Ala. Admin. Code r. 660-5-27-.06
Current through Register Vol. 43, No. 1, October 31, 2024
Section 660-5-27-.06 - Care Of The Children(1) Supervision of the Children. The children shall be supervised at all times. The licensee shall be responsible for the care and supervision of the children at all times. Doors should not be closed in any area where children are sleeping.(2) Infants and children shall be handled gently. The licensee and each caregiver shall support each infant's head while lifting and holding the infant. Rough or harsh handling is prohibited, including but not limited to: shaking; lifting or jerking by one or both arms; pushing; pulling; forcing or restricting movement; lifting or moving by grasping clothing; covering an infant's or a child's mouth, face or head, etc. (3) Health. (a) Immunizations. Each child two (2) months up to five (5) years of age and five (5) year olds who are not enrolled in public or private school kindergarten shall have a valid State of Alabama Certificate of Immunization on file in the home on the child's first day of attendance and the Certificate shall be kept current thereafter unless one of the following certificates is on file in the home: 1. A valid Alabama Certificate of Medical Exemption OR
2. A valid Alabama Certificate of Religious Exemption. OR
3. The child meets the definition of homelessness, according to the McKinney-Vento Homeless Assistance Act.(b) Observations. Each child shall be observed for illness and injuries upon his/her arrival at the child care home, and if possible, shall be observed in the presence of his/her parent(s)/guardian(s).(c) Illness or injury.1. The licensee shall report promptly to the child's parent(s)/guardian(s): (i) Any injury, suspected illness or other changes observed in the health of their child;(ii) Any exposure to a contagious disease, so that the child may be observed for symptoms of the disease.2. No child who is ill shall be admitted to the home. This regulation is not intended to require the exclusion of children in violation of the Americans with Disabilities Act (ADA). The Department of Human Resources is not the enforcement agency for the ADA. Determinations of illness may be based on: the child's inability to participate in the home's activities; the need for additional care that cannot be provided without taking time and attention away from the other children; signs of serious or contagious disease or condition, such as but not limited to food and allergic reactions, fever, diarrhea, vomiting, unexplained rash, scabies, head lice; a physician's diagnosis requiring that the child be separated from other children.3. Isolation and removal. (i) Any child in attendance who becomes ill, has a contagious disease or condition, or suffers an injury that requires professional medical attention shall be separated promptly from the group, but shall have continuous supervision. Toys, bedding, equipment and bathroom facilities used by an ill child or adult shall be cleaned and disinfected prior to use by another person.(ii) The ill or injured child's parent(s)/guardian(s) shall be notified immediately and required to come for, or arrange for another designated person to come for the child.(iii) If the parent(s)/guardian(s) or person designated by the parent(s)/guardian(s) cannot be reached or if the injury or illness is severe, the licensee shall obtain emergency medical treatment.4. Contagious diseases/conditions. (i) When a contagious disease/condition (a disease/condition which can be transmitted or spread from person to person) has been introduced into the home, parent(s)/ guardian(s) of each exposed child shall be notified.(ii) The licensee shall urge parent(s)/guardian(s) to notify the licensee when their child is known to have been exposed to a contagious disease/condition outside the home.5. Food Allergies. Each child with a food allergy should have a written care plan that includes(i) Instructions regarding the food(s) to which the child is allergic and steps to be taken to avoid that food;(ii) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of prompt administration of any medications. The plan should include specific symptoms that would indicate the need to administer one or more medications;(iii) The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction, should be carried on field trips and when the child is transported;(iv) The home provider should notify the parent(s)/guardian(s) immediately of any suspected allergic reactions, as well as the ingestion of or contact with the problem food even if a reaction did not occur. The home provider should contact the emergency medical services system immediately whenever epinephrine has been administered;(v) Each child's food allergies should be readily available and known by the child's teacher(s).(d) Medication/Medical Procedures. 