to the child; 6 Punishment for toileting accidents; and 7. Punishment by applying unpleasant or harmful substances. (8VAC20-790-710) The center must obtain eligible background checks for each staff to include a Viriginia Child Abuse and Neglect Registry search and interstate child abuse and neglect registry search from any state that an individual has lived in within the last five years. (§ 22.1-289.035) 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 [ ] 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: VDOE was notified of possible non- compliance with the requirement to have all of the above areas covered in emergency preparedness and response planning standards on June 28, 2023. Virginia’s health and safety standards for family day homes do not include procedures for volunteer emergency preparedness training and practice drills. In addition, requirements for Child Day Centers do not include procedures for volunteer practice drills. Additional time is needed to address compliance with this requirement through the state regulatory process. 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: Staff are required to complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-780-240 and 8VAC20-790-600) Hazardous substances such as cleaning materials, insecticides, and pesticides must be kept in a locked place. The only exception is cleaning supplies used to clean and sanitize the diapering area or toilet chairs. These do not need to be kept locked during the diapering or toilet training time as long as those products are inaccessible to children. Pesticides or insecticides shall not be stored in areas used by children or in areas used for food preparation or storage. Cleaning and sanitizing materials shall not be located above food, food equipment, utensils or single-service articles and shall be stored in areas physically separate from food. Cleaning materials and insecticides/pesticides shall be stored in areas physically separate from each other. Hazardous substances shall be stored in the original container unless this container is of such a large size that its use would be impractical, and if hazardous substances are not kept in original containers, the substitute containers shall clearly indicate their contents and shall not resemble food or beverage containers. Cosmetics, medications, or other harmful agents shall not be stored in areas, purses or pockets that are accessible to children. Hazardous art and craft materials shall not be used with children. Additionally, smoking and the use of electronic smoking devices is prohibited in the interior of the center, in vehicles when children are being transported, and if permitted outside, is prohibited in the presence of children. (8VAC20-780-280 and 8VAC20- 790-640) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and staff’s personal medication, shall be kept in a locked place. When medication is stored in a refrigerator used for food, the medication shall be stored together in a container or in a clearly defined area away from food. (8VAC20-780-510) Sunscreen must be inaccessible to children under five years of age, and diaper ointment and insect repellent must be inaccessible to children. (8VAC20-780-520) First aid kits shall be inaccessible to children. (8VAC20-780-540) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) Firearms shall be stored unloaded in a locked container, compartment, or cabinet, and apart from ammunition. Ammunition shall be stored in a locked container, compartment, or cabinet during the family day home's hours of operation. (8VAC20-270) Potentially poisonous substances, materials and supplies such as cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children. Cleaning and sanitizing materials shall not be located above food, food equipment or single-service articles and shall be stored separate from food. Substitute containers shall clearly indicate the contents. (8VAC20-800-280 and 8VAC20-790- 270) All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. (8VAC20-800-320) Children shall not be allowed access to garbage storage areas. (8VAC20-800-360) Animal litter boxes, toys, food dishes, and water dishes shall be inaccessible to children. (8VAC20-800-460) Smoking is prohibited indoors when children are in care, in a vehicle when children are transported, and outdoors in an area occupied by children. (8VAC20- 800-470) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place. When medication is stored in a refrigerator used for food, the medication shall be stored together in a container or in a clearly defined area away from food. (8VAC20-800- 730) Topical skin products such as sunscreen, diaper ointment, oral teething medicine, and insect repellent must be inaccessible to children. (8VAC20-800-750) First aid kits shall be inaccessible to children. (8VAC20-800-760) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) Firearms shall be stored unloaded in a locked container, compartment, or cabinet, and apart from ammunition. Ammunition shall be stored in a locked container, compartment, or cabinet during the family day home's hours of operation. (8VAC20-800-270) Potentially poisonous substances, materials and supplies such as cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children. Cleaning and sanitizing materials shall not be located above food, food equipment or single-service articles and shall be stored separate from food. Substitute containers shall clearly indicate the contents. (8VAC20-800-280 and 8VAC20-790- 270) All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. (8VAC20-800-320) Children shall not be allowed access to garbage storage areas. (8VAC20-800-360) Animal litter boxes, toys, food dishes, and water dishes shall be inaccessible to children. (8VAC20-800-460) Smoking or use of an electronic smoking device is prohibited indoors when children are in care, in a vehicle when children are transported, and outdoors in an area occupied by children. (8VAC20-800-470 and 8VAC20-790-270) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place. When medication is stored in a refrigerator used for food, the medication shall be stored together in a container or in a clearly defined area away from food. (8VAC20-800- 730) Topical skin products such as sunscreen, diaper ointment, oral teething medicine, and insect repellent must be inaccessible to children. (8VAC20-800-750) First aid kits shall be inaccessible to children. (8VAC20-800-760) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-600) Hazardous substances such as cleaning materials, insecticides, and pesticides must be kept in a locked place. The only exception is cleaning supplies used to clean and sanitize the diapering area or toilet chairs. These do not need to be kept locked during the diapering or toilet training time as long as those products are inaccessible to children. Pesticides or insecticides shall not be stored in areas used by children or in areas used for food preparation or storage. Cleaning and sanitizing materials shall not be located above food, food equipment, utensils or single-service articles and shall be stored in areas physically separate from food. If hazardous substances are not kept in original containers, the substitute containers shall clearly indicate their contents. Additionally, smoking and the use of electronic smoking devices is prohibited in the interior of the center, in vehicles when children are being transported, and if permitted outside, is prohibited in the presence of children. (8VAC20-790-640) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and staff’s personal medication, shall be kept in a locked