A file shall be kept on the licensed premises for each employee of the child care center or group child care home which shall include an acceptable medical statement, completed within 12 months before the date of employment for new program staff, and every 36 months for current program staff. Such statement shall document the presence of any known medical or emotional illness or disorder that would currently pose a risk to children.

[19a-79-4a(a)(1)] · Corrected Dec 17, 2025

All unused or expired medication, except for controlled substances, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

[19a-79-9a(b)(5)(D)] · Corrected Dec 17, 2025

Documentation of professional development for each program staff who cares for the children, including new employee orientation and annual training for current program staff on the child care center or group child care home policies, plans and procedures. Program staff, including the director, shall complete health and safety training no later than three months after the date of hire. Written verification of ongoing training that is at least one percent of the total annual hours worked. As of April 1, 2025, such annual training shall include content as defined in 45 CFR § 98.41(a)(1)(i) to (a)(1)(xi). Such education may include, but is not limited to, early education and child development, licensing and regulations, emergency preparedness, prevention and control of infectious diseases, prevention of sudden infant death syndrome and use of safe sleep practices, administration of medication, prevention and response to emergencies due to food and allergic reactions, building and physical premises safety, protection from hazards, bodies of water, and vehicular traffic; handling and storage of hazardous materials and the appropriate disposal of bio contaminants; child maltreatment, prevention of shaken baby syndrome and abusive head trauma, precautions in transporting children, pediatric first aid and cardiopulmonary resuscitation, nutrition and programming for children with disabilities or special health care needs.

[19a-79-4a(a)(2), (h)(1-2)] · Corrected Dec 17, 2025

The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child's parent(s) and the local health director. The record shall include enrollment information signed and dated by the parent(s) that shall include, but not be limited to: the child’s name, address, date of birth and date enrolled, the residence, business address(es) and telephone number(s) of the parent(s) and the name and telephone number of the child’s physician or other primary health care provider.

[19a-79-5a(a)(1)(A)-(C)] · Corrected Dec 17, 2025

Potentially hazardous substances and materials in the child care centers and group child care homes shall be stored in a labeled container identifying the exact contents and dilutions, used according to the manufacturer’s instructions and for the intended purpose, handled in a safe manner and inaccessible to children.

[19a-79-7a(e)(10)] · Corrected Dec 17, 2025

There shall be access to a minimum of seventy-five (75) square feet per child of outdoor space for the number of children using the space at any one time. The outdoor area shall be fenced or protected for safety. Outdoor play equipment shall have a shock absorbing surface, under and around, that shall effectively cushion the fall of a child, except where the child is sitting or standing at ground level. The shock absorbing surface shall be maintained at a depth of at least eight inches, be free of water and not allowed to become compacted. Acceptable shock absorbing surfaces may include mulch, sand, and wood chips. Synthetic material that is less than eight inches in depth, including but not limited to, rubber mats or tiles may be acceptable surfaces provided the operator maintains documentation on the licensed premises that the synthetic material is manufactured for this purpose, installed in accordance with the manufacturer’s specifications and sufficient to cushion the fall of a child. Concrete, asphalt, grass and dirt shall not be considered a shock absorbing surface. The playground shall be free of glass, debris, holes and other hazards. Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. Outside equipment shall be anchored for stability when recommended by the manufacturer. Anchors shall be buried below ground level. The operator shall provide documentation to the Office, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. Drinking water shall be available and accessible to children. Outdoor equipment shall be arranged in such a way as to avoid accidents. All play equipment, fences, and structures shall not pose a hazard.

[19a-79-7a(h)(1-9)] · Corrected Dec 17, 2025

Every area used by children shall be adequately ventilated and programs serving children younger than school age shall have a non-mercury thermometer affixed to the wall. The ambient air temperature shall be at least sixty-five degrees Fahrenheit as measured three feet from the floor. Programs that serve exclusively school age children may utilize program space with the ambient air temperature less than sixty-five degrees Fahrenheit provided the temperature is warm enough to accommodate the activities with comfort. When the temperature exceeds eighty degrees Fahrenheit, the operator shall provide more fluids and increase ventilation.

[19a-79-7a(e)(1-2)] · Corrected Dec 17, 2025

In child care centers there shall be a sink with hot and cold running water designated for diaper changing and hand washing of program staff and children. This sink shall be located in the program space. Child care centers which have three program staff for a group of infants or toddlers may use an accessible diaper changing facility if it is immediately adjoining the program area. Separate sinks shall be available for purposes other than hand washing after diaper changing within child care centers. Group child care homes shall have a sink accessible for hand washing other than the sink used for food preparation.

[19a-79-10(d)(1)(A-C)] · Corrected Dec 17, 2025

The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication shall be kept on file at the facility for each child administered a nonprescription topical medication. The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child’s record. The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating the individual child’s name; the name of the medication; and directions for the medication’s administration. The medication shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s). Any expired medication shall be destroyed in a safe manner or returned to the parent.

