218 R.I. Code R. 218-RICR-70-00-1.9

Current through December 26, 2024

Section 218-RICR-70-00-1.9 - Health, Safety, and Nutrition

A. Medical Requirements

1. Child care programs adopt policies and procedures consistent with the Rhode Island Department of Health's Immunization and Communicable Disease in Preschool, School, Colleges or Universities, 216-RICR-30-05-3.

a. Programs are not required to maintain immunization for children who attend public, private, or parochial schools approved by the Rhode Island Department of Education.

b. If a child is a foster child or is experiencing homelessness, a grace period of ninety (90) days can be granted to obtain the immunization documentation.

2. The parent/guardian submits evidence of an annual health examination, signed by the child's primary care provider, which includes information regarding any condition or limitation that may affect the child's general health or participation in the program.

a. Programs are not required to maintain documentation of an annual health examination for children who attend public, private, or parochial schools approved by the Rhode Island Department of Education.

b. If a child is a foster child or is experiencing homelessness, a grace period of ninety (90) days can be granted to obtain the annual health examination documentation.

B. Communicable Disease

1. In the event a child or staff member suffers from a communicable disease of public health significance, or in the event of an outbreak of any type, the facility must:

a. Report the disease to Rhode Island Department of Health, Center for Acute Infectious Disease Epidemiology;

b. Provide written notice to inform all parents/guardians to which communicable disease the child(ren) may have been exposed, without providing any identifying information regarding the source of the communicable disease.

2. In all matters of exclusion and readmission of children for reasons of illness, the decision of the Child Care or School Age Administrator applies. If applicable, due to communicable disease, this decision is made in consultation with a licensed physician, physician's assistant, or nurse practitioner, and Rhode Island Department of Health, Center for Acute Infectious Disease Epidemiology.

C. Medication Administration

1. Prescribed and non-prescribed (over the counter) medication is not administered to a child without:

a. Written permission from the parent/guardian; and

b. A written order from a licensed physician, physician's assistant, or nurse practitioner (which may include the label on the medication) indicating that the medicine is for a specified child. The medication must be in the original container.

(1) The written order includes the name of the child, the name of the medication, circumstances under which it may be administered, route, dosage, and frequency of administration.

(2) For School Age children (enrolled in Kindergarten or older) who self-carry rescue medication (prescription inhalers and/or auto-injectable epinephrine), there must also be medical documentation that the rescue medication has been prescribed and that the child needs to carry it on his or her person due to a medical condition.

(3) Non-prescription sunscreen, insect repellent and diaper cream always require parental consent but do not require instructions from each child's prescribing health professional.

2. The Child Care or School Age Administrator or designee dispenses all medications if a nurse or health care consultant is not on site (excluding school age children who self-carry).

3. A daily log is maintained of every medication administered except for those noted in § 1.9(C)(1)(b)(2) of this Part. This record includes the:

a. Child's name;

b. Name and dosage of medication administered;

c. Date and time administered;

d. Name and signature of the person who administered the medication; and

e. Name of the licensed physician, physician's assistant, or nurse practitioner prescribing the medication.

4. The medication log is transported with the child to the emergency treatment facility in the event of an emergency.

5. The first (1st) dose of a medication must be administered by the parent/guardian.

6. Medications are stored:

a. In clearly labeled original containers;

b. In spaces secured with child safety locks that are separate from any items that attract children;

(1) Rescue medications for infants, toddlers and preschoolers may be kept unlocked but out of reach of children at all times.

c. In a way that does not contaminate play surfaces or food preparation areas; and

d. School-age children (enrolled in Kindergarten or older) may carry their own rescue medication (prescription inhalers and/or auto-injectable epinephrine).

D. Special Health Care Needs

1. If there are children in the program who have special health care needs, specific health procedures are delivered by a licensed/certified health professional or a staff person who has been trained to appropriately carry out such procedures.

2. Programs must be able to ensure safe participation of all children with special needs, who are enrolled, in all experiences, activities, and opportunities, including active play.

E. Child Abuse and Neglect

1. Any suspected case of child abuse and/or neglect is reported to the Rhode Island Department of Children, Youth and Families' Child Protective Services (CPS) hotline (1-800-RI-CHILD/1-800-742-4453) within twenty-four (24) hours in accordance with State law and Department policy.

2. If the suspected case occurred at the program, the program must report to the Department's licensing unit immediately after reporting to the CPS hotline.