place. (8VAC20-790-770) First aid kits shall be inaccessible to children. (8VAC20-790-780) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. (8VAC20-790-260) Potentially poisonous substances, materials and supplies such as cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children. Cleaning and sanitizing materials shall not be located above food, food equipment or single-service articles and shall be stored separate from food. Substitute containers shall clearly indicate the contents. Smoking or use of an electronic smoking device is prohibited indoors when children are in care, in a vehicle when children are transported, and outdoors in an area occupied by children. (8VAC20- 790-270) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place. When medication is stored in a refrigerator used for food, the medication shall be stored together in a container or in a clearly defined area away from food. (8VAC20-790- 400) Animal litter boxes, toys, food dishes, and water dishes shall be inaccessible to children. (8VAC20-790-470) Voluntarily registered family day homes that are exempt from licensure are required to store firearms unloaded in a locked container, compartment, or cabinet, and apart from ammunition. Ammunition shall be stored in a locked container, compartment, or cabinet during the family day home's hours of operation. (§ 22.1-289.056) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) All flammable and combustible materials such as, but not limited to, matches, lighters, lighter fluid, kerosene, turpentine, oil and grease products, aerosol cans, and alcohol shall be stored in an area inaccessible to children. (8VAC20-790-260) Potentially poisonous substances, materials and supplies such as cleaning agents, disinfectants, deodorizers, plant care chemicals, pesticides, and petroleum distillates shall be stored away from food in areas inaccessible to children. Cleaning and sanitizing materials shall not be located above food, food equipment or single-service articles and shall be stored separate from food. Substitute containers shall clearly indicate the contents. Smoking or use of an electronic smoking device is prohibited indoors when children are in care, in a vehicle when children are transported, and outdoors in an area occupied by children. (8VAC20- 790-270) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place. When medication is stored in a refrigerator used for food, the medication shall be stored together in a container or in a clearly defined area away from food. (8VAC20-790- 400) Animal litter boxes, toys, food dishes, and water dishes shall be inaccessible to children. (8VAC20-790-470) Voluntarily registered in-home programs that are exempt from licensure are required to store firearms unloaded in a locked container, compartment, or cabinet, and apart from ammunition. Ammunition shall be stored in a locked container, compartment, or cabinet during the family day home's hours of operation. (§ 22.1-289.056) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.8.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-600) Hazardous substances such as cleaning materials, insecticides, and pesticides must be kept in a locked place. The only exception is cleaning supplies used to clean and sanitize the diapering area or toilet chairs. These do not need to be kept locked during the diapering or toilet training time as long as those products are inaccessible to children. Pesticides or insecticides shall not be stored in areas used by children or in areas used for food preparation or storage. Cleaning and sanitizing materials shall not be located above food, food equipment, utensils or single-service articles and shall be stored in areas physically separate from food. If hazardous substances are not kept in original containers, the substitute containers shall clearly indicate their contents. Additionally, smoking and the use of electronic smoking devices is prohibited in the interior of the center, in vehicles when children are being transported, and if permitted outside, is prohibited in the presence of children. (8VAC20-790-640) Medication, except for those prescriptions designated otherwise by written physician’s order, including refrigerated medication and staff’s personal medication, shall be kept in a locked place. (8VAC20-790-770) First aid kits shall be inaccessible to children. (8VAC20-790-780) 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: Staff are required to complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. Staff must also complete orientation training on facility specific topics prior to the staff working alone with children and within seven days of employment that addresses prevention and control of disease. (8VAC20-780-240 and 8VAC20-790-600) There must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes staff occupational health and safety practices in accordance with OSHA bloodborne pathogens regulation. (8VAC20-780-245 and 8VAC20-790-600) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-780-490) Disposable diapers shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak-proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. Additionally, children’s hands must be washed with soap and running water after contact with any blood, feces or urine, and staff must wash their hands with soap and running water after contact with any body fluids. (8VAC20-780-500) Manure shall be removed from barns, stables and corrals at least once a day and stored and disposed of in a manner to prevent the breeding of flies. (8VAC20-780- 600) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized.(8VAC20-800-300) Garbage shall be removed on a daily basis from rooms occupied by children and removed from the premises at least once weekly or more often as needed. (8VAC20-800-360) All animal excrement shall be removed promptly, disposed of properly, and, if indoors, the soiled area cleaned. (8VAC20-800-460) Children’s and caregiver’s hands are washed with liquid soap and running water after contact with any body fluids and after handling or caring for animals. Additionally, caregiver’s hands are washed after handling raw eggs or meat. (8VAC20-800-680) Disposable diapers and wipes shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak- proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. (8VAC20-800-690) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-800-300) Garbage shall be removed on a daily basis from rooms occupied by children and removed from the premises at least once weekly or more often as needed. (8VAC20-800-360) All animal excrement shall be removed promptly, disposed of properly, and, if indoors, the soiled area cleaned. (8VAC20-800-460) Children’s and caregiver’s hands are washed with liquid soap and running water after contact with any body fluids and after handling or caring for animals. Additionally, caregiver’s hands are washed after handling raw eggs or meat. (8VAC20-800-680) Disposable diapers and wipes shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak- proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. (8VAC20-800-690) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. Additionally, there must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes staff occupational health and safety practices in accordance with OSHA bloodborne pathogens regulation. (8VAC20-790-600) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized.(8VAC20-790-750) Disposable diapers shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak-proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. Additionally, children’s hands must be washed with soap and running water after contact with any blood, feces or urine, and staff must wash their hands with soap and running water after contact with any body fluids. (8VAC20-790-760) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790-380) Children’s hands are washed with soap and running water after any contact with blood, feces or urine, and caregiver’s hands are washed with liquid soap and running water after contact with any body fluids. (8VAC20-790-390) Disposable diapers and wipes shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak- proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. (8VAC20-790-390) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. (8VAC20-790-250) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790-380) Children’s hands are washed with soap and running water after any contact with blood, feces or urine, and caregiver’s hands are washed with liquid soap and running water after contact with any body fluids. (8VAC20-790-390) Disposable diapers and wipes shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper or wipe touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak- proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. (8VAC20-790-390) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.8.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated with body fluids. Additionally, there must always be at least one staff on duty who has obtained instruction within the last three years in performing a daily health observation of children that includes staff occupational health and safety practices in accordance with OSHA bloodborne pathogens regulation. (8VAC20-790-600) When any surface has been contaminated with body fluids, it shall be cleaned and sanitized. (8VAC20-790-750) Disposable diapers shall be disposed of in a leak-proof or plastic-lined storage system that is either foot operated or used in such a way that neither the caregiver's hand nor the soiled diaper touches the exterior surface of the storage system during disposal. When cloth diapers are used, a separate leak-proof storage system shall be used. Toilet chairs shall be emptied promptly and cleaned and sanitized after each use. Additionally, children’s hands must be washed with soap and running water after contact with any blood, feces or urine, and staff must wash their hands with soap and running water after contact with any body fluids. (8VAC20-790-760) 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: Staff records must contain documentation to demonstrate that the individual possesses the education, certification and experience required of the position, which would include a valid driver’s license for drivers. (8VAC20-780-70) Staff who transport children shall disclose all moving traffic violations that occurred five years prior to or during employment or assignment as a driver. (8VAC20-780-180) Staff are required to complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of employment, which includes transportation. Staff must also complete facility specific orientation on and be provided in writing information prior to working alone with children and within seven days of employment that covers precautions in transporting children. (8VAC20-780-240 and 8VAC20-790-600) Before the child’s first day of attending, parents must be provided in writing, information on the center’s transportation policy. (8VAC20-780-420) At least one staff in each area where children are present, including during transportation, shall have current first aid and CPR certification. (8VAC20-780- 530) First aid supplies must be available on field trips, in vehicles used to transport children, and wherever children are in care. (8VAC20-780-540 and 8VAC20-790- 780) The center must keep a document in vehicles used to transport children that contains local emergency contact information, potential shelters, hospitals, evacuation routes that pertain to each site frequently visited or of routes frequently driven by center staff for business, field trips or to pick up and drop off children. (8VAC20-780-550) Centers are responsible from the time the child boards a vehicle until returned to a parent or designee. Staff who transport children must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. Safety belts and child restraints as required by the Code of Virginia must be followed; the stated maximum number of passengers in a vehicle cannot be exceeded. Children shall remain seated with arms, legs and head remaining in the vehicle. Doors must be properly closed and locked, and at least one staff member or driver remains in the vehicle when children are present. Staff shall have a list of the children being transported and any allergy care plans, if necessary, as well as emergency numbers and the center’s contact information. Vehicles used by the center for the transportation of children must be manufactured for the purpose of transporting people seated in an enclosed area; have seats that are attached to the floor; be insured with at least the minimum limits established by Virginia state statutes; meet the safety standards set by the Department of Motor Vehicles; and be kept in satisfactory condition to assure the safety of children. If volunteers supply personal vehicles, the center is responsible for ensuring that vehicle requirements are met. Children are required to enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. One staff or adult in addition to driver is needed when 16 or more preschool or younger children are being transported. There shall be a communication plan between the center staff and staff who are transporting children. Children are removed from the vehicle at the conclusion of any trip. Parents must give written permission to transport children. (8VAC20-780-580 and 8VAC20-790-830) Therapeutic child day programs and special needs child day programs providing transportation have additional transportation requirements. They must ensure that non ambulatory children are transported in a vehicle which is equipped with a ramp or hydraulic lift to allow entry and exit. Arrangements of wheelchairs in a vehicle shall not impede access to exits, and wheelchairs shall be equipped with restraining devices and shall be securely fastened to the floor when used to seat children in a vehicle. The center shall develop a plan based on the needs of the children in care to assure their safe supervision during on-loading, off-loading and transporting. When 16 or more children are being transported, there shall be at least one center aide or adult besides the driver, for each group of 16. If a child has a known seizure disorder or neurological, genetic or physiological disability causing increased medical risk and that child is being transported, one center aide or adult who is not the driver and who is trained in CPR shall be present in the vehicle. (8VAC20-780-590) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that covers transportation. (8VAC20-790-250) Caregivers, including providers, substitute providers, and assistants left alone with children must have current certification in first aid and CPR. (8VAC20-800-140 and 8VAC20-800-150) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. No caregiver can be under the effects of medication that impairs functioning, alcohol or illegal drugs. (8VAC20-800-470 and 8VAC20-790-270) First aid supplies must be available on field trips, in vehicles used to transport children, and wherever children are in care. (8VAC20-800-760) Parents must give written permission to transport children. (8VAC20-800-980) Drivers must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. They must ensure during transportation that