8 Colo. Code Regs. § 1402-1-2.321

Current through Register Vol. 47, No. 11, June 10, 2024

Section 8 CCR 1402-1-2.321 - HEALTH CARE

A. Statements of Health Status and Immunization

1. The provider has the right to refuse to admit a child if a statement from a health care provider is not submitted.

2. At the time of admission, the parent or guardian must provide the following information to the provider for each child entering the family child care home:

a. Health information, including any known allergies, medication being taken and possible side effects, special dietary requirements, and chronic health conditions;

b. If applicable, a Department-approved health care plan authorized by the child's health care provider and parent(s) and/or guardian(s), defining the interventions needed to care for a child who has an identified health condition or developmental concerns, including, but not limited to: seizures, asthma, diabetes, severe allergies, heart or respiratory conditions, and physical disabilities. Any applicable medications, supplies, and or medical equipment must be available to the primary provider, applicant 2, equally qualified providers, qualified substitutes, and any staff members prior to the child's first day of care. The primary provider, applicant 2, equally qualified providers, qualified substitutes, and any staff members working with a child with a health care plan must be informed, trained, and delegated responsibility for carrying out the health care plan by the Department-approved child care health consultant; supervision of the plan and interventions must be documented.

c. Documentation of school-required immunization status or medical or nonmedical exemption, is required by the Colorado Board of Health.. Up-to-date, school-required immunizations must be documented as specified on the Colorado Department of Public Health and Environment (CDPHE) certificate of immunization or on an "approved alternate" certificate of immunization as described in CDPHE regulations at 6 CCR 1009-2:VI(A), (May 15, 2023), no later editions or amendments are incorporated. These regulations are available from the Colorado Department of Public Health and Environment at no cost at www.sos.state.co.us/CCR. These regulations are also available for public inspection and copying at the Colorado Department of Early Childhood, 710 S. Ash St., Denver, CO 80246, during regular business hours.. Colorado law requires that proof of immunization be provided prior to the first day of admission.

1) If the parent(s) or guardian(s) of a child wants a nonmedical exemption from the immunization requirement based on a religious belief whose teachings are opposed to immunizations or a personal belief that is opposed to immunizations, the child's parent(s) or guardian(s) must submit the CDPHE Certificate of Nonmedical Exemption (May 2023) with a signature from an immunizing provider in Colorado, or

2) Submit the Colorado Department of Public Health and Environment Certificate of Nonmedical Exemption (May 2023) received upon the completion of Colorado Department of Public Health and Environment Online Immunization Education Module (Aug. 2021). The Certificate of Nonmedical Exemption and Education Module are herein incorporated by reference, no later editions or amendments are incorporated. The Certificate and Education Module are available at no cost from the Colorado Department of Public Health and Environment at https://cdphe.colorado.gov/vaccine-exemptions. The Certificate is available for public copying and inspection at the Colorado Department of Early Childhood, 720 S. Ash St., Denver, CO 80246, during normal business hours.

3) The primary provider has the right to refuse to admit any child if a completed certificate of nonmedical exemption is not submitted.

3. Within thirty (30) days after admission, and within thirty (30) days following the expiration date, the parent(s) or guardian(s) of each child must submit a statement of the child's current health status or written verification of a scheduled appointment with a healthcare provider. The statement of the child's current health status must be signed and dated by a health care provider who has seen the child within the last twelve (12) months, or within the last six (6) months for children under two and one-half (2-1/2 ) years of age. The statement must include when the next visit is required by the health care provider. All health statements must be kept at the licensed family child care home.

4. Statements of health status of children less than two (2) years of age must be updated as required in writing by the health care provider, or in accordance with the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care recommended schedule at https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf (4th ed. American Academy of Pediatrics, 2017) herein incorporated by reference. No later editions or amendments are incorporated. These recommendations are available at no cost from https://www.aap.org/. These recommendations are also available for public inspection and copying at the Colorado Department of Early Childhood, 710 S. Ash St., Denver, CO 80246, during regular business hours..

5. Health statements for children over two (2) years to seven (7) years of age must be updated in accordance with the American Academy of Pediatrics Recommendations for Preventive Pediatric HealthCare or as required in writing by health care provider.

6. For children seven (7) years of age and older, health statements must be updated every three (3) years as long as the children are in care.

B. Medication

1. Children are not allowed to bring medications to the family child care home unless accompanied by a responsible adult.

