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340:110-3-33.2. Requirements for child care centers for sick children

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Issued 7-1-99

(a) Centers for sick children. A center providing care for sick children is a child care center that serves children with illnesses or symptoms that:

(1) prevent them from comfortable participation in program activities in a child care center caring for well children; and
(2) require more care than child care staff in a regular child care center can provide without compromising the health and safety of other children in care.

(b) Requirements. Centers for sick children are required to meet the rules contained in OAC 340:110-3-1 through OAC 340:110-3-33, except as otherwise provided in this Section.

(1) Health professional. A health professional is a registered nurse, pediatric nurse practitioner, physician's assistant or physician with at least one year of pediatric or public health experience.
(2) Level I center. A Level I center:

(A) is a component of a regular child care center that is licensed to care for no more than eight sick children and serves only children who are mildly ill; and
(B) does not serve children with illnesses or symptoms that meet the criteria for exclusion in a Level I center as defined in OAC 340:110, Appendix DD.

(3) Level II center. A Level II center:

(A) is licensed to care for nine or more sick children;
(B) is licensed to provide child care only for sick children; or
(C) is a component of a regular child care center and serves both mildly and moderately ill children.

(4) Mildly ill. Mildly ill means children with mild symptoms of an episodic minor childhood illness who do not present a risk of serious infection to other children. Mildly ill children show interest and involvement in program activities and are able to participate.
(5) Moderately ill. Moderately ill means children with symptoms of an episodic illness which prevents them from being cared for in a child care center serving only well or mildly ill children due to the risk for contagion and the need for increased care. Moderately ill children display more severe symptoms than mildly ill children.

(d) Inclusion and exclusion criteria. A center licensed to care for sick children may serve any child who exhibits symptoms or illnesses for which they are excluded from a center caring for well children unless prohibited by the exclusion criteria specified in OAC 340:110, Appendix DD.

(e) Admission criteria. The guidelines for admission in a center for sick children are described in (1) - (2) of this subsection. A provider is not obligated to admit a child if the provider does not have adequate information about the child's condition or diagnosis to determine whether he or she can be safely included in the program.

(1) Level I. A written physical assessment of the child is conducted by the director or designated caregiver to determine the appropriateness of the child's attendance that day or the need for a medical evaluation prior to admission. The assessment includes:

(A) any pertinent information from the parent or authorized adult relevant to the child's condition and symptoms; and
(B) an evaluation of the child's general appearance including physical appearance, demeanor, mood and activity level.

(2) Level II. A written medical evaluation that includes a diagnosis from a licensed physician indicating a child is eligible for admission is required before a child can be admitted to a Level II center.

(f) Policy and procedure. The center has written policies and procedures that are approved in writing by a licensed physician or by a pediatric nurse practitioner.

(1) In addition to the requirements in OAC 340:110-3-5.1(a) (1)-(8), the center policy must also include:

(A) the criteria for admission in the center;
(B) intake and admission procedures;
(C) plans for the daily care of children including methods used to monitor the condition of children;
(D) plans for staff training and communication with parents and health care providers; and
(E) procedures for injury prevention and infection control.

(2) A health professional provides on-going consultation to the program in its overall operation and the management of illness for individual children.

(g) Staff qualifications. In addition to the requirements for child care center employees contained in OAC 340:110-3-7.1(a)-(h), employees caring for sick children are required to have completed:

(1) at least one year of satisfactory full-time experience in a child care setting; or
(2) a minimum of 20 documented clock hours of training in child development, early childhood education or a closely related subject.

(h) Staff training. The training requirements for staff caring for sick children are contained in (1) - (4) of this subsection.

(1) Staff caring for sick children must have current documentation of completed training in community first aid and CPR, including infant and child, conducted by an individual certified as an instructor through the American Red Cross, First Care or American Heart Association, or by a health professional trained as an instructor in CPR and first aid training.
(2) Prior to working with sick children, employees must complete the DHS approved training for the care of sick children which is conducted by a health professional. The training includes:

(A) policy and procedures relating to the care of sick children;
(B) recognizing signs and symptoms of illness;
(C) administration of medication;
(D) when and how to call for medical help;
(E) taking children's temperatures;
(F) infection control procedures including handwashing, handling contaminated items, use of disinfectants and food handling;
(G) communicating with parents concerning a child's illness; and
(H) any other care that may be required for admissible illnesses and conditions.

(3) Staff caring for sick children must obtain two hours of training annually related to the care of sick children and the prevention and control of communicable disease.
(4) All training required for staff who care for sick children will count toward the 12 hours of annual training required for all child care center staff listed in OAC 340:110-3-7.1(j)(3).