they have the contact information of the home, a copy of the parent’s permission to transport, a copy of each child’s emergency contact information, emergency first aid supplies, and a mechanism for making telephone calls to emergency responders and parents. (8VAC20-800-990 and 8VAC20-790-460) Vehicles used for the transportation of children must meet the safety standards set by the Department of Motor Vehicles; be kept in satisfactory condition to assure the safety of children; is insured according to state law; be manufactured for the purpose of transporting people seated in an enclosed area; and have seats that are attached to the floor. (8VAC20-800-1000) During transportation, safety belts and child restraints as required by the Code of Virginia must be followed; children remain seated and their arms, legs and head must remain in the vehicle; and doors must be properly closed and locked. Additionally, children may not be left unattended inside or outside of a vehicle, and children must board and leave from the curbside of the street. (8VAC20-800- 1010 and 8VAC20-790-460) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. If volunteers supply personal vehicles, the center is responsible for ensuring that vehicle requirements are met. Caregivers shall have a list of the children being transported and any allergy care plans. (8VAC20-790- 460) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that covers transportation. (8VAC20-790-250) Caregivers, including providers, substitute providers, and assistants left alone with children must have current certification in first aid and CPR. (8VAC20-800-140 and 8VAC20-800-150) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. No caregiver can be under the effects of medication that impairs functioning, alcohol or illegal drugs. (8VAC20-800-470 and 8VAC20-790-270) First aid supplies must be available on field trips, in vehicles used to transport children, and wherever children are in care. (8VAC20-800-760) Parents must give written permission to transport children. (8VAC20-800-980) Drivers must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. They must ensure during transportation that they have the contact information of the home, a copy of the parent’s permission to transport, a copy of each child’s emergency contact information, emergency first aid supplies, and a mechanism for making telephone calls to emergency responders and parents. (8VAC20-800-990 and 8VAC20-790-460) Vehicles used for the transportation of children must meet the safety standards set by the Department of Motor Vehicles; be kept in satisfactory condition to assure the safety of children; is insured according to state law; be manufactured for the purpose of transporting people seated in an enclosed area; and have seats that are attached to the floor. (8VAC20-800-1000) During transportation, safety belts and child restraints as required by the Code of Virginia must be followed; children remain seated and their arms, legs and head must remain in the vehicle; and doors must be properly closed and locked. Additionally, children may not be left unattended inside or outside of a vehicle, and children must board and leave from the curbside of the street. (8VAC20-800- 1010 and 8VAC20-790-460) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. If volunteers supply personal vehicles, the center is responsible for ensuring that vehicle requirements are met. Caregivers shall have a list of the children being transported and any allergy care plans. (8VAC20-790- 460) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Children’s records must contain parents written permission to transport the child if transportation is provided. (8VAC20-790-540) Staff records must contain documentation of certifications required by the responsibilities held by the staff member, which would include a valid driver’s license for drivers. (8VAC20-790-550) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes transportation. Additionally, staff who work directly with children must have current first aid and CPR certification within 90 days of employment. (8VAC20-790-600) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. (8VAC20-790-640) First aid supplies must be available on field trips, in vehicles used for transportation, and wherever children are in care. (8VAC20-790-780) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. Staff who transport children must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. Safety belts and child restraints as required by the Code of Virginia must be followed; the stated maximum number of passengers in a vehicle cannot be exceeded. Children shall remain seated with arms, legs and head remaining in the vehicle. Doors must be properly closed and locked, and at least one staff member or driver remains in the vehicle when children are present. Staff shall have a list of the children being transported and any allergy care plans, if necessary. Vehicles used by the center for the transportation of children must be manufactured for the purpose of transporting people seated in an enclosed area; have seats that are attached to the floor; be insured with at least the minimum limits established by Virginia state statutes; meet the safety standards set by the Department of Motor Vehicles; and be kept in satisfactory condition to assure the safety of children. If volunteers supply personal vehicles, the center is responsible for ensuring that vehicle requirements are met. Children are required to enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Children are removed from the vehicle at the conclusion of any trip. (8VAC20-790- 830) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Parents written permission to transport children must be on file. (8VAC20-790- 190) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that covers transportation. All caregivers must have current certification in first aid and CPR within 90 days of employment. (8VAC20-790-250) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. No caregiver can be under the effects of medication that impairs functioning, alcohol or illegal drugs. (8VAC20-790-270) First aid supplies must be available on field trips, in vehicles used to transport children, and wherever children are in care. (8VAC20-790-410) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. Drivers must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. They must ensure during transportation that safety belts and child restraints as required by the Code of Virginia must be followed; the stated maximum number of passengers in a given vehicle is not exceeded; children remain seated and their arms, legs and head must remain in the vehicle; doors must be properly closed and locked; and at least one caregiver or the driver always remains in the vehicle when children are present. They must also have a list of the children being transported, a copy of each child’s emergency contact information, and any allergy care plans. Vehicles used for the transportation of children must meet the safety standards set by the Department of Motor Vehicles; be kept in satisfactory condition to assure the safety of children; is insured according to state law; be manufactured for the purpose of transporting people seated in an enclosed area; and have seats that are attached to the floor. Additionally, children must enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Caregivers shall verify all children have been removed from the vehicle at the conclusion of any trip. (8VAC20-790-460) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Parents written permission to transport children must be on