Ordered Steps Learning Center

Ratios- 1:4 (6wks-24mths), 1:5 (24-36mths): There shall be at least one program staff qualified under section 19a79-4a(e) of the Regulations of Connecticut State Agencies for every four children or fraction thereof who are under the age of two years in attendance and for every five children or fraction thereof who are two years old in attendance, indoors and outdoors.

Rule 19a-79-10(c)(2). From a complaint.

Ratios- 1:4 (6wks-24mths), 1:5 (24-36mths): There shall be at least one program staff qualified under section 19a79-4a(e) of the Regulations of Connecticut State Agencies for every four children or fraction thereof who are under the age of two years in attendance and for every five children or fraction thereof who are two years old in attendance, indoors and outdoors.

Rule 19a-79-10(c)(2). From a complaint.

Consultants: An education consultant shall be available to the operator and program staff for advice and support regarding the educational content and practice of the program. A person needs to apply for approval to be an education consultant. Program staff shall not serve as education consultants for programs in which they provide direct care or direct program supervision in a non-consultative role; or in a program with the same operator as a program in which they provide direct care or direct program supervision in a non-consultative role. Specific duties of the education consultant shall include, but not be limited to making, at a minimum, annual site visits to the facility, reviewing daily plans, curriculum documents, and educational policies for the developmental and age appropriate practices, observing program staff interactions, use of materials and equipment, implementation of plans and approaches to classroom management; and providing feedback on documentation review and classroom observations to the director and head teacher. A health consultant shall be available to the operator and program staff for advice regarding the health of the children and the health program. Specific duties of the health consultant shall include, but not be limited to making, at a minimum, quarterly site visits to facilities that serve children three years of age and older; or for group child care homes, facilities that operate no more than three hours per day, or facilities that enroll only school age children, semi-annual site visits. Facilities that are closed during the summer months may omit the summer quarterly visit. Site visits shall be made by the health consultant during customary business hours when the children are present at the facility. Specific duties include, but are not limited to reviewing health and immunization records of children and program staff, reviewing the contents, storage and plan for maintenance of first aid kits, observing the indoor and outdoor environments for health and safety, observing children’s general health and development, observing diaper changing and toileting areas and diaper changing, toileting and hand washing procedures, reviewing the policies, procedures and required documentation for the administration of medications, including petitions for special medication authorizations needed for programs that administer medication, assisting in the review of individual care plans for children with special health care needs or children with disabilities, as needed; and quarterly review of all injury, illness, incident and accident reports. A social service consultant shall be available to the operator and program staff for advice regarding the emotional needs, program staff support and the social service program. A registered dietitian consultant shall be available to the operator and program staff for advice regarding nutrition and food service for those programs that prepare or plan meals. A written plan for consultation services shall be developed, signed annually by the consultant and implemented. Consultative service shall include, but not be limited to an annual review of written policies, plans and procedures that relate to the services provided by the consultant, availability by telecommunication for advice regarding problems, availability, in person, of the consultant to the program, consulting with administration and program staff about specific problems, acting as a resource person to program staff and the parent(s) to include coordinating services and assisting families and program staff in identifying necessary resources, and seeking and supporting the collaboration of multiple consultants serving the program. The activities and observations required by each consultant shall be documented in a consultation log that is kept on file at the facility for two years.

Rule 19a-79-4a(i)(1-2)(H), (F). From a complaint.

Child Health Records: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. It shall include a health record that shall include date of birth, a signed physical examination form including the child’s date of birth, a statement about the child’s general health and the presence of any known medical or emotional illness or disorder that would currently pose a risk to other children or which would currently affect this child’s functional ability to participate safely in a child care setting.

Rule 19a-79-5a(a)(2)(A)-(E). From a complaint.

Individual Care Plan- signed by parents/staff: An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child’s parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

Rule 19a-79-5a(a)(2)(E). From a complaint.

Indoor/Outdoor space inspected/approved: All indoor and outdoor space used for child care services as identified in the application shall be inspected and approved by the Office prior to use. Plans for new construction, expansion or renovation, indicating the proposed use and accompanied by a written narrative shall be submitted to the Office prior to the start of construction, expansion, or renovation. (2) Completed plans and specifications shall be submitted to and reviewed by the Office on the basis of compliance with the Public Health Code. Written approval by the local building inspector, local director of health or designee, local zoning and local fire marshal shall be submitted to the Office, upon request of the Office. Approval by Office is required prior to the use of any space that has been newly constructed, expanded or renovated. All construction, expansions, renovation, repairs or alterations of structures shall be done in such a manner to prevent hazards or unsafe physical or environmental conditions during periods of operation.