1. No medication or medical procedures (prescription or over-the-counter) shall be administered without being ordered by the child's health professional and without a written, signed, authorization form from the child's parent(s)/ guardian(s). Blanket authorization forms are prohibited. The authorization form shall include time(s) and date(s) to be administered, dosage, storage instructions (refrigerated or unrefrigerated), and specific directions for administering the medication/medical procedure, such as given by mouth, apply to skin, (such as but no limited to sunscreen, bug spray, hand sanitizer), inhale, drops in eyes, etc. An authorization form shall be valid for no more than seven (7) days, unless accompanied by a written physician's statement.2. Any prescription drug or over-the-counter drug sent to the home shall be in its original container. Prescription drugs shall have a pharmacy label or shall be accompanied by a physician's written instructions. Over-the-counter drugs shall be clearly labeled with the child's name and directions for administering the drug. Medication should not be used beyond the date of expiration. A measuring device (if the medication requires measuring) shall be provided for each child's medication.3. All medication (children's or household member's) shall be kept under lock and key or combination lock.4. Medicines/drugs shall be returned to the child's parent(s)/guardian(s) or disposed of properly when no longer needed.5. Time and date of all medication dosages or medical procedures administered by the licensee/caregiver shall be documented, in writing, signed by the person administering the medication or medical procedure (initials not acceptable), and kept in the child's file in the home. Copies shall be made available to the child's parent(s)/guardian(s) on request.(4) Daily Program.(a) In accordance with recommendations from the American Academy of Pediatrics, unless the infant has a note from a physician specifying otherwise, each infant shall be placed in a supine (on his/her back) position for sleeping to lower the risks of Sudden Infant Death Syndrome (SIDS).(b) In accordance with recommendations from the American Academy of Pediatrics, when an infant can easily turn over from the supine (back) to the prone (front) position, he/she shall be put down to sleep on his/her back, but allowed to adopt whatever position he/she prefers for sleep.(c) In accordance with recommendations from the American Academy of Pediatrics, each infant (younger than twelve (12) months) shall be placed in a prone (front) position as often as tolerated by the infant while he/she is awake and observed. "Tummy time" helps muscle development and reduces the tendency of back positioning to flatten the back of the infant's head. Caregivers should engage with infants on the ground each day to optimize adult/infant interaction.(d) Infants should not be seated for more than 15 minutes at a time, except during meal or snacks. Infant equipment such as swings, stationary activity centers, infant seats, (e.g., bouncers) and molded seats should only be used for short periods at a time. The least restrictive environment should always be encouraged.(e) In accordance with recommendations from the American Academy of Pediatrics, unless a physician specifies the need for a positioning device that restricts movement within the child's bed, such devices shall not be used.(f) In accordance with recommendations from the American Academy of Pediatrics, soft materials are prohibited in the infant's sleeping environment (younger than twelve (12) months).1. Soft materials or objects, such as pillows, quilts, comforters, or sheepskins, shall not be placed under a sleeping infant.2. Soft objects, such as pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys, and other gas-trapping objects shall be kept out of the infant's sleeping environment.3. No infant shall be put to sleep on a sofa, soft mattress, or other soft surface.(g) The diapering area shall be a washable surface and shall be cleaned and disinfected after each use.(h) Sufficient clean, dry diapers and clothing shall be provided for each infant/toddler.(i) Wet or soiled diapers and other clothing shall be changed promptly.(j) Disposable diapers shall be placed in a covered, plastic-lined trash container inaccessible to children.(k) Reusable (cloth) diapers shall be rinsed in the toilet, placed in a plastic bag, and stored out of reach of children.(l) Staff shall use universal precautions when changing diapers or being exposed to blood, fecal material, or urine.(m) The licensee and each caregiver shall wash his/her hands with soap and warm running water after diapering each child, after assisting with toileting, and after contact with bodily fluids. Individual disposable paper towels shall be used for hand drying.(n) The licensee and each caregiver shall use single-use disposable gloves for diapering. Clean gloves shall be used for diapering each child. Used gloves shall be disposed of in a covered, plastic-lined container, inaccessible to children, and shall be disposed of daily.(o) Spills of body fluids, including blood, feces, nasal and eye discharges, saliva, urine, and vomit shall be cleaned up immediately. Caregivers shall wear gloves unless the fluid can be easily contained by the material (e.g., paper towel or cloth) that is being used to clean up. Caregivers shall be careful not to get any of the fluid in your eyes, nose, mouth or any open sores. Caregivers shall clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Contaminated materials shall be discarded in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be:2. rinsed with a disinfecting solution;3. wrung as dry as possible;4. hung to dry completely. Caregivers should wash their hands with soap and water after cleaning up any spills.