file. (8VAC20-790-190) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that covers transportation. All caregivers must have current certification in first aid and CPR within 90 days of employment. (8VAC20-790-250) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. No caregiver can be under the effects of medication that impairs functioning, alcohol or illegal drugs. (8VAC20-790-270) First aid supplies must be available on field trips, in vehicles used to transport children, and wherever children are in care. (8VAC20-790-410) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. Drivers must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. They must ensure during transportation that safety belts and child restraints as required by the Code of Virginia must be followed; the stated maximum number of passengers in a given vehicle is not exceeded; children remain seated and their arms, legs and head must remain in the vehicle; doors must be properly closed and locked; and at least one caregiver or the driver always remains in the vehicle when children are present. They must also have a list of the children being transported, a copy of each child’s emergency contact information, and any allergy care plans. Vehicles used for the transportation of children must meet the safety standards set by the Department of Motor Vehicles; be kept in satisfactory condition to assure the safety of children; is insured according to state law; be manufactured for the purpose of transporting people seated in an enclosed area; and have seats that are attached to the floor. Additionally, children must enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Caregivers shall verify all children have been removed from the vehicle at the conclusion of any trip. (8VAC20-790-460) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.9.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Children’s records must contain parents written permission to transport the child if transportation is provided. (8VAC20-790-540) Staff records must contain documentation of certifications required by the responsibilities held by the staff member, which would include a valid driver’s license for drivers. (8VAC20-790-550) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes transportation. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes transportation. Additionally, staff who work directly with children must have current first aid and CPR certification within 90 days of employment. (8VAC20-790-600) Smoking and the use of electronic smoking devices are prohibited in vehicles when children are being transported. (8VAC20-790-640) First aid supplies must be available on field trips, in vehicles used for transportation, and wherever children are in care. (8VAC20-790-780) Vendors are responsible from the time the child boards a vehicle until returned to a parent or designee. Staff who transport children must be at least 18 years of age and possess a valid driver’s license to operate the vehicle being driven. Safety belts and child restraints as required by the Code of Virginia must be followed; the stated maximum number of passengers in a vehicle cannot be exceeded. Children shall remain seated with arms, legs and head remaining in the vehicle. Doors must be properly closed and locked, and at least one staff member or driver remains in the vehicle when children are present. Staff shall have a list of the children being transported and any allergy care plans, if necessary. Vehicles used by the center for the transportation of children must be manufactured for the purpose of transporting people seated in an enclosed area; have seats that are attached to the floor; be insured with at least the minimum limits established by Virginia state statutes; meet the safety standards set by the Department of Motor Vehicles; and be kept in satisfactory condition to assure the safety of children. If volunteers supply personal vehicles, the center is responsible for ensuring that vehicle requirements are met. Children are required to enter and leave the vehicle from the curb side of the vehicle or in a protected parking area or driveway. Children are removed from the vehicle at the conclusion of any trip. (8VAC20-790- 830) 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: Within 30 days of the first day of employment, staff must complete orientation training in first aid, as appropriate to the age of the children in care. Staff must also receive information in writing prior to working alone with children and within seven days of employment regarding procedures for injured children and medical emergencies. (8VAC20-780-240) At least one staff in each classroom or area where children are present shall have current certification in first aid. There must always be at least two staff members with current certification in first aid present on the premises during the center’s hours of operation, on field trips, and wherever children are in care. Primitive camps shall have a staff member on the premises during the hours of operation who has at least current certification in first responder training. (8VAC20-780- 530) A first aid kit and ice pack or cooling agent are required on each floor of each building used by children, accessible to outdoor play areas, on field trips, in vehicles used for transportation, and wherever children are in care. (8VAC20-780- 540 and 8VAC20-790-780) All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in first aid appropriate to the ages of children in care. However, a staff who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. (8VAC20-790-600) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Providers, substitute providers, and any assistants left alone with children in care must maintain current certification in first aid. However, a caregiver who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. (8VAC20-800-140 and 8VAC20-800-150) Caregivers must receive orientation by the end of their first week of assuming job responsibilities, to include the location of the first aid kit and emergency supplies. (8VAC20-800-200) The provider shall notify a parent the same day whenever first aid is administered to a child. (8VAC20-800-650) A first aid kit and ice pack or cooling agent are required in the family day home, accessible to outside play areas, on field trips, in vehicles used for transportation and wherever children are in care. (8VAC20-800-760) The provider shall record in each child’s record an injury or accident sustained by a child while at the family day home that requires first aid. (8VAC20-800-840) All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in first aid. (8VAC20-790-250) iii. All CCDF-eligible licensed in-home care. Provide the standard: Providers, substitute providers, and any assistants left alone with children in care must maintain current certification in first aid. However, a caregiver who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. (8VAC20-800-140 and 8VAC20-800-150) Caregivers must receive orientation by the end of their first week of assuming job responsibilities, to include the location of the first aid kit and emergency supplies. (8VAC20-800-200) The provider shall notify a parent the same day whenever first aid is administered to a child. (8VAC20-800-650) A first aid kit and ice pack or cooling agent are required in the family day home, accessible to outside play areas, on field trips, in vehicles used for transportation and wherever children are in care. (8VAC20-800-760) The provider shall record in each child’s record an injury or accident sustained by a child while at the family day home that requires first