§ 16.55.300. Centers serving sick children.


Latest version.
  • A.

    Purpose. The purpose of this section is the protection of the health, well-being, and safety of sick children cared for in a child care center.

    B.

    General requirements.

    1.

    A center serving sick children shall meet all requirements of this chapter and the Alaska Child Care Statutes and Regulations as well as the provisions for centers serving sick children in this section.

    2.

    Centers serving sick children may be a separate child care center licensed only to provide child care for sick children, or it may be a component of a licensed child care center with facilities and rooms designated for use by sick children physically separated from other components of the center.

    3.

    A center serving sick children as the component of another licensed child care center shall be issued a separate license for the care of sick children and shall ensure:

    a.

    The sick child care component is physically separated from all other components of the center; and

    b.

    The physical space designated for use by sick children shall not be used by children or staff from any other component of the center. The administrator is exempt from this requirement, when not providing direct care.

    C.

    Levels of care. The level of regulation for the care of sick children shall be determined by the number of sick children for which the center is licensed, the types of illnesses served by the center, and the physical setting.

    1.

    Level 1: A center is Level 1 when it provides child care for sick children and meets all of the following criteria:

    a.

    Is licensed for no more than eight sick children;

    b.

    Serves only children with minor illnesses and those recuperating from acute episodic illnesses;

    c.

    Does not serve children with short-term physical disabilities or illnesses that require special equipment and staff; and

    d.

    Operates as the component of another licensed child care and educational center.

    e.

    The administrator for the licensed child care and educational center shall be permitted to serve as the administrator for a Level 1 center for sick children.

    2.

    Level 2: A center is Level 2 it provides child care for sick children and meets any one of the following criteria:

    a.

    Is licensed for nine or more sick children; or

    b.

    Serves children with short-term physical disabilities or illnesses that require special equipment and staff; or

    c.

    Serves children with illnesses or symptoms requiring separation or isolation from other children; or

    d.

    Is licensed to provide child care for sick children only.

    e.

    A Level 2 center providing child care for sick children must meet the following requirements:

    i.

    It shall employ an on-site administrator with no responsibilities related to the care of well children; and

    ii.

    The center shall employ a licensed registered nurse, with documented experience in pediatric or community health nursing, to serve as administrator or caregiver.

    D.

    Administration and organization.

    1.

    Health consultant.

    a.

    A center providing child care for sick children shall have an agreement for continuing medical/nursing consultation from a licensed physician or a licensed registered nurse with experience in pediatric or community health nursing, with a backup arrangement with a licensed physician.

    b.

    The health consultant shall perform the following duties:

    i.

    Oversee the development, review and approval, of the center's written policies and procedures, and review and update those annually;

    ii.

    Provide at least quarterly on-site monitoring of the implementation of the written policies and procedures in the program; and

    iii.

    Provide ongoing consultation to the program in its daily operation and the management of illness in individual children.

    2.

    Policies and procedures.

    a.

    Generally. The program shall have written policies and procedures for operation that address the following:

    i.

    Admission policy;

    ii.

    Infection control;

    iii.

    Methods for the daily care of children including procedures for recording each child's progress;

    iv.

    Procedures for the care and referral of children for medical evaluation who develop worsening symptoms, including a listing of such symptoms;

    v.

    Staff training;

    vi.

    Policy and procedures for staff communication with parents and health care providers;

    vii.

    Plans for feeding children as appropriate to each child's illness or symptoms, and bathing of children as needed; and

    viii.

    Procedures for cleaning and sanitation in the facility.

    b.

    Admission policy. In addition to the requirements of section 16.55.160, a center serving sick children shall have written criteria for admission made available to the public, including:

    i.

    A description of illnesses or symptoms to be served and specific illnesses or symptoms to be excluded;

    ii.

    Ages of children to be served;

    iii.

    A description of services offered; and

    iv.

    Intake and admission procedures, including criteria for determining the appropriateness of a child's admission.

    c.

    Admission procedures required.

    i.

    Prior to admitting a child, the center shall require:

    (A)

    A copy of the standard emergency record card and the child's health examination as required in 7 AAC 57.400(a) and 7 AAC 57.550(a).

    (B)

    A description, written and signed by the parent, of the child's current and recent illnesses, special diet, medication needs and symptoms requiring notification of parent or health care provider; and

    (C)

    A written physical assessment of the child by the administrator or designated caregiver to determine the appropriateness of the child's attendance that day or the need for a medical evaluation prior to admission. In a Level 2 center, the written assessment for arriving children shall be conducted by a State of Alaska licensed medical professional.

    ii.

    The center administrator shall determine whether admission is appropriate given a child's history, symptoms and general condition.

    iii.

    The center administrator shall have the authority to require a written medical evaluation for a child, to include diagnosis, treatment and prognosis, if such evaluation is necessary to verify the appropriateness of the child's attendance.

    3.

    Criteria for admission or exclusion.

    a.

    A center serving sick children may care for children with illnesses or symptoms that exclude them from another child care and educational center, except as prohibited in subsection B.

    b.

    A center serving sick children shall not admit a child with the following symptoms, unless the program has written approval from a licensed physician:

    i.

    Diarrhea continued beyond three days;

    ii.

    Vomiting lasting over a six-hour period;

    iii.

    Difficult or rapid breathing;

    iv.

    Asthmatics with upper respiratory infections and coughing interfering with the child's ability to drink, talk or sleep;

    v.

    Undiagnosed rash; or

    vi.

    Fever over 103 degrees F (oral) or 104 degrees F (rectal).

    c.

    A center serving sick children shall not admit any child with the following illnesses or symptoms:

    i.

    Contagious stages of pertussis, measles, mumps, rubella, diphtheria, tuberculosis, shigella, giardiasis or chicken pox; or

    ii.