F. Prohibited Practices

1. Physical restraint of children is prohibited.

2. Corporal punishment is strictly prohibited. Corporal punishment includes, but is not limited to:

a. Hitting, spanking, shaking, slapping, twisting, pulling, squeezing, or biting a child;

b. Demanding excessive physical exercise, excessive rest, or strenuous or bizarre postures of a child;

c. Compelling a child to eat or have in his/her mouth soap, food, spices, or foreign substances;

d. Exposing a child to extremes of temperature;

e. Isolating a child in an adjacent room, hallway, closet, darkened area, play area, or any other area where a child cannot be seen or supervised; and

f. Binding, tying, or taping to restrict movement.

3. Other practices that are strictly prohibited include, but may not be limited to:

a. Using or withholding food as a punishment or reward;

b. Toilet training methods that punish, demean, or humiliate a child;

c. Rejecting, terrorizing, ignoring, isolating, or corrupting a child;

d. Using abusive, profane, sarcastic language, verbal abuse, threats, or derogatory remarks about the child or child's family;

e. Engaging in any form of public or private humiliation, including threats of physical punishment;

f. Taking away physical activity/outdoor time as punishment;

g. Smoking and the use of tobacco products in the program or on program grounds;

h. Smoking in any vehicle used by the program for transporting children;

i. Possessing, using, or being under the influence of illegal drugs and/or alcohol while in the program or on program grounds; and

j. Possessing or using firearms or weapons of any kind in the program or on program grounds.

G. Environmental Health

1. The facility, equipment, and materials are clean, free of hazards, and kept in good repair.

2. Any product used for cleaning, sanitizing and/or disinfecting is approved by the United States Environmental Protection Agency (incorporated at § 1.5(A) of this Part) and is used in accordance with the manufacturer's instructions.

3. Toxic substances and any other items of potential danger to children are clearly labeled and are in an area that is secured by a child safety lock or out of reach of all children in the facility.

4. All preventive maintenance performed within the program must be performed at times when children are not in the area of the equipment or systems being serviced.

a. Tools, supplies, materials, parts, or debris must not be left at the job site, unless they are secured and stored in an area that is not accessible to children.

5. Garbage receptacles are covered in all areas that are accessible to children, lined and garbage is removed from the program daily.

6. Any rodent and insect infestation is promptly treated. Insecticides and rodenticides are used in accordance with the Rules and Regulations Relating to Pesticides, 250-RICR-40-15-2, issued by the Rhode Island Department of Environmental Management and used in accordance with manufacturer's instructions.

7. The program posts in a conspicuous place and follows a regular cleaning and sanitation schedule, including provisions for deep cleaning.

8. Tables used for eating are sanitized before and after meals and snacks.

9. Sensory water tables or other receptacles used for water play are emptied and sanitized daily.

10. Reusable sponges and dish clothes are not used for cleaning and/or sanitizing.

11. The program utilizes a dishwasher with a sanitizing option or a three (3) bay sink to wash all reusable tableware.

a. If there is no dishwasher with a sanitizing option or a three (3) bay sink located in the program, all tableware must be single use.

12. If a water fountain within the program is used, the program must:

a. Execute a plan for sanitizing the water fountain; and

b. Provide disposable cups.

13. Programs operating in public, private, or parochial schools approved by the Rhode Island Department of Education may use water fountains in those facilities without the use of cups.

14. The use of any water fountain outside of the licensed program's facility is prohibited.

H. Hygiene

1. The program stocks, and makes accessible, a sufficient supply of items required to maintain personal hygiene for children and staff. A sufficient supply of items should include:

a. Liquid soap

b. Hand sanitizer

c. Paper towels within arm's reach of the user of each sink.

d. Toilet paper within arm's reach of the user of each toilet.

2. Staff wash their hands with liquid soap and warm running water as needed and:

a. After each diaper change;

b. After personal toileting;

c. After assisting a child with toileting;

d. After wiping a runny nose;

e. After touching any bodily fluid;

f. Before and after using water, sand, or other sensory tables;

g. After messy play; and/or

h. Before any food preparation or service.

3. Staff ensure that children wash their hands with liquid soap and warm running water as needed and:

a. After each toileting;

b. Before each meal or snack;

c. After wiping or blowing their nose;

d. After touching any bodily fluid;

e. Before and after using water, sand, or other sensory tables;

f. After messy play; and/or

g. Upon entry from the outdoors.