aid. (8VAC20-800-840) All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in first aid. (8VAC20-790-250) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in first aid appropriate to the ages of children in care. However, a staff who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. During the 90-day period, there must always be at least one staff with current first aid training present during operating hours of the center. (8VAC20-790-600) A first aid kit and ice pack or cooling agent are required on each floor of each building used by children, accessible to outdoor play areas, on field trips, in vehicles used for transportation, and wherever children are in care. (8VAC20-790- 780) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in first aid. However, a staff who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. During the 90-day period, there must always be at least one caregiver with current first aid training present during operating hours of the family day home. (8VAC20-790-250) A first aid kit and ice pack or cooling agent are required in the family day home, accessible to outside play areas, on field trips, in vehicles used for transportation and wherever children are in care. (8VAC20-790-410) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in first aid. However, a staff who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. During the 90-day period, there must always be at least one caregiver with current first aid training present during operating hours of the family day home. (8VAC20-790-250) A first aid kit and ice pack or cooling agent are required in the family day home, accessible to outside play areas, on field trips, in vehicles used for transportation and wherever children are in care. (8VAC20-790-410) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.10.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in first aid appropriate to the ages of children in care. However, a staff who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification. During the 90-day period, there must always be at least one staff with current first aid training present during operating hours of the center. (8VAC20-790-600) A first aid kit and ice pack or cooling agent are required on each floor of each building used by children, accessible to outdoor play areas, on field trips, in vehicles used for transportation, and wherever children are in care. (8VAC20-790- 780) 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: Within 30 days of the first day of employment, staff must complete orientation training in cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care. Staff must also receive information in writing prior to working alone with children and within seven days of employment regarding procedures for injured children and medical emergencies. (8VAC20-780-240) At least one staff in each classroom or area where children are present shall have current certification in CPR. There must always be at least two staff members present with current CPR certification on the premises during the center’s hours of operation, on field trips, and wherever children are in care. Primitive camps shall have a staff member on the premises during the hours of operation who has at least current certification in first responder training. (8VAC20-780-530) All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in CPR appropriate to the ages of children in care. The training shall include an in-person competency demonstration. (8VAC20-790-600) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Providers, substitute providers, and any assistants left alone with children in care must maintain current certification in cardiopulmonary resuscitation (CPR). (8VAC20-800-140 and 8VAC20-800-150) All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in CPR appropriate to the ages of children in care. (8VAC20-790-250) iii. All CCDF-eligible licensed in-home care. Provide the standard: Providers, substitute providers, and any assistants left alone with children in care must maintain current certification in cardiopulmonary resuscitation (CPR). (8VAC20- 800-140 and 8VAC20-800-150) All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in CPR appropriate to the ages of children in care. (8VAC20-790-250) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in cardiopulmonary resuscitation (CPR), appropriate to the ages of children in care. The training shall include an in-person competency demonstration. During the 90-day period, there must always be at least one staff with current CPR present during operating hours of the center. (8VAC20-790-600) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. During the 90-day period, there must always be at least one caregiver with current CPR training present during operating hours of the family day home. (8VAC20-790-250) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All caregivers shall have within 90 days of employment or 90 days from vendor approval, current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. During the 90-day period, there must always be at least one caregiver with current CPR training present during operating hours of the family day home. (8VAC20-790-250) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.10.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: All staff who work directly with children shall have within 90 days of employment or 90 days from subsidy vendor approval, current certification in cardiopulmonary resuscitation (CPR), appropriate to the ages of children in care. The training shall include an in-person competency demonstration. During the 90-day period, there must always be at least one staff with current CPR present during operating hours of the center. (8VAC20-790-600) 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: Staff are required to complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of employment, which includes recognizing child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes recognizing child abuse and neglect. (8VAC20-780-240 and 8VAC20-790-600) Staff who do not work in a group of children at the center shall be required to complete annual training on child abuse and neglect. (8VAC20-780-245) ii. All CCDF-eligible licensed family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. (8VAC20-790-250) iii. All CCDF-eligible licensed in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. (8VAC20-790- 250) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes recognizing child abuse and neglect. (8VAC20-790-600) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. (8VAC20-790-250) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. (8VAC20-790- 250) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.11.a.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes recognizing child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes recognizing child abuse and neglect. (8VAC20-790-600) 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: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-780-80 and 8VAC20-790-570) Staff are required to complete the Department’s sponsored orientation (i.e., Virginia Preservice Training) within 90 days of employment, which includes reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes the legal requirements for reporting suspected child abuse and neglect as required by the Code of Virginia. (8VAC20-780-240 and 8VAC20-790-600) Staff who do not work in a group of children at the center shall be required to complete annual training on being a mandated reporter. (8VAC20-780-245) Before the child’s first day of attendance, parents shall be provided in writing with information on the center’s policy for reporting suspected child abuse as required by the Code of Virginia. (8VAC20-780-420) ii. All CCDF-eligible licensed family child care homes. Provide the standard: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Before the child’s first day of attendance, parents shall be provided in writing that paid caregivers are required to report suspected child abuse and neglect as required by the Code of Virginia. