8 Colo. Code Regs. § 1402-1-2.512

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

Section 8 CCR 1402-1-2.512 - HEALTH CARE

A. Statements of Health Status

1. At the time of enrollment, the parent(s)/guardian(s) must provide for each child entering the center:

a. A complete health history for each child, including any communicable diseases; chronic illnesses or injuries; known drug reactions and allergies; current medications; any special diets needed; and the name address and phone number for the child's health care provider and dentist.

b. Documentation of school-required immunization status or Certificate of 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 Certificate of Immunization or on an "approved alternate" Certificate of Immunization, defined in Colorado Department of Public Health and Environment regulation 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 https://www.coloradosos.gov/CCR/Welcome.do. 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 proof of immunization status or exemption be provided prior to or on the first day of admission.

(1) If the parent or legal guardian 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 or legal guardian must:

(a) Nonmedical Exemption with a signature from an immunizing provider in Colorado, or

(b) 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.

2. Guest Child care Facilities as defined in section 26.5-5-303(10), C.R.S., are exempt from obtaining immunization records for students when all of the following conditions are met:

a. Students attend for fifteen (15) days or less in a fifteen-consecutive-day period, no more than twice in a calendar year; and

b. At least sixty (60) calendar days separate the two sessions within the calendar year; and

c. The center notifies parents/guardians that non-immunized children are enrolled on the above short-term basis.

3. The center must inform its child care health consultant (CCHC) prior to the first day of care of the enrollment of a child with special health care needs, if known, so staff receives training, delegation and supervision as indicated by the child's individualized health care plan.

a. If the center is located at an elementary school and all the children attend that school, the immunization records may be maintained at the school office, but must be accessible to center staff members and licensing specialists during the hours the center is open.

B. Emergency Procedures

1. Written authorization for emergency medical care must be in the child's file as required in rule section 2.525.

2. When accidents, injuries, or illnesses occur, the program director or responsible adult in charge must notify the child's parent or guardian and, if necessary, seek medical care for the child.

3. A responsible staff member must be directly supervising any ill or injured child.

4. Portable first aid kits must be available to staff at all times, including field trips, and must be located out of reach of children and maintained in a sanitary condition. First aid kits must be checked and restocked on at least a monthly basis.

C. Medication

1. Any un-expired routine medication, prescription and non-prescription (over-the-counter) medications must be administered only with a current written order of a health care provider with prescriptive authority and with written parental consent. Home remedies, including homeopathic medications, must never be given to a child.

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

a. Child's name;

b. Licensed prescribing practitioner 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.

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

4. Over-the-counter medication must be kept in the originally labeled container and be labeled with the child's first and last name.

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

6. Staff designated by the program director to give medications must complete the Department-approved medication administration training and have current annual delegation or more often as determined by the Child Care Health Consultant. Delegation must be from the center's Current Child Care Health Consultant who must observe and document the competency of each staff member involved in medication administration. All staff administering medication must have current Department-approved Cardiopulmonary Resuscitation (CPR), first aid training prior to administering medication with the following exceptions:

a. Staff determined by the program director, in consultation with the Child Care Health Consultant, to be responsible for providing routine emergency medications covered in the approved medication administration training for the treatment of severe allergies or inhaled medications for the treatment of asthma must receive training and delegation from their Child Care Health Consultant for those medications only. Staff must then provide those medications to children based on the instructions from the child's individualized health care plan.

b. Staff determined by the director, in consultation with the Child Care Health Consultant, to be responsible for providing medications not covered in the approved medication administration training must also be permitted to administer medications and/or medical treatments such as emergency seizure medication, insulin, or oxygen with individualized training and delegation from the Child Care Health Consultant based on instructions from the child's individualized health care plan.

c. Staff may be trained and delegated in the administration of a single rescue medication or rescue medical intervention by the center's Child Care Health Consultant. Such training and delegation must qualify the staff member to provide a rescue medication or treatment for a specific child based on instructions from the child's individualized health care plan.

7. All medications, except those medications specified in the Department's approved medication administration training as emergency medications, must be kept in an area inaccessible to children, but available to staff trained in administering medication. If refrigeration is required, the medication must be stored in either a separate refrigerator or a leak proof container in a designated area of a food storage refrigerator, separate from food and inaccessible to children. Controlled medications must be counted and safely secured, and specific policies regarding their handling require special attention in the centers policies. Access to these medications must be limited (see sections 27-80-210 and 12-280-134(3), C.R.S.).

8. Emergency medications must be stored in accordance with the Child Care Health Consultant's recommendation. Emergency medications are not required to be stored in a locked area. Emergency medications may be stored in an area easily accessible and identifiable to staff but out of reach of children. When away from the classroom, staff must carry emergency medications in a bag on their person.

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

a. Child's name;

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

c. Time medication is to be given;

d. Special instructions;

e. Name and initials of the individuals giving the medication; and

f. Notation if the medication was not given and the reason.

10. Topical preparations such as petroleum jelly and bug sprays may be administered to children with written parental authorization. These preparations may not be applied to open wounds or broken skin unless there is a written order by the prescribing practitioner.

11. The center must have a written policy on the storage and access of inhalers and epinephrine auto injectors for all children in care. This policy must be reviewed by the Child Care Health Consultant.

12. The center may, with written parental consent and authorization of the prescribing health care provider, permit children who have asthma to carry their own inhalers or children who are at risk of anaphylaxis to carry their own epinephrine, and use them as directed. The center must have a specific written policy on the storage and access of inhalers and epinephrine for children who are permitted to carry or self-administer these medications. The policy must include a contract with the parent(s)/guardian(s), and child acknowledgement, assigning levels of responsibility of each individual. This contract must accompany orders for the medication from the health care provider, along with confirmation from Child Care Health Consultant that the student has been instructed and is capable of self-administration of the prescribed medications.

13. All staff members and Child Care Health Consultants must be aware of which children have asthma and severe allergies, and which of those may administer their own inhaler or auto injectors.

D. Sun Protection

1. The center must obtain the parent/guardian's written authorization and instructions for applying sunscreen or use of another form of parent/guardian approved sun protection. A health care provider's permission is not needed to use sunscreen at the center.

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

3. If sunscreen is provided by the center, parents must be notified in advance, in writing, of the type of sunscreen the center will use.

4. Children may apply sunscreen to themselves under the direct supervision of a staff member.

5. The center must apply sunscreen, have the child apply sunscreen, have the parent or guardian apply sunscreen, or use another form of parent or guardian approved sun protection for children prior to children going outside. Sunscreen must be reapplied as directed by the product label.

E. Control of Communicable Illness

1. When children show signs of communicable illness, they must be separated from other children, the parent(s) or guardian(s) must be notified, and the center must consult a medical physician or medical facility as needed regarding treatment.

2. Staff members with a communicable illness must not be permitted to work or have contact with children or other staff members if the illness could be readily transmitted during normal working activities.

8 CCR 1402-1-2.512

46 CR 22, November 25, 2023, effective 12/15/2023