4. Single use cloths or towelettes are permitted in Infant classrooms for washing children's faces and hands before and after eating.

5. Drinking-water is never obtained from any bathroom facility.

6. Programs ensure arrangements for children to engage in personal hygiene including brushing teeth and changing clothes.

I. Animals

1. Parents/Guardians are notified in advance of any animals maintained as pets or visiting the program.

2. All animals maintained as pets or visiting the program are cared for in a clean, safe and sanitary manner.

3. All animals maintained as pets or visiting the program are kept in accordance with State and local requirements, including all applicable vaccinations.

4. Children are protected from animals that are potentially dangerous to their health or safety.

J. Illness and Injury

1. A daily health check is conducted on each child as soon as possible after the child arrives at the program.

2. If a child presents with symptoms of concern, staff:

a. Document the findings;

b. Determine the needs of the child and make accommodations as necessary; and

c. Notify the parent/guardian, as necessary.

3. If a child becomes ill while at the program:

a. A cot is available for an ill child to rest that is away from other children.

b. When in use, the cot must be placed in a supervised area, away from other children.

c. Furniture and materials touched by an ill child are disinfected after use.

4. A first aid kit is available in each classroom and outdoor play areas.

a. The following first aid supplies should be in all first aid kits:

(1) Adhesive bandages (assorted sizes)

(2) Cold pack

(3) Disposable powder-free, latex-free gloves

(4) Plastic bags (for disposing of blood and other bodily fluids)

(5) Thermometer - digital or ear - should not contain glass/mercury.

b. The first aid kit is restocked after each use.

c. Staff should inventory or check first aid supplies once a month and replace any used or expired items.

(1) A list of supplies and a written log should be kept that documents the date the inventory was conducted, verification expiration dates were checked, and name of staff member conducting inventory.

5. Injuries are documented on an injury report.

a. A parent/guardian must sign the written injury report.

b. Parents/guardians are notified of injuries on the same day of the injury.

(1) Any injury that is head related or an injury that may require medical attention should be an immediate phone call to the parent/guardian.

c. A copy of this report is placed in the child's file.

d. The injury, first aid and parent/guardian communication are recorded in the program's daily health log.

6. A choke-saving poster, that outlines the Heimlich Maneuver, is prominently displayed in any area where children eat.

K. Equipment and Furniture

1. Program furniture must be clean, durable, maintained in good repair and free of hazards.

2. The program ensures that parents/guardians provide an adequate supply of clean diapers, bed linens and clothing changes.

a. The program maintains an additional supply of clean diapers, bed linens, and clothing changes.

3. Programs serving Infants and/or Toddlers have a choke prevention gauge readily available.

4. Bucket seats and high chairs are used for feeding and are never used for activities or as a form of restraint.

5. All cribs and cots are washed and sanitized before use by another child.

6. All bedding used on cots or cribs is laundered weekly.

7. All bedding used on cots must be removed in between uses and safely stored in individual plastic bags, or comparable means, to prevent contamination.

8. A crib or cot is available for each resting child.

9. There is one (1) assembled evacuation crib equipped with wheels for every five (5) children under two (2) years of age, accessible in case of emergency.

10. Evacuation cribs are to remain empty of materials and accessible for use in case of an emergency.

a. In the event of an emergency, the evacuation cribs are used to safely remove children from the facility.

b. Evacuation cribs may be utilized for sleeping children at naptime.

11. There is at least two feet (2') of space between each cot and/or crib with a resting child during nap/rest time.

12. The program maintains proof on-site that every crib meets the United States Consumer Product Safety Commission Standards incorporated at § 1.5(B) of this Part).

13. Prohibited equipment and furniture include:

a. Toilet training chairs;

b. Mobile-walkers; and

c. Baby corrals.

d. Infant inclined sleepers

14. Pack-n-plays, playpens, play-yards and other portable cribs may only be used, for a period of up to fifteen (15) minutes, outdoors by non-mobile Infants.

L. Emergency/Disaster Plans and Procedures

1. The program is required to have an emergency preparedness and response plan approved by the Department that addresses all of the required components found at 45 C.F.R. § 98.41(a)(1)(vii), incorporated above at § 1.5(E) of this Part.

2. In all situations where an emergency or suspected emergency occurs the program follows the Department approved Emergency Preparedness and Response plan.