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes reporting suspected child abuse and neglect. (8VAC20-800-200 and 8VAC20-790-250) Caregivers shall immediately call the local department of social services or the child abuse and neglect hotline whenever there is reason to suspect child abuse or neglect. (8VAC20-800-860) iii. All CCDF-eligible licensed in-home care. Provide the standard: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Before the child’s first day of attendance, parents shall be provided in writing that paid caregivers are required to report suspected child abuse and neglect as required by the Code of Virginia. (8VAC20-800-70) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes reporting suspected child abuse and neglect. (8VAC20-800-200 and 8VAC20-790-250) Caregivers shall immediately call the local department of social services or the child abuse and neglect hotline whenever there is reason to suspect child abuse or neglect. (8VAC20-800-860) [ ] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-790-570) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes the legal requirements for reporting suspected child abuse and neglect as required by the Code of Virginia. (8VAC20-790-600) v. All CCDF-eligible license-exempt family child care homes. Provide the standard: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-790-220) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes reporting suspected child abuse and neglect. (8VAC20-790-250) vi. All CCDF-eligible license-exempt in-home care. Provide the standard: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-790-220) Caregivers are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Caregivers must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes reporting suspected child abuse and neglect. (8VAC20-790-250) vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Licensed CCDF eligible out-of-school programs must meet all standards identified previously in 5.3.11.b.i. CCDF eligible out-of-school programs exempt from licensure must meet the following standards: In the state of Virginia, all teachers and other persons employed by a public or private school or child day program, any person providing full-time or part-time child care for pay on a regularly planned basis, and any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody or control of children, are "mandated reporters," and are required by law to report suspected child abuse and neglect. (§ 63.2-1509 A) Any suspected incident of child abuse or neglect shall be reported in accordance with § 63.2-1509 of the Code of Virginia. (8VAC20-790-570) Staff are required to complete the Virginia Preservice Training within 90 days of employment, which includes reporting child abuse and neglect. Staff must also complete facility specific orientation prior to working alone with children and within seven days of employment that includes the legal requirements for reporting suspected child abuse and neglect as required by the Code of Virginia. (8VAC20-790-600) c. Confirm if child care providers must comply with the Lead Agency’s procedures for reporting child abuse and neglect as required by the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a(b)(2)(B)(i): [x] Yes, confirmed. [ ] No. If no, describe: 5.3.12 Additional optional standards In addition to the required health and safety standards, does the Lead Agency require providers to comply with the following optional standards? [x] Yes. [ ] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: Home-based and center-based vendors must ensure drinking water is accessible to all children. Vendors providing meals or snacks shall serve a variety of nutritious foods and sufficient portions. When food is brought from home, a subsidy vendor shall ensure the food container is labeled to identify the owner, and shall have extra food or provisions to obtain food to serve to children so they can have an appropriate snack or meal if they forget to bring food from home, bring an inadequate meal or snack, or bring perishable food. Unused portions of opened food shall be discarded by the end of the day or returned to the parent. Food shall be prepared, stored, transported and served in a clean and sanitary manner. When food is prepared to which a child in care is allergic, staff shall take steps to avoid cross contamination in order to prevent an allergic reaction. Caregivers shall not serve prohibited food to a child. Children three years of age or younger may not be offered foods that are considered to be potential choking hazards. (8VAC20-790-440 and 8VAC20-790-810) In home-based and center-based programs, highchairs, infant carrier seats, or feeding tables shall be used for children less than 12 months who are not held while being fed. Bottle fed infants who cannot hold their own bottles shall be held when fed. Bottles shall not be propped or used while the child is in his designated sleeping location. Infants shall be fed on demand or in accordance with parental instructions. Prepared infant formula shall be refrigerated, dated, and labeled with the child's name if more than one infant is in care. Heated formula and baby food shall be stirred or shaken and tested for temperature before serving to children. Milk, formula, or breast milk shall not be heated or warmed directly in a microwave. Formula or breast milk shall not remain unrefrigerated for more than two hours and may not be reheated. Prepared baby food not consumed during that feeding by an infant may be used by that same infant later in the same day, provided that the food is not served out of the baby jar and is labeled with the child's name, dated, and stored in the refrigerator; otherwise, it shall be discarded or returned to the parent at the end of the day. (8VAC20-790-450 and 8VAC20-790-820) Home-based vendors shall require that caregivers feed semisolid food with a spoon unless written instructions from a physician or physician’s designee state differently. (8VAC20-790-450) Home-based and center-based caregivers and staff who work with children that have food allergies shall receive training in preventing exposure to foods to which the child is allergic, preventing cross contamination, and recognizing and responding to any allergic reactions. (8VAC20-790-250 and 8VAC20-790-600) Home-based and center-based vendors shall ensure children’s hands are washed with soap and running water or disposable wipes before and after eating, and staff must wash their hands before preparing or serving food or beverages and before feeding or helping children with feeding. (8VAC20-790- 390 and 8VAC20-790-760) Center based vendors who serve food must receive an initial inspection from the local health department for food service, and annual inspections thereafter. (8VAC20-790-610 and 8VAC20-790-620) Home-based and center-based vendors may not withhold food or water from children. (8VAC20-790-340 and 8VAC20-790-710) ii. Access to physical activity. Describe: Home-based and center-based vendors must ensure caregivers and staff complete orientation prior to working alone with children and within seven days of employment that includes playground safety procedures. (8VAC20-790-250 and 