Rule 19a-79-7a(b). From a complaint.

Space not approved-not used for field trips-written parent permission: Indoor or outdoor space not inspected or approved by the Office at the same address as the facility shall not be used for field trips unless the program takes reasonable efforts to ensure the health and safety of all children using such space. Written permission from the parent(s) of children having access to such space shall be obtained and kept on file for Office review and such parent(s) shall be advised such space is not inspected or approved by the Office.

Rule 19a-79-7a(b)(6). From a complaint.

Authorized prescriber/parent permission: Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least three years after the child is no longer attending the program.

Rule 19a-79-9a(b)(3)(A-B). From a complaint.

Diapering: The diapering area shall be an elevated sturdy table or counter equipped with a safety rail. Infants and toddlers shall be diapered at a diapering area used only for this purpose and located in the program area. Each diapering area shall have a non-porous surface and be kept in good repair. Diapering areas shall be washed and disinfected after each use. Disposable paper sheets shall be used and discarded immediately after each diapering. A covered washable lined waste receptacle shall be available and located in a convenient place for soiled waste material. These materials shall be removed to an exterior waste storage area at least daily. Disposable diapers shall be discarded in a covered receptacle immediately after diapering. The hands of the program staff and the children shall be washed after each diaper change. Diapering and hand washing policies and procedures shall be posted in each diapering area and followed. When cloth diapers or training pants are used, a written plan for their use and care shall be developed and implemented. This plan shall include, but not be limited to, these procedures: placing soiled clothing and diapers in a sealed air tight container; removing soiled clothing and diapers from the child care center or group child care home daily; and cleaning and sanitizing the container daily.

Rule 19a-79-10(e)(1-10).

Local Health Inspection: At least every two (2) years, the local health director shall make unannounced visits, inspections or investigations of the licensed child care center or group child care home.

Rule 19a-79-2a(c)(8).

Documentation of Behavioral Management Techniques Discussed with Parents: The operator shall document that parents have been informed of the techniques used to manage child behaviors in the facility prior to enrollment and reviewed as needed during the period of the child’s enrollment.

Rule 19a-79-3a(b)(7)(B).

Professional development: Documentation of professional development for each program staff who cares for the children, including new employee orientation and annual training for current program staff on the child care center or group child care home policies, plans and procedures. Program staff, including the director, shall complete health and safety training no later than three months after the date of hire. Written verification of ongoing training that is at least one percent of the total annual hours worked. As of April 1, 2025, such annual training shall include content as defined in 45 CFR � 98.41(a)(1)(i) to (a)(1)(xi). Such education may include, but is not limited to, early education and child development, licensing and regulations, emergency preparedness, prevention and control of infectious diseases, prevention of sudden infant death syndrome and use of safe sleep practices, administration of medication, prevention and response to emergencies due to food and allergic reactions, building and physical premises safety, protection from hazards, bodies of water, and vehicular traffic; handling and storage of hazardous materials and the appropriate disposal of bio contaminants; child maltreatment, prevention of shaken baby syndrome and abusive head trauma, precautions in transporting children, pediatric first aid and cardiopulmonary resuscitation, nutrition and programming for children with disabilities or special health care needs.

Rule 19a-79-4a(a)(2), (h)(1-2).

Comprehensive background checks: The operator shall ensure that all program staff have completed a comprehensive background check before they have unsupervised access to children. The operator shall provide to the Office of Early Childhood any information obtained concerning substantiated child abuse or neglect records or criminal convictions upon request. The operator shall obtain from each prospective employee, who is eighteen years of age or older, for a position that requires the provision of care to a child or involves unsupervised access to a child, a listing of all employment held in the United States for an organization that provides care or services to children in the preceding five years. The operator shall take reasonable steps to contact each previous employer provided by the prospective employee to verify at a minimum the prospective employee�s job title, description of his/her regular duties, confirmation of employment dates, and whether such previous employer would recommend the prospective employee for rehire. This information shall be made accessible to the Office upon request. The operator shall not employ program staff, including volunteers, who have a record that the commissioner reasonably believes renders such program staff unsuitable to be employed in a child care center or group child care home.

Rule 19a-79-4a(b).