(p) Each child's hands shall be washed after diapering and toileting.(q) No child shall be left unattended while being diapered.(r) The diapering area shall be separate from areas used for serving, preparing, or storing food.(s) Infants shall be handled gently. The licensee and each caregiver shall support each infant's head while lifting and holding the infant. Rough or harsh handling is prohibited, including but not limited to: shaking; lifting or jerking by one or both arms; pushing; pulling; forcing or restricting movement; lifting or moving by grasping clothing; covering an infant's mouth, face or head, etc.(t) Eliminate screen time (TV, movies, cell phones, video games, computers, and other digital devices) for children under two (2) years old.(u) For children over two (2) years old, limit screen time to less than 30 minutes per day for children in half day programs and to less than one hour per day for those in full day programs. Screen time shall only be used for educational purposes or physical activity.(v) Drinking water with no added sweeteners or carbonation shall be readily available in indoor and outdoor areas throughout the day.(w) A variety of indoor and outdoor experiences shall be available. These experiences must include 60 minutes of moderate and vigorous physical activity daily for full day programs and 30 minutes for half day programs. These activities shall build bone and muscle strength, and increase the heart rate and breathing rate of a child by running, climbing, dancing, skipping and jumping.(5) Child Abuse/Neglect Reporting. (a) The licensee and any other caregivers are required by law, (Code of Ala. 1975, §§ 26-14-1 through 26-14-13) to report known or suspected child abuse or neglect to the County Department of Human Resources or the local chief of police, or county sheriff. The report shall be made immediately by telephone or direct oral communication, followed by a written report, containing all known information.(b) Any person making a report in good faith is immune from any civil or criminal liability.(c) The law further provides that all reports to the Department of Human Resources and certain other records of child abuse and neglect are considered confidential under penalty of law.(d) The licensee, household members, and all caregivers shall cooperate with the Department personnel on any child abuse or neglect investigation, including providing information to workers and allowing access to children and records.(6) Meals and Snacks. (a) The licensee shall provide breakfast or a morning snack, a mid-day meal and at least one afternoon snack each day for the children in care. Rule 660-5-27-.14. Meals and snack components and serving sizes shall comply with the USDA guidelines. No child shall be deprived of a meal or snack if he/she is in attendance at the time the meal/snack is served. 1. Breakfast, if served, shall include at least the following: (i) fruit and/or vegetable;(ii) whole grain or enriched bread or bread product;2. Snacks shall include at least two of the following four choices: (ii) meat or meat alternate;(iii) fruits and/or vegetables;(iv) whole grain or enriched bread or bread products.3. Meals shall include at least the following:(i) meat or meat alternate;(ii) vegetables/fruits (one vegetable and one fruit, or two fruits);(iii) whole grain or enriched bread or bread product;(b) Formula or food for infants and other special diets recommended or prescribed by a physician shall be prepared as directed by the parent(s)/guardian(s). Special foods for any child shall be clearly labeled with the child's name and stored as directed.(c) If formula is provided by the parent(s)/ guardian(s), it shall be sent ready to feed, labeled with the child's name and stored in the refrigerator. All bottles shall be sent home or the contents discarded at the end of the day.(d) Bottles and infant food shall be served according to parental request. If a parent requests bottles to be warmed, they should be warmed under running, warm tap water; using a commercial bottle warmer, slow cooking device, or by placing them in a container of warm water. Bottles should never be warmed in microwaves. Warming devices and dangling cords should not be accessible to children.(e) Expressed human milk should be sent in a bottle or container that is properly labeled with the infant's full name and date and should only be given to the specified child. Parents must provide written instructions on how to prepare, store, and use the expressed human milk. Unused breast milk should be returned to the parent in the bottle or container. Infant formula for a breast fed infant should be used with written parental consent.(f) Fluid (liquid) milk shall be served. No powdered milk shall be used for drinking.(g) Small hard candies and nuts shall not be served to children younger than four years of age.(h) Foods with a shape and consistency that may cause choking shall be prepared appropriately for the age and ability of the child. The following foods shall be served only under close supervision: peanut butter; popcorn; small pieces of raw vegetables; raisins; seeds; grapes (cut in half); foods with bones, meats (cut in pieces small enough to prevent choking); and hot dogs (cut length-wise, then chopped in small pieces, not cut in circular pieces).(7) Food Service. (a) The licensee, each caregiver, and each child shall wash his/her hands with soap and warm running water before eating, preparing, or serving foods. Individual disposable paper towels shall be provided for drying hands.(b) Feeding chairs shall be provided for infants. Feeding chairs and tables on which food is served shall be thoroughly cleaned and disinfected prior to and after snacks and meals. Each child's food shall be served from an individual dish or napkin and shall not be placed directly on tables.