(i) Staff-child ratios. A program providing care for sick children is exempt from the requirements pertaining to staff-child ratios in OAC 340:110-3-9.1(e)(1)-(4). However, the program is required to meet the minimum staff-child ratios described in (1) - (4) of this subsection.

(1) When all children in a group are under 2 years old, the staff-child ratio is 1:3 with a maximum group size of 6.
(2) When the children in a group are 2 through 5 years old, the staff-child ratio is 1:4 with a maximum group size of 8.
(3) When all children in a group are 6 years old and up, the staff-child ratio is 1:6 with a maximum group size of 12.
(4) When children of mixed ages are cared for in the same group, the staff-child ratio and group size for the youngest child apply.

(j) Indoor space. In addition to the requirements pertaining to indoor space in OAC 340:110-3-11(a)-(d)(1), a center providing care for sick children meets the additional requirements regarding indoor space listed in (1) - (7) of this subsection.

(1) Toilets are in a bathroom that is adjacent to or opens directly into each room used to care for sick children.
(2) Sinks for hand-washing are located in each room used for the care of sick children, or in a bathroom that opens directly into the room.
(3) The use of potty chairs is prohibited.
(4) Rest equipment is available and accessible for use by children throughout the day and is placed three feet apart when in use.
(5) Mats may not be used as rest equipment.
(6) The use of carpet is prohibited; however, rugs may be used if they are washed daily.
(7) In a Level I facility:

(A) rooms used for the care of sick children are separated from other components of the center by floor to ceiling walls; and
(B) rooms, fixtures, furniture, equipment and supplies used by sick children are not used by staff or children from any other component of the child care center when sick children are in care.

(k) Outdoor space. A center for sick children is exempt from the requirements pertaining to outdoor play space in OAC 340:110-3-11(d)(2), and in OAC 340:110-3-22(a)-(d). However, if outdoor play space is provided:

(1) all requirements in OAC 340:110-3-11(d)(2), and OAC 340:110-3-22 (a)-(d) are met; and
(2) if the same area is shared by well and sick children, it is used at separate times.

(l) Health. In addition to the requirements in OAC 340:110-3-27(a)-(h), a center for sick children:

(1) requires staff to monitor and record the condition of each child throughout the day. The monitoring includes:

(A) temperature;
(B) amount of fluid and food intake;
(C) output including urine, vomit and stools, as appropriate;
(D) medication administered; and
(E) sleeping patterns and general behavior.

(2) notifies parents immediately of any significant change in a child's condition; and
(3) takes additional precautions to prevent the spread of disease, including:

(A) cleaning and disinfecting floors, toys, equipment and furniture daily or more often if necessary, or before being used by another group of children;
(B) posting the proper procedure for hand washing at each sink;
(C) providing liquid soap from mounted dispensers for hand washing;
(D) using paper towels from a dispenser with waste containers provided for disposal;
(E) providing toys that are non-porous and easily washable; and
(F) prohibiting staff and children who begin their day in the area serving sick children to transfer to any other part of the child care facility during that day.

(m) Food and nutrition. In addition to the requirements contained in OAC 340:110-3-28 (a)-(e), a center caring for sick children:

(1) modifies menus to meet the individual physical condition of each child in care;
(2) prohibits staff involved with food preparation or service from changing diapers or assisting children with toileting;
(3) uses only single-use and disposable eating and drinking utensils. Infant bottles and toddler drinking cups may be used if they are sent home daily;
(4) prohibits the use of drinking fountains; and
(5) requires staff to frequently offer drinking water and other fluids to each child.

(n) Additional requirements for Level II centers. In addition to the requirements listed in (a) - (m) of this Section, a Level II center must meet the requirements outlined in (1) - (6) of this subsection.

(1) A physical assessment of each child is conducted by a health professional as the child is admitted to the program.
(2) A health professional or licensed practical nurse (LPN) with immediate, direct access to a health professional must remain onsite at all times when sick children are in care.
(3) The LPN may not make the determination whether to admit a child into the program. The LPN may provide care and collect clinical information, and must report to the health professional.
(4) Children are cared for in separate rooms unless grouped with other children diagnosed with the same illness.
(5) Separate outside ventilation is required when care is provided for children diagnosed with:

(A) measles;
(B) diphtheria, until 5 days of the appropriate antibiotic therapy, which is to be given a total of 14 days;
(C) rubella;
(D) tuberculosis; or
(E) chicken pox.

(6) In a Level II center that is a component of a center caring for well children:

(A) rooms are separated from other components of the center by floor to ceiling walls;
(B) rooms, furniture, equipment and supplies used by sick children are not used by children or staff from other components of the center; and
(C) a separate entrance is required for sick children.

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