Ala. Admin. Code r. 660-5-19-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 660-5-19-.04 - Child Care Program

(1) Staffing

(a) Required ratios shall be maintained at all times.

1. Staff-child ratio shall be:

Age	Staff to Child Ratio
4 years up to school age*	1 to 18
School age* up to 8 years	1 to 21
8 years and older	1 to 22

* The term "school age" Includes children who are five (5) years of age on or before September 1. This definition corresponds with the minimum age at which a child is entitled to admission to public school kindergarten.

2. A staff person shall be counted in the staff-child ratio only if he/she meets child care worker qualifications and he/she is giving full attention to the direct supervision of the children.

(b) Staff Coverage shall be determined by the following:

1. All children shall have staff supervision at all times.

2. The name of the staff person in charge shall be posted in a conspicuous place in the facility.

3. At least two (2) staff who are at least 18 years of age, who meet child care worker qualifications and have a current Infant-Child (Pediatric) Cardiopulmonary Resuscitation Certificate (CPR) and a current First Aid Certificate, shall be present during all hours of operation.

4. There shall be a second staff person, age 18 or older available in the facility building or on the premises, whenever seven (7) or more children are present. Required staff-child ratios shall be met at all times.

5. Staff persons shall be free from all other duties during the hours they are working directly with the children.

(2) Preschool/School-age Children - Daily Program.

(a) Toileting.

1. Children's toileting shall be according to each child's needs. Each child's hands shall be washed with soap and running water after toileting.

2. Staff shall use universal precautions when diapering/toileting or being exposed to blood, fecal material, or urine.

(b) Feeding

1. Service and serving equipment.

(i) Single-use cups or glasses or drinking fountains shall be supplied for water service during the day. A common drinking container shall not be used.

(ii) Drinking water with no added sweeteners or carbonation shall be readily available in indoor and outdoor areas to each child throughout the day.

(iii) Vending machines shall be prohibited in areas used by the children.

2. Face and hand washing.

(i) Each child's hands shall be washed with soap and running water before and after meals and snacks, and after toileting and diapering.

(ii) Each staff person shall wash his/her hands with soap and running water before food preparation or service, after assisting with toileting, and after any contact with bodily fluids, including wet or soiled diapers, runny nose, spit, vomit, etc.

(iii) Individual paper towels shall be supplied for each washing and drying.

(3) Disciplinary Practices

(a) Discipline shall be appropriate to the age and developmental level of each child.

(b) Disciplinary practices, including but not limited to the following, are prohibited:

1. The use of corporal or physical punishment is prohibited, including but not limited to: spanking; shaking; slapping; kicking; pushing; biting; pinching; hitting; thumping; hair pulling; ear pulling; excessive physical exercise, excessive rest, or strenuous/bizarre posture;

2. The use of verbal abuse is prohibited, including but not limited to: yelling; shouting; name calling; shaming; making derogatory remarks about a child or a child's family; using language that threatens, humiliates, or frightens a child;

3. The use of discipline associated with food, naps, or bathroom procedures is prohibited, including but not limited to: withholding food as punishment; use of food such as hot sauce, lemon juice, vinegar, etc., or soap, as punishment; punishment for lapses in toilet training; punishment for not sleeping during nap/rest time;

4. The use of physical restraint as punishment is prohibited;

5. Punishment administered by another child is prohibited.

6. Rough or harsh handling of children, whether associated with discipline or not, is prohibited, including but not limited to: shaking; lifting or jerking by one or both arms; pushing; pulling; forcing or restricting movement; lifting or moving by grasping clothing; covering a child's head; etc.

7. Physical activity/outdoor time taken away as punishment is prohibited.

(4) Health Information.

(a) Illness and injury.

1. No child who is ill shall be admitted to the facility. This regulation is not intended to require the exclusion of children in violation of the Americans with Disabilities Act (ADA). The Department of Human Resources is not the enforcement agency for the ADA. Determinations of illness may be based on: the child's inability to participate in the facility's activities; the need for additional care that facility staff cannot provide without taking time and attention away from the other children; signs of serious or contagious disease or condition, such as but not limited to food and allergic reactions, fever, diarrhea, vomiting, unexplained rash, scabies, head lice; a physician's diagnosis requiring that the child be separated from other children.

2. Isolation and removal.

(i) Any child in attendance who becomes ill, has a contagious disease or condition, or suffers an injury that requires professional medical attention shall be separated promptly from the group, but shall have continuous supervision by a staff person. Toys, bedding, equipment, and bathroom facilities used by an ill child or adult shall be cleaned and disinfected prior to use by another person.

(ii) The ill or injured child's parent(s)/guardian(s) shall be notified immediately and required to come for, or arrange for another designated person to come for the child.

(iii) If the parent(s)/guardian(s) or person designated by the parent(s)/guardian(s) cannot be reached or if the injury or illness is severe, the facility shall obtain emergency medical treatment.

3. Contagious diseases/conditions.

(i) When a contagious disease/condition (a disease/condition which can be transmitted or spread from person to person) has been introduced into the facility, parent(s)/guardian(s) of each exposed child shall be notified.

(ii) The facility shall urge parent(s)/guardian(s) to notify the facility when their child is known to have been exposed to a contagious disease/condition outside the facility.

(iii) The facility shall report any known or suspected case of contagious disease/condition to the county or state health department.

