• Low

  [19a-79-4a(i)(1-2)(H), (F)] · An education consultant shall be available to the operator and program staff for advice and support regarding the educational content and practice of the program. A person needs to apply for approval to be an education consultant. Program staff shall not serve as education consultants for programs in which they provide direct care or direct program supervision in a non-consultative role; or in a program with the same operator as a program in which they provide direct care or direct program supervision in a non-consultative role. Specific duties of the education consultant shall include, but not be limited to making, at a minimum, annual site visits to the facility, reviewing daily plans, curriculum documents, and educational policies for the developmental and age appropriate practices, observing program staff interactions, use of materials and equipment, implementation of plans and approaches to classroom management; and providing feedback on documentation review and classroom observations to the director and head teacher. A health consultant shall be available to the operator and program staff for advice regarding the health of the children and the health program. Specific duties of the health consultant shall include, but not be limited to making, at a minimum, quarterly site visits to facilities that serve children three years of age and older; or for group child care homes, facilities that operate no more than three hours per day, or facilities that enroll only school age children, semi-annual site visits. Facilities that are closed during the summer months may omit the summer quarterly visit. Site visits shall be made by the health consultant during customary business hours when the children are present at the facility. Specific duties include, but are not limited to reviewing health and immunization records of children and program staff, reviewing the contents, storage and plan for maintenance of first aid kits, observing the indoor and outdoor environments for health and safety, observing children’s general health and development, observing diaper changing and toileting areas and diaper changing, toileting and hand washing procedures, reviewing the policies, procedures and required documentation for the administration of medications, including petitions for special medication authorizations needed for programs that administer medication, assisting in the review of individual care plans for children with special health care needs or children with disabilities, as needed; and quarterly review of all injury, illness, incident and accident reports. A social service consultant shall be available to the operator and program staff for advice regarding the emotional needs, program staff support and the social service program. A registered dietitian consultant shall be available to the operator and program staff for advice regarding nutrition and food service for those programs that prepare or plan meals. A written plan for consultation services shall be developed, signed annually by the consultant and implemented. Consultative service shall include, but not be limited to an annual review of written policies, plans and procedures that relate to the services provided by the consultant, availability by telecommunication for advice regarding problems, availability, in person, of the consultant to the program, consulting with administration and program staff about specific problems, acting as a resource person to program staff and the parent(s) to include coordinating services and assisting families and program staff in identifying necessary resources, and seeking and supporting the collaboration of multiple consultants serving the program. The activities and observations required by each consultant shall be documented in a consultation log that is kept on file at the facility for two years.

  Corrected Corrected by Oct 7, 2025

  Category: supervision. Marked corrected in the state record.

• Low

  [19a-79-7a(e)(10)] · 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.

  Corrected Corrected by Oct 7, 2025

  Category: other. Marked corrected in the state record.

• Low

  [19a-79-5a(a)(2)(E)] · An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child's parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

  Corrected Corrected by Oct 7, 2025

  Category: health medication. Marked corrected in the state record.

• Low

  [19a-79-10(g)(1-8)] · 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.

• Low

  [19a-79-4a(a)(2), (h)(1-2)] · 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.

  Corrected Corrected by Oct 7, 2025

  Category: ratio. Marked corrected in the state record.

• Low

  [19a-79-5a(a)(1)(A)-(C)] · 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.

  Corrected Corrected by Oct 7, 2025

  Category: health medication. Marked corrected in the state record.

• Low

  [19a-79-5a(a)(1)(D)(i-iv)] · 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 the operator to use the programs emergency policies which shall accompany the child on trips away from the premises, authorizing one responsible person other than the parent(s) who can remove the child from the child care center or group child care home, authorizing any activity away from the premises, and authorizing transportation services.

  Corrected Corrected by Oct 7, 2025

  Category: health medication. Marked corrected in the state record.

• Low

  [19a-79-7a(c)(2)] · For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

  Corrected Corrected by Oct 7, 2025

  Category: physical safety. Marked corrected in the state record.

• Low

  [19a-79-9a(b)(1)(A-F)-(2)(A-C)] · 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 pharmacist, 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 as required herein. In addition to being trained in the methods of medication administration, such trained staff may administer injectable medications by a premeasured, commercially prepared auto-injector used to treat allergic reactions or other type of injectable medication and rectal medications, only after he or she has successfully completed a training program on the administration of such type of medication. After completing such training, the director, head teacher, program staff or group child care home provider shall annually have his or her skills and competency in the administration of such medication reviewed and/or validated in accordance with the regulations. The facility shall have program staff trained in the use such medications on site during all hours when a child who has orders to receive such medication is on-site. Upon completion of the required training program or the review and validation of the required training, the written training approval for staff shall be on file at the facility. Approval for the administration of oral, topical, inhalant medications, rectal medications and injectable medications other than by a premeasured commercially prepared auto-injector shall remain valid for three years. Approval for the administration of injectable medications by a premeasured commercially prepared auto-injector shall be valid for one year. A copy of the approval shall be on file at the facility for a period of three years and shall be available to Office staff upon request. The operator shall ensure that the trainer provides the trainee with an outline of the curriculum content which verifies that all mandated requirements have been included in the training program. A copy of said outline shall be on file at the facility for a period of three years for Office review. The Office may require at any time that the operator obtain the full curriculum from the trainer for review by the Office.

  Corrected Corrected by Oct 7, 2025

  Category: health medication. Marked corrected in the state record.

• Low

  [19a-79-9a(b)(3)(A-B)] · 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 three years after the child is no longer attending the program.

  Corrected Corrected by Oct 7, 2025

  Category: ratio. Marked corrected in the state record.

Corrected Corrected by Oct 7, 2025

Category: physical safety. Marked corrected in the state record.