(c) Each infant and toddler shall be encouraged to experiment with self-feeding with his/her hands or a spoon. Utensils shall be provided for each child who feeds himself/herself. Disposable utensils and cups shall be used only under close supervision.(d) All prepared formula and food brought from the child's home shall be labeled with the child's name and properly stored. Milk and prepared formula shall be placed immediately in the refrigerator. Previously opened baby food jars shall not be accepted by the licensee. All formula remaining in the bottle after a feeding shall be discarded.(e) Each infant shall be held when fed from a bottle. Bottles shall not be propped.(f) The size of servings shall be adequate to meet each child's needs.(g) Food, including dessert or milk, shall not be forced on or withheld from a child.(h) Each child shall be seated while eating.(8) Food protection and preparation.(a) No home-canned/preserved foods shall be used.(b) Food shall be protected from contamination during storage, preparation, and serving.(c) All food preparation surfaces and utensils shall be thoroughly cleaned before use.(d) Once food has been served to a child, portions of leftover food shall not be served again.(e) Tableware, cooking utensils, and all food contact surfaces shall be thoroughly cleaned after each use.(f) Animals shall not be allowed in food storage, food preparation, or food service areas during hours of child care.(g) Floors in food preparation and service areas shall be swept or vacuumed daily and mopped as needed to maintain cleanliness.(9) Personal Belongings. (a) The licensee shall require the parent(s)/ guardian(s) to provide appropriate seasonal clothing for each child to permit a change when necessary.(b) Sufficient clean, dry diapers and clothing shall be provided for each infant/toddler. Wet or soiled diapers and other clothing shall be changed promptly.(c) Adequate space shall be available to each child for storing his/her personal belongings.(10) Disciplinary Practices. (a) Discipline shall be appropriate to the age and developmental level of the children.(b) The following disciplinary practices are prohibited:1. Corporal or physical punishment is prohibited, including, but not limited to: spanking; shaking; slapping; kicking; pushing; biting; pinching; hitting; thumping; hair pulling; or ear pulling; excessive physical exercise; excessive rest; or strenuous/bizarre postures;2. Verbal abuse is prohibited, including but not limited to: yelling; shouting; name calling; shaming; making derogatory remarks about a child or a child's family; using language that is inappropriate, offensive, threatens, humiliates, or frightens a child;3. Discipline associated with food, naps, or bathroom procedures is prohibited, including but not limited to: withholding food as punishment; use of food such as hot sauce, lemon juice, vinegar, etc., or soap, as punishment; punishment for lapses in toilet training; punishment for not sleeping during nap/rest time;4. Physical restraint as punishment is prohibited;5. Punishment administered by another child is prohibited;6. Rough or harsh handling of children, whether associated with discipline or not, is prohibited, including but not limited to: shaking; lifting or jerking by one or both arms; pushing; pulling; forcing or restricting movement; lifting or moving by grasping clothing; covering a child's head; etc.;7. Physical activity/outdoor time taken away as punishment is prohibited.(11) Outdoor Play. All children shall spend time outdoors each day, when weather permits. (a) Infants (Birth-12 mos.) should be taken outside two-three times daily as tolerated.(b) Toddlers and preschoolers should be allowed 60-90 total minutes of outdoor play.(12) Sign in/Sign out Procedures. (a) The licensee shall require the parent(s)/ guardian(s) or other person designated by the parent(s)/ guardian(s) to sign (signature required, initials not acceptable) each child in/out at each arrival/departure to the home, indicating the time of arrival/departure. An exception to the written signature will allow the use of the Biometric ID for parent(s)/guardian(s). The Biometric ID system will measure some unique aspect of the individual such as but not limited to fingerprint and/or eyes-iris recognition.(b) If a child walks to the home from school or another designated location, or is transported to/from the home by school bus, the licensee/caregiver shall sign (signature required, initials not acceptable) each child in upon arrival and out upon departure, indicating time of arrival/departure.(13) Release of the children. (a) The licensee/caregiver shall not release a child to anyone without written authorization from the child's parent(s)/guardian(s).(b) Authorized persons who are unfamiliar to the licensee or caregiver shall show photographic identification when picking up a child.(14) Visits by parent(s)/guardian(s). Parent(s)/ guardian(s) shall have the right to visit and observe their child in the home at any time during hours of operation. Parent(s)/ guardian(s) shall be informed of this right.(15) Parent Communication. Information on child development and children's health must be shared annually with parent(s)/guardian(s).Ala. Admin. Code r. 660-5-27-.06
New Rule: Filed December 18, 2000; effective January 22, 2001. Amended: Filed November 4, 2005; effective December 9, 2005.Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 04, January 31, 2020, eff. 3/16/2020.Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 10, July 30, 2021, eff. 9/13/2021.Author: Teresa Haag
Statutory Authority:Code of Ala. 1975, as amended (hereinafter referred to as Code), §§ 38-7-1 through 38-7-18, § 41-22-19, §§ 38-2-6(10), (12), (13), (15), § 26-14-3, § 26-14-4.