2. Any routine unexpired medication, prescription or non-prescription (over-the-counter), may be administered to a) child by a primary provider, applicant 2, or staff member with the Department-approved medication administration training. Medication can be administered only with a current written order of a health care provider with prescriptive authority, and written parental consent. Home remedies, homeopathics, vitamins, and supplements must not be administered to children while in care at the family child care home.

a. If the routine medication involves the administration of unit dose epinephrine, the administration must be accompanied by a written individual health care plan by the prescribing health care provider that identifies the factors for determining the need for the administration of the medication, and is limited to emergency situations only.

b. If the routine medication involves the administration of a inhaled medication, the administration must be accompanied by a written health care plan by the prescribing health care provider that identifies the factors for determining the need for the administration of the medication.

c. If applicable, the primary provider must have a written policy on the storage and access of inhalers and epinephrine carried by school-age children (five (5) years to eighteen (18) years). The policy must include a written contract with the parent(s) or guardian(s) and child acknowledgement assigning levels of responsibility of each individual. This contract includes orders for the medication from their health care provider, along with confirmation from the health care provider that the student has been instructed and is capable of self-administration of the prescribed medications.

3. The written order by the health care provider with prescriptive authority must include:

a. Child's name and birthdate;

b. Licensed prescribing health care provider's name, telephone number, and signature;

c. Date authorized;

d. Name of medication and dosage;

e. Time of day medication is to be given;

f. Route of medication;

g. Length of time the medication is to be given;

h. Reason for medication (unless this information needs to remain confidential);

i. Side effects or reactions to watch for; and

j. Special instructions.

4. Medications must be kept in the original labeled bottle or container. Prescription medications must contain the original pharmacy label.

5. Over-the-counter medications must be labeled with the child's first and last name.

6. In the case where medication needs to be given on an ongoing, long-term basis, the authorization and consent forms must be reauthorized on an at least annual basis. Any changes in the original medication authorization require a new written order by the prescribing health care provider and a change in the prescription label.

7. The provider, applicant 2, equally qualified providers, qualified substitutes, and any staff responsible for administering medications must have current Department-approved medication administration training; current Department-approved CPR certification; current Department-approved first aid certification; and the Department-approved standard precautions training prior to administering medication.

a. All providers who administer medication must have daily face-to-face communication with parent(s) or guardian(s) of children needing medication and must be currently trained through the Department-approved medication administration course and must administer meditation in compliance with the concepts taught in the course.

8. All medications in the family child care home, except those medications specified in the Department-approved medication administration training as emergency medications, must be locked and inaccessible to children, but available to the primary provider, applicant 2, equally qualified provider, qualified substitute, or staff members trained in administering medication.

a. If refrigeration of medication is required, it must be stored in a locked, leak- proof container in a designated area of the refrigerator separated from food.

b. The primary provider must have specific policies regarding controlled medications. Controlled medications must be counted, locked, and access to these medications must be limited.

c. All personal medications, vitamins, and supplements of the primary provider, applicant 2, staff members, or any residents of the home must be locked and inaccessible to children.

d. When away from the family child care home, the primary provider, applicant 2, equally qualified provider, qualified substitute, or staff members trained in administering medication carry emergency medications.

9. If a medication is expired or left over, parent(s) and or guardian(s) are responsible for picking up the medication. If the parent(s) and or guardian(s) do not respond, the medication shall be disposed of in accordance with 6 CCR 1007-2, Part 1, Regulations Pertaining to Solid Waste Sites and Facilities (Sept. 30, 2023) and 6 CCR 1007-3, Parts 99 (June 30, 2018), 100 (July 15, 2020) and 260-165 (July 15, 2023), 266 (June 30, 2014), 267 (Apr. 14, 2021), and 268 (July 15, 2023), and as required by the Colorado Department of Public Health and Environment (CDPHE) https://cdphe.colorado.gov/colorado-medication-take-back-program (2023), herein incorporated by reference. No later editions or amendments are incorporated. These regulations are available at no cost from CDPHE at https://www.sos.state.co.us/CCR. The recommendations are available at no cost from CDPHE at https://cdphe.colorado.gov/hm/prep-med-waste-disposal and https://cdphe.colorado.gov/colorado-medication-take-back-program. These regulations and recommendations are also available for public inspection and copying at the Colorado Department of Early Childhood, 710 S. Ash St., Denver, CO 80246, during regular business hours.