[19a-79-9a(a)(2-3)] · Corrected Dec 17, 2025

Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or other piece of equipment designed for infant sleeping and appropriate for the particular child. A well-constructed, free standing crib or other piece of equipment shall be used designed for infant sleeping and appropriate for the particular child, with a snug fitting mattress covered by a tightly-fitted sheet. Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or other piece of equipment designed for infant sleeping and appropriate for the particular child, with a snug fitting mattress covered by a tightly-fitted sheet unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for an alternative sleep position or alternate piece of equipment. When infants can easily turn over from the supine to the prone position, they shall be put down to sleep on their back, but allowed to adopt whatever position they prefer for sleep. No items including, but not limited to, pillows, soft bumpers, toys and blankets, including weighted blankets, weighted sleepers, and weighted swaddles, shall be placed with an infant in a crib or hung over the side of a crib or other piece of equipment designed for sleeping except for a pacifier without attachments unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for its use. Bibs and garments with ties or hoods shall be removed from infants that are placed to sleep. No toys or objects shall be attached to sleeping or rest equipment. No infant shall be put to sleep on a sofa, bed, couch, soft mattress, waterbed or other soft surface. No infant shall be put to sleep or allowed to remain asleep in a child restraint system intended for use in a vehicle, an infant carrier, a swing or any place that is not specifically designed to be an infant bed unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for their use. No infant shall be swaddled unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying instructions and a timeframe for swaddling the infant. Infants under twelve months of age shall be physically observed at least every fifteen minutes to assess the infants breathing, color, temperature and comfort. No child under three years of age shall have access to teething necklaces, teething bracelets or other jewelry that could present a choking or strangulation hazard. Written policies and procedures for sleep arrangements shall include the requirements of this subsection and shall be posted in a conspicuous place in the areas where infants under twelve months of age sleep. The operator shall document that the child’s parent(s) has been informed of the child care center or group child care home’s policies and procedures for sleep arrangements prior to enrollment and reviewed as needed during the period of the child’s enrollment.

The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication shall be kept on file at the facility for each child administered a nonprescription topical medication. The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child’s record. The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating the individual child’s name; the name of the medication; and directions for the medication’s administration. The medication shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s). Any expired medication shall be destroyed in a safe manner or returned to the parent.

[19a-79-9a(a)(2-3)] · Corrected Jan 16, 2025

All unused or expired medication, except for controlled substances, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

[19a-79-9a(b)(5)(D)] · Corrected Jan 16, 2025

The diapering area shall be an elevated sturdy table or counter equipped with a safety rail. Infants and toddlers shall be diapered at a diapering area used only for this purpose and located in the program area. Each diapering area shall have a non-porous surface and be kept in good repair. Diapering areas shall be washed and disinfected after each use. Disposable paper sheets shall be used and discarded immediately after each diapering. A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. Disposable diapers shall be discarded in a covered receptacle immediately after diapering. The hands of the program staff and the children shall be washed after each diaper change. Diapering and hand washing policies and procedures shall be posted in each diapering area and followed. When cloth diapers or training pants are used, a written plan for their use and care shall be developed and implemented. This plan shall include, but not be limited to, these procedures: placing soiled clothing and diapers in a sealed air tight container; removing soiled clothing and diapers from the child care center or group child care home daily; and cleaning and sanitizing the container daily.

[19a-79-10(e)(1-10)] · Corrected Jan 16, 2025

Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or other piece of equipment designed for infant sleeping and appropriate for the particular child. A well-constructed, free standing crib or other piece of equipment shall be used designed for infant sleeping and appropriate for the particular child, with a snug fitting mattress covered by a tightly-fitted sheet. Infants under twelve months of age shall be placed in a supine (back) position for sleeping in a well-constructed, free standing crib or other piece of equipment designed for infant sleeping and appropriate for the particular child, with a snug fitting mattress covered by a tightly-fitted sheet unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for an alternative sleep position or alternate piece of equipment. When infants can easily turn over from the supine to the prone position, they shall be put down to sleep on their back, but allowed to adopt whatever position they prefer for sleep. No items including, but not limited to, pillows, soft bumpers, toys and blankets, including weighted blankets, weighted sleepers, and weighted swaddles, shall be placed with an infant in a crib or hung over the side of a crib or other piece of equipment designed for sleeping except for a pacifier without attachments unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for its use. Bibs and garments with ties or hoods shall be removed from infants that are placed to sleep. No toys or objects shall be attached to sleeping or rest equipment. No infant shall be put to sleep on a sofa, bed, couch, soft mattress, waterbed or other soft surface. No infant shall be put to sleep or allowed to remain asleep in a child restraint system intended for use in a vehicle, an infant carrier, a swing or any place that is not specifically designed to be an infant bed unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying a medical reason for their use. No infant shall be swaddled unless the child has written documentation from a physician, physician assistant or advanced practice registered nurse specifying instructions and a timeframe for swaddling the infant. Infants under twelve months of age shall be physically observed at least every fifteen minutes to assess the infants breathing, color, temperature and comfort. No child under three years of age shall have access to teething necklaces, teething bracelets or other jewelry that could present a choking or strangulation hazard. Written policies and procedures for sleep arrangements shall include the requirements of this subsection and shall be posted in a conspicuous place in the areas where infants under twelve months of age sleep. The operator shall document that the child’s parent(s) has been informed of the child care center or group child care home’s policies and procedures for sleep arrangements prior to enrollment and reviewed as needed during the period of the child’s enrollment.