8VAC20-790-600) Center-based vendors must provide a variety of daily activities that are age and stage appropriate and provide opportunities for outdoor activities. Infants are provided frequent opportunities to creep, crawl, toddle and walk. Infants who cannot turn themselves over and are awake shall be placed on their stomachs for at least 30 minutes each day to facilitate upper body strength. (8VAC20-790-690) Home-based vendors must ensure infants and toddlers have opportunities to reach, grasp, pull up, creep, crawl, and walk to develop motor skills. (8VAC20-790-320) Licensed homes must provide daily age-appropriate activities that include opportunities for vigorous outdoor play, depending on the weather, ages, and the health of the children. (8VAC20-800-580) Licensed centers must provide outdoor time if weather and air quality allow for infants, toddlers, preschoolers and school age children. Toddlers and preschools must receive outdoor activity for at least 15 minutes if the center operates up to three hours a day, 30 minutes if the center operates between three and five hours a day, and one hour if the center operates more than five hours per day. On non-school days, school age children must receive the same amount of outdoor time as toddlers and preschool children, and on school days and non-school days, school age children shall have an opportunity for large motor activities at least 25% of the time. (8VAC20-780- 370, 8VAC20-780-380 and 8VAC20-780-390). Licensed homes must provide each child with adequate space to allow free movement and active play indoors and out. (8VAC20-800-380) iii. Caring for children with special needs. Describe: Home-based and center- based vendors must maintain children’s records that contain information on physical problems, pertinent developmental information, and any special accommodations needed, as well as special care instructions, including recommendations for the care and activities of a child with special needs. (8VAC20-790-190 and 8VAC20-790-540) Home-based and center-based vendors must ensure accommodations or special requirements for children with special needs must be in place to ensure their safety during evacuation and relocation, shelter-in-place, and lockdown drills or actual events. (8VAC20-790-420 and 8VAC20-790-790) Licensed centers have requirements specific to programs that serve only children with special needs that address enrollment procedures, individual assessments, service plans, specialized qualifications and training for staff, reduced staff-to-child ratios, and additional transportation requirements. (8VAC20-780-100, 8VAC20-780-110, 8VAC20-780-120, 8VAC20-780-180, 8VAC20-780-190, 8VAC20-780-210, 8VAC20-780-240, 8VAC20-780-245, 8VAC20-780-355, and 8VAC20-780-590) Licensed homes must ensure that caregivers provide a child with special needs with the care and activities recommended in writing by a physician, psychologist, or other professional who has evaluated or treated the child. The written recommendation shall include instructions for any special treatment, diet, or restrictions in activities that are necessary for the health of the child; and be maintained in the child's record. The provider shall ensure the environment is appropriate for the child based on the plan of care and shall instruct other caregivers in the proper techniques of care. Caregivers shall perform only those procedures and treatments for which they the necessary training, experience, credentials, or license to perform. Staffing shall be appropriate and adequate to meet the specific physical and developmental needs of a child with special needs in care, which is mutually determined by the provider and parent based on the child's chronological and functional age and degree of disability. Within 30 days of the child's enrollment, the provider shall provide the department's representative a written recommendation for the level of staffing necessary to care for and supervise the child, and the department makes the final decision regarding the level of staffing or any capacity limitations necessary to care for, supervise, and protect all children in care when a child with special needs is receiving care. A separate area shall be provided for the purpose of privacy for diapering, dressing, and other personal care procedures for a child above age three with special needs who requires assistance in these activities. (8VAC20-800-620) iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: Home-based and center- based vendors must ensure children’s information is treated confidentially. Vendors must maintain a written record of daily attendance that documents the arrival and departure of each child as it occurs. (8VAC20-790-180 and 8VAC20-790-530) Home-based and center-based vendors must ensure children’s records must contain contact information for parents, an emergency contact person, names of persons other than the custodial parents who are authorized to pick up the child, written authorization for emergency medical care from parent if the parent cannot be located immediately unless the parent objects in writing to the provision of such care on religious or other grounds, and permission for swimming or wading activities to include a parent’s statement of the child’s swimming ability. (8VAC20-790-190 and 8VAC20-790-540) Home-based and center-based vendors must ensure caregivers and staff complete the Virginia Preservice Training within 90 days of beginning employment, which includes foundations of child development and oral health. Caregivers and staff also must complete orientation prior to working alone with children and within seven days of employment that includes confidentiality, supervision of children, including arrival and dismissal procedures, procedures to take in case of a lost or missing child. Caregivers and staff are required to complete the Department’s annual health and safety update course each year, which currently covers supervision during age-appropriate meals, supervision during learning and play times, transportation safety and supervision, and supervision during diapering and bathroom times. (8VAC20-790-250 and 8VAC20-790-600) Home-based vendors must provide infants and toddlers with opportunities to interact with caregivers and other children in the home in order to stimulate language development, play with a wide variety of safe, age- appropriate toys, and receive individual attention from caregivers including holding, cuddling, talking, and reading. (8VAC20-790-320) Center-based vendors must provide a variety of daily activities that are age and stage appropriate and provide opportunities for teacher-directed, self- directed, and self-chosen tasks and activities; a balance of active and quiet activities; indoor and outdoor activities; individual and group activities; and curiosity and exploration. (8VAC20-790-690) Center-based vendors at least semiannually must provide parents in writing information on their child's behavior, development, adjustment, and needs. (8VAC20-790-720) Home-based vendors must ensure that caregivers are physically present on site and provide direct care and supervision of each child at all times. Caregivers shall actively supervise each child during outdoor play to minimize the risk of injury to a child. (8VAC20-790-300) Center-based vendors must ensure that children are within sight and sound supervision. When the outdoor activity area is not adjacent to the center, there shall be at least two staff members in the outdoor activity area whenever one or more children are present. Staff shall not allow a child to leave the center unsupervised. (8VAC20-790-670)