3. An individualized graphic evacuation plan identifying alternative escape routes is posted in each classroom.

4. All required emergency phone numbers are posted in a conspicuous place adjacent to the telephone.

5. The program Administrator or designee conducts regular safety drills.

a. One (1) fire drill is conducted every month the program is in operation, with no more than three (3) drills delayed for weather.

b. Every fourth (4th) drill must be obstructed, by means of not using one (1) of the typical exits/egresses. The other drills may be unobstructed.

c. Two (2) shelter-in-place drills are conducted every twelve (12) months.

d. A record of all safety drills is maintained.

e. Programs with Night Time Care conduct an additional set of safety drills during the night time hours of operation.

M. Nutrition

1. All meals and snacks provided by the program must meet current United States Department of Agriculture (USDA) Child and Adult Care Food Program nutritional standards (incorporated at § 1.5(C) of this Part).

2. The program does not serve drinks with caffeine and/or sweetened artificially or with sugar, including soda and flavored milk.

3. Children are provided the opportunity to eat at intervals not to exceed three (3) hours.

4. Exceptions may be made during Night Time Care programs.

5. A supply of food that meets the USDA Child and Adult Care Food Program nutritional standards is kept at the program for:

a. Meals (if applicable) and snacks;

b. When a child is still hungry after a meal or snack; and

6. If a program chooses to serve juice, it must:

a. Be one hundred percent (100%) fruit juice;

b. Be in accordance with the USDA Child and Adult Care Food Program;

c. Be served only at meal or snack time; and

d. Never be served to younger infants under twelve (12) months.

7. Menus for meals and snacks are planned and are posted weekly.

8. The program gives parents/guardians written nutrition guidelines at the time of enrollment.

9. On special occasions (not to exceed two (2) per month) food and beverages (not to include soda or other caffeinated drinks) that do not meet nutritional requirements may be served in addition to required meals and snacks.

10. Drinking-water is readily available and offered throughout the day, especially before, during and after outdoor play.

11. Drinking-water supplies are located in or near classrooms and activity rooms.

N. Food Allergies

1. For each child with food allergies or special nutritional needs, the program requests that the parent/guardian obtains a care plan from the child's health care provider.

2. The program makes provisions for protecting children with food allergies from contact with the allergen(s).

3. The program asks the parent/guardian of a child with food allergies to give consent for posting information within the program about that child's food allergy.

a. If consent for posting is provided, that information is posted in the food preparation area and in the areas of the program the child uses.

b. If consent for posting is not provided, then this information is shared verbally with all relevant staff, including substitutes, and is documented in the child's file.

O. Child Care Center Regulations During a Declared Pandemic

1. In the event that a national state of emergency is declared in relation to a pandemic, the Department may require Child Care Centers to follow certain health and safety protocols based on recommendations from the Centers for Disease Control (CDC) and/or the Rhode Island Department of Health (RIDOH) including, but not limited to:

a. Providers may be required to immediately contact DHS Child Care Licensing and RIDOH if the provider, the assistant, or any member of the staff has been instructed to isolate or quarantine due to having contracted or been exposed to the virus that caused the declared pandemic, in order to assess the need for creating an alternate care plan. DHS may revoke a child care license for failure to report an instruction to isolate or quarantine due to contracted illness or exposure to the virus that caused the declared pandemic.

b. Cloth face coverings may be required to be worn in accordance with CDC recommendations, RIDOH recommendations, and/or Rhode Island Executive Orders.

c. Providers may be required to have an isolation room or area that can be used to isolate a sick child, in accordance with their child illness policy.

d. Providers may be required to self-attest for common symptoms of the virus that caused the declared pandemic and ensure that prior to entering the program, all individuals attest to common symptoms of the virus that caused the declared pandemic. Individuals with symptoms may not be allowed to enter the program.

e. Child Care Centers may be required to maintain stable groups while still in adherence to staff/child ratios and licensed capacity.

2. In the event that a national state of emergency is declared in relation to a pandemic, communication will be given to providers via email or alternative means, to ensure they understand that at that time, the Regulations as set forth in § 1.8(O) of this Part are effective and will be monitored.

a. Providers shall communicate changes in licensing standards that are made in response to the declared pandemic to the families they serve.

218 R.I. Code R. 218-RICR-70-00-1.9

Adopted effective 10/28/2019
Amended effective 4/19/2021
Amended effective 2/2/2022
Amended effective 11/2/2022
Amended effective 11/29/2023