Children’s Enrollment information: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. The record shall include enrollment information signed and dated by the parent(s) that shall include, but not be limited to: the child�s name, address, date of birth and date enrolled, the residence, business address(es) and telephone number(s) of the parent(s) and the name and telephone number of the child�s physician or other primary health care provider.

Rule 19a-79-5a(a)(1)(A)-(C).

Injury, Illness, Incident, Accident reports: A written report shall be produced and maintained on the licensed premises, and for a period of not less than 2 years, documenting any injuries or accidents that result in an injury to a child, or illness of a child enrolled at the facility, an incident that is required to be reported to DCF. This report shall be available to the OEC upon request and a copy shall be provided to the parent no later than the next business day.

Rule 19a-79-5a(a)(3)(A).

Proper Refrigeration -41 degrees: There shall be proper refrigeration of no more than forty-one (41) degrees Fahrenheit for perishable foods in all child care centers and group child care homes and on field trips.

Rule 19a-79-6a(a)(3).

Licensed premises-clean, good repair, hazard free-maintenance program: For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

Rule 19a-79-7a(c)(2).

Lead Paint- testing, management plans: If the child care center or group child care home is housed in any portion of a building that was constructed prior to 1978, the operator shall submit to the Office and maintain documentation on file at the child care center or group child care home of the following. Prior to use, all space used by staff, program staff, and children shall have undergone a comprehensive lead inspection by a lead consultant licensed by the Department of Public Health. Such lead inspection shall include testing of representative components of each type of painted surface throughout the facility, dust wipes sampling of a window well, window sill and floor in each room, hallway and entry/egress areas, and testing of bare soil areas in the child play areas. Identified toxic level(s) of lead on defective surface(s) as those terms are defined in section 19a-111-1 of the Regulations of Connecticut State Agencies shall be remediated by an EPA Certified Firm using lead-safe work practice standards. All intact surfaces, including areas that have undergone remediation, for paint and soil shall be documented on a lead management plan that has been approved by the local director of health and shall be monitored in accordance with the approved plan by the operator. A letter issued by the local director of health confirming that appropriate action to remediate identified lead hazards has been completed, that clearance dust wipes have passed and that an approved lead management plan is on file.

Rule 19a-79-7a(c)(6)(A-D).

Potentially hazardous substances, materials � labeled, inaccessible to children: Potentially hazardous substances and materials in the child care centers and group child care homes shall be stored in a labeled container identifying the exact contents and dilutions, used according to the manufacturer�s instructions and for the intended purpose, handled in a safe manner and inaccessible to children.

Rule 19a-79-7a(e)(10).

Walls/ceilings/floors/rugs-clean, good repair: Walls, ceilings, floors and rugs shall be maintained in a state of good repair and be washable or easily cleanable. Rugs, if used, shall not present a tripping or slipping hazard.

Rule 19a-79-7a(e)(5).

Outdoor space: There shall be access to a minimum of seventy-five (75) square feet per child of outdoor space for the number of children using the space at any one time. The outdoor area shall be fenced or protected for safety. Outdoor play equipment shall have a shock absorbing surface, under and around, that shall effectively cushion the fall of a child, except where the child is sitting or standing at ground level. The shock absorbing surface shall be maintained at a depth of at least eight inches, be free of water and not allowed to become compacted. Acceptable shock absorbing surfaces may include mulch, sand, and wood chips. Synthetic material that is less than eight inches in depth, including but not limited to, rubber mats or tiles may be acceptable surfaces provided the operator maintains documentation on the licensed premises that the synthetic material is manufactured for this purpose, installed in accordance with the manufacturer�s specifications and sufficient to cushion the fall of a child. Concrete, asphalt, grass and dirt shall not be considered a shock absorbing surface. The playground shall be free of glass, debris, holes and other hazards. Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. Outside equipment shall be anchored for stability when recommended by the manufacturer. Anchors shall be buried below ground level. The operator shall provide documentation to the Office, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. Drinking water shall be available and accessible to children. Outdoor equipment shall be arranged in such a way as to avoid accidents. All play equipment, fences, and structures shall not pose a hazard.

Rule 19a-79-7a(h)(1-9).

Authorized prescriber/parent permission: Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least three years after the child is no longer attending the program.

Rule 19a-79-9a(b)(3)(A-B).

CO/NCAP Compliance Violation(s): A Negotiated Corrective Action Plan or Consent Order is a voluntary agreement in which a provider/