    Untreated scabies or head lice.

    d.

    A Level 2 center may admit children needing postoperative convalescent care and children with short-term disabilities, including but not limited to tracheotomy tubes, colostomy or gastrostomy tubes or apnea monitors, or children with long-term disabilities exhibiting illnesses or symptoms excluding them from a day care program for well children, as long as the program ensures:

    i.

    The center employs a licensed nurse with demonstrated competence to handle a specific disability;

    ii.

    The center has appropriate equipment and staff with documented competence or experience in operating the equipment; and

    iii.

    The center has, prior to admission, written permission from a licensed health care provider for each child and specification of any skilled nursing treatment to be provided to the child.

    E.

    Staff.

    1.

    Qualifications.

    a.

    The administrator of a Level 1 or 2 center shall fulfill the requirements of 7 AAC 57.300, 7 AAC 57.310, 7 AAC 57.315, 7 AAC 57.320, 7 AAC 57.320, and AMC 16.55.130. The administrator of a Level 1 or 2 center shall have written evidence of immunization against, or immunity from, rubella and measles.

    b.

    Caregivers of a Level 1 or 2 center shall fulfill the requirements of 7 AAC 57.310, 7 AAC 57.315, 7 AAC 57.320, 7 AAC 57.320, and AMC 16.55.130. Caregivers in a Level 1 or 2 center shall have written evidence of immunizations against, or immunity from, rubella and measles.

    2.

    Training. A center serving sick children shall ensure the following training is received by each employee, including the administrator and substitutes, as follows:

    a.

    Minimum of 40 hours for staff of a Level 1 center and a minimum of 60 hours for staff of a Level 2 center;

    b.

    All required training must be completed within three months from date of hire;

    c.

    The training shall include:

    i.

    The recognition and care of sick children;

    ii.

    The prevention and control of communicable disease;

    iii.

    First aid and CPR;

    iv.

    The center's policies and procedures;

    v.

    Recognizing and documenting signs and symptoms of illness and common infectious diseases;

    vi.

    Administration of medication;

    vii.

    When and how to call for medical assistance;

    viii.

    Infection control procedures;

    ix.

    Communication with parents of sick children;

    x.

    Immunizations; and

    xi.

    Other care as required by admissible illnesses or conditions.

    3.

    Child-to-caregiver ratios. A center serving sick children shall ensure the following minimum child-to-caregiver ratios:

    Age of Children Term for Age Group # Children # Caregivers Max Group Size (children: caregivers)
    6 weeks through 11 months, or older if not walking independently Young Infants 4 1 8:2
    12—18 months Older Infants 4 1 8:2
    19—36 months Toddlers 4 1 8:2
    3 years Preschoolers 4 1 8:2
    4 years Preschoolers 5 1 10:2
    5—6 years Kindergartners 5 1 10:2
    7—12 years School age 5 1 10:2

     

    4.

    For mixed age groups with children under 24 months of age, the child-to-caregiver ratio shall be for the age of the youngest child present.

    F.

    Health practices.

    1.

    A center serving sick children shall immediately notify parents of any significant change in a child's illness or symptoms or any injury in the facility, and obtain instructions for action to be taken.

    2.

    The center shall make prompt arrangement with the parents for obtaining medical evaluation or treatment for a child, if necessary, as provided by the program policies.

    3.

    The center shall obtain emergency medical treatment without specific parental instruction as specified in 7 AAC 57.400 (a)(1)(D—F).

    4.

    The center shall periodically monitor each child's condition throughout the day as appropriate to the child's illness and plan of care.

    5.

    A center serving sick children shall modify the program requirements of 7 AAC 57.520 and AMC 16.55.190 to meet the needs of sick children including provision of:

    a.

    Quiet and active indoor and outdoor activities, according to the development level, ability, and physical condition of each child;

    b.

    Individual activities for use by children in the contagious stage of disease and by children not physically well enough to participate in group activities; and

    c.

    Toys and equipment that are disposable or able to be sanitized.

    6.

    Children shall be given opportunity to nap or rest without distraction or disturbance from other activities in the center.

    7.

    A center serving sick children shall follow the guidelines of the child care food program in 7 C.F.R. 226.20 but shall modify the menus to meet the individual physical condition of each child in care.

    G.

    Physical environment and safety.

    1.

    Separation from other rooms. A center serving sick children as a component of a licensed child care and educational center shall areas physically separated by floor-to-ceiling walls from other components of the center.

    2.

    Outdoor area.

    a.

    A center licensed only for sick children shall not be required to have an outdoor play area, but shall have a written plan ensuring opportunities for safe outdoor activities.

    b.

    In a center serving sick children as a component of a licensed child care and educational center, the outdoor play area for sick children shall be physically separated from that used by well children, or used at separate times from well children.

    3.

    Indoor area.

    a.

    Centers for sick children shall provide 50 square feet of usable indoor space per child, exclusive of hallways, bathrooms, storage areas, office and administrative space, furnace and laundry rooms, crib space, diaper tables, cubbies, and any area children are prevented from using.

    b.

    Cots for resting shall be placed at least three feet apart when in use.

    c.

    The center shall not use potty chairs, and shall ensure only soap from a liquid soap dispenser is used for handwashing.

    d.

    The center shall ensure carpeted floors are vacuumed at least daily and shampooed at least monthly.

    e.

    The center shall ensure all washable toys, equipment, and furniture used for one group of children are washed and disinfected before use by another group.

    f.

    The center shall ensure that a telephone or an intercom system is available to staff in every area of the center where care is provided.

    g.

    Drinking fountains shall not be used.

( AO No. 2016-82 , § 1, 8-9-16)