4. Food allergies. Each child with a food allergy should have a written care plan that includes:

(i) Instructions regarding the food(s) to which the child is allergic, and the steps to be taken to avoid that food.

(ii) A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses and methods of prompt administration of any medicines.

(iii) The written child care plan, a mobile phone, and the proper medications for appropriate treatment if the child develops an acute allergic reaction should be carried on field trips and when the child is transported.

(iv) The facility should notify the parent(s)/ guardian(s) immediately of any suspected allergic reactions, as well as the ingestion of or contact the problem food even if a reaction did not occur. The facility should contact the emergency medical services system immediately whenever epinephrine has been administered.

(v) Each child's food allergies should be readily available and known by the child's teacher(s).

5. Infant-child Cardiopulmonary Resuscitation (CPR) and First Aid. At least two (2) staff person(s) with a current Infant-Child (Pediatric) Cardiopulmonary Resuscitation Certificate (CPR) and a current First Aid Certificate shall be in the facility during hours of operation. A copy of the Certificates shall be on file in the facility.

6. Authority and procedure for administering medication or medical procedures shall be clearly defined.

(i) No medication or medical procedures (prescription or over-the-counter) shall be administered without being ordered by the child's health professional and without a written, signed authorization, from the child's parent(s)/guardian(s). Blanket authorization forms are prohibited. The authorization form shall include time(s) and date(s) to be administered, dosage, storage instructions, (refrigerated and unrefrigerated), and specific directions for administering the medication/medical procedures, such as "give-by-mouth", apply to skin, inhale, drop in eyes, etc. An authorization form shall be valid for no more than seven (7) days unless accompanied by a written physician's statement.

(ii) Any prescription drug or over the counter drug sent to the facility shall be in its original container. Prescription drugs shall have a pharmacy label or shall be accompanied by a physician's written instructions. Over the counter drugs shall be clearly labeled with the child's name and directions for administering the drug. Medication should not be used beyond the date of expiration. A measuring device (if the medication requires measuring) shall be provided for each child's medication.

(iii) Medication or medical procedures shall be administered to the child by the designated staff.

(iv) Locked storage (lock and key or combination lock), inaccessible to children, shall be provided for all medication or drugs (children's or staff's).

(v) Medicines/drugs shall be returned to the parent(s)/guardian(s) or disposed of properly when no longer needed.

(vi) Time and date of all medication dosages or medical procedures administered at facility shall be documented, in writing, signed by the staff person administering the medication or medical procedure (initials not acceptable), and kept in the child's file. Copies shall be made available to the child's parent(s)/guardian(s) on request.

(5) Emergency Preparedness and Response Plans. The Center shall develop a written disaster plan and make is available to all child care staff members and employees. This plan shall be posted in a conspicuous place. This emergency preparedness plan must be submitted to the Department and copies provided to all parents/guardians.

(a) The plan shall include procedures that will be used to prepared for and respond to the following types of emergency or disaster situations:

1. Weather emergencies and natural disasters which include severe thunderstorms, tornadoes, flash flooding, major snowfall, blizzards, ice storms, or earthquakes;

2. Emergency outdoor or indoor lockdown or evacuation due to threats of violence which includes active shooter, bioterrorism or terrorism;

3. Emergency or disaster evacuations due to hazardous materials and spills, gas leaks or bomb threats;

4. Outbreaks, epidemics, or other infectious disease emergencies;

5. Loss of power, water or heat;

6. Other threatening situations that may pose a health or safety hazard to the children in the center.

(b) The disaster plan shall include details for:

1. Shelter in place or evacuation, how the center will care for and account for the children until they can be reunited with the parent;

2. Assisting infants and children with special needs and/or health conditions;

3. Reunification with parents;

(i) Emergency contact information for the parents and the center,

(ii) Procedures for notifying and communicating with parents regarding the location of the children if evacuated,

(iii) Procedures of communicating with parents during loss of communications (no phone or internet service available),

4. The location of supplies and procedures for gathering necessary supplies for staff and children if required to shelter in place;

5. What to do if a disaster occurs during the transport of children, or when on a field trip or routine trip;

6. Training of staff or reassignment of staff duties as appropriate;

7. Updating the plan on a yearly basis;

8. Contact with local emergency management officials.

(c) The plan should also be inclusive of:

1. Current emergency plans and procedures;

2. Location and use of fire extinguishers;

3. Location on the first aid and emergency supply kits;

4. Phones for on-site and off-site use;

5. Drills including but not limited to fire, tornado, lock-down, and relocation.

(d) Emergency procedures shall be practiced at least once each quarter so that children are familiar with the types of procedures and are able to be engaged, and not overwhelmed by the fear of an event. The recommended schedule is to rotate one or more types of drill each month so that all drills are practiced each quarter (4 times per year).

Ala. Admin. Code r. 660-5-19-.04

Adopted by Alabama Administrative Monthly Volume XXXVI, Issue No. 06, March 30, 2018, eff. 4/22/2018.

Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 04, January 31, 2020, eff. 3/16/2020.

Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 10, July 30, 2021, eff. 9/13/2021.

Authors: Dawn Owens/Tonya Swanner

Statutory Authority: Child Care and Development Block Grant Act of 2014 (42 U.S.C.S. §§9857 et seq.).