[19a-79-10(g)(1-8)] · Corrected Jan 16, 2025

Medication shall be stored in the original child-resistant safety container and appropriately labeled. Medication shall be stored in a locked area or a locked container in a refrigerator in keeping with the label directions away from food and inaccessible to children. Only personnel authorized to administer medication may be provided with the means to access such medication. Controlled drugs shall be stored in accordance with state law.

[19a-79-9a(b)(5)(A-B)] · Corrected Jan 16, 2025

Walls, ceilings, floors and rugs shall be maintained in a state of good repair and be washable or easily cleanable.

[19a-79-7a(e)(5)] · Corrected Nov 20, 2023

Infants under twelve (12) months of age shall be placed for sleeping in a well constructed, free standing crib or bed designed for infant sleeping, with a snug fitting mattress. Furniture shall include well constructed free standing cribs, not stacked cribs, each of which has slats no more than two and three-eighths (2 3/8) inches apart and a fully waterproofed, firm, snug-fitting mattress for infants.

[19a-79-10(g)(1) and/or 19a-79-10(d)(2)(A)] · Corrected Jan 5, 2023

The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child's parent(s) and the local health director. It shall include a health record that shall include date of birth, a physical examination form, an immunization record, and information regarding disabilities or special health care needs.

[19a-79-5a(a)(2)(A) through (E)and/or19a-79-6a(e)] · Corrected Jan 5, 2023

The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child's parent(s) and the local health director. It shall include an individual plan of care for any child with special health care needs or disabilities, developed with the child's parent(s) and health care provider and updated, as necessary.

[19a-79-5a(a)(2)(E)] · Corrected Jan 5, 2023

Where swings, seesaws or climbing apparatus are used, the surface in the space shall be protected with a minimum of eight (8) inches of impact absorbing materials.

[19a-79-7a(h)(2)] · Corrected Jan 5, 2023

The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication and a medication administration record shall be written in ink and kept on file at the facility for each child administered a nonprescription topical medication.

[19a-79-9a(a)(2)] · Corrected Jan 5, 2023

Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child's parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least two (2) years after the child is no longer attending the program.

[19a-79-9a(b)(3) and/or 19a-79-9a(b)(4)] · Corrected Jan 5, 2023

When a child care center or group child care home provides either meals or snacks, menus shall be prepared at least one (1) week in advance, dated and copies posted in a conspicuous place, accessible to the public. Changes shall be documented by the end of the program day. A copy of what was served shall be kept on file for three (3) months.

[19a-79-3a(e)(5) and/or 19a-79-6a(a)(4)] · Corrected Jan 5, 2023

A file shall be kept on the licensed premises for each employee of the child care center or group child care home which shall include an acceptable medical statement and a written report of a negative tuberculin test.

[19a-79-4a(a)(1) and/or 19a-79-4a(a)(2)] · Corrected Jan 5, 2023

Prior to the administration of any medication, the director(s), head teacher(s), program staff or group child care home provider(s) who are responsible for administering the medications shall first be trained by a physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medications and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program. A director(s), head teacher(s), program staff or group child care home provider(s) trained and approved to administer medication shall be present whenever a child who has orders to receive medication is present at the facility. The training in the administration of medications shall be documented. A copy of the approval shall be on file at the facility where the director, head teacher, program staff or group child care home provider is employed and shall be available to Office of Early Childhood staff upon request.

[19a-79-9a(b)(1) &/or 19a-79-9a(b)(2)] · Corrected Jan 5, 2023

The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child's parent(s) and the local health director. It shall include specific written permission forms signed by the parent(s) authorizing one responsible person other than the parent(s) who can remove the child from the child care center or group child care home.

[19a-79-5a(a)(1)(D)(ii)] · Corrected Sep 13, 2021

Hardware such as air conditioners, water heaters or fuse boxes shall be inaccessible to children. The playground shall be free of glass, debris, holes and other hazards.

[19a-79-7a(g)(4) and/or 19a-79-7a(h)] · Corrected Sep 13, 2021

All unused or expired medication shall be returned to the parent(s) or disposed of if it is not picked up within one (1) week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed which shall be signed by both parties. The facility shall require the parent(s) of a child who has a prescription for an automatic prefilled cartridge injector, or similar automatic injectable equipment used to treat an allergic reaction or injectable equipment used to administer glucagon or inhalant medication to treat asthma, to provide the injector or equipment labeled with the information from the prescriber upon enrollment and attendance of such child at the facility, and replace such medication and equipment prior to its expiration date.

[19a-79-9a(b)(5)(D) and/or 19a-79-9a(b)(5)(E)] · Corrected Sep 13, 2021