10. A written medication log must be kept for each child. This log is a part of the child's record. The log must contain the following:

a. Child's name and birthdate;

b. Time medication is supposed to be given according to the written medication authorization;

c. Name of the medication, dosage, and route;

d. Time medication is actually administered to the child;

e. Special instructions;

f. Name or initials of the individual giving the medication; and

g. Notation if the medication was not given, and the reason.

11. Topical preparations such as diaper rash ointments, sunscreen, insect repellants, sprays, and other ointments may be administered to children with written parent and/or guardian authorization. These preparations may not be applied to open wounds or broken skin unless there is a written order from a prescribing health care provider.

C. Children With Special Needs

1. The admission of children who have special health care needs, disabilities, or developmental delays which includes children with social emotional and behavioral needs must be in alignment with the training and ability of the primary provider, applicant 2, equally qualified provider, qualified substitute, or staff member, in compliance with the Americans With Disabilities Act. Services offered must show that a reasonable effort is made to accommodate the child's needs and to integrate the child with other children. (see rule section 2.119 in the General Rules for Child Care Facilities)

2. The primary provider must secure the services of a registered nurse, physician or Department-approved child care health consultant (CCHC) prior to the first day of care of the enrollment of a child with special health care needs that require delegation beyond routine medications, so the primary provider, applicant 2, equally qualified provider, qualified substitute, and or staff members can receive training, delegation, and supervision by the registered nurse, physician, or Department-approved CCHC as indicated by the child's individualized health care plan.

3. For a child with special health care needs requiring intervention and or medication, the primary provider must obtain written instructions for providing services from the child's parent or guardian, and the child's health care provider. If an existing individualized health care plan is provided for the child, it must be reviewed and followed by the primary provider, applicant 2, equally qualified provider, qualified substitute, and or staff members when caring for the child. If the child does not have an existing individualized health care plan, the individualized health care plan must be obtained by the child's first day of care.

4. For an enrolled child with a newly identified special health care need, the primary provider must obtain written instructions for providing services from the child's parent(s) or guardian(s) and the health care provider. If the child with special health care needs does not have an existing individualized health care plan, the individualized health care plan must be completed within thirty (30) calendar days of the child's identified need. For a life-threatening health care need, the health care plan and any associated medication(s) must be available prior to the child's re-admittance to the family child care home.

5 The individual health care plan must be updated at least every twelve (12) months from the date of the initial plan and as changes occur. The plan must include all information needed to care for the child, and must be signed by the health care provider and the parent(s) or guardian(s). The plan must include if applicable, but not limited to, the following:

a. Medication and dosing schedule;

b. Nutrition and feeding instructions;

c. Medical equipment or adaptive devices, including instructions;

d. Medical emergency instructions;

e. Toileting and personal hygiene instructions;

f. Behavioral interventions; and

g. Medical procedure/intervention orders.

D. Sun Protection

1. The primary provider must obtain written authorization and instructions from the parent(s) or guardian(s) for the application of sunscreen to their children's sun exposed skin prior to outdoor play, year-round. The authorization must include instructions for the application of full-spectrum UVA/UVB rating sunscreen with an SPF of thirty (30) or greater; or the use of alternative forms of sun protection approved by the parent(s) or guardian(s), which may include but is not limited to: hats, long sleeves, umbrellas, and tents.

2. The primary provider, applicant 2, equally qualified provider, qualified substitutes, or staff members must apply sunscreen, have the parent(s) and/or guardian(s) apply sunscreen, or use an alternative form of sun protection for children approved by the parent(s) or guardian(s), prior to children going outside. Sunscreen must be reapplied as directed by the product label.

3. When supplied for an individual child, the sunscreen must be labeled with the child's first and last name.

4. If sunscreen is provided by the primary provider, parent(s) and or guardian(s) must be notified in advance, in writing, of the type of sunscreen the primary provider will use.

5. Children over four (4) years of age may apply sunscreen to themselves under the direct supervision of the primary provider, applicant 2, equally qualified provider, qualified substitute, or staff member.

6. Sunscreen must not be applied to infants under six (6) months of age. Infants under six (6) months must be kept out of direct sunlight while outdoors.

8 CCR 1402-1-2.321

47 CR 04, February 25, 2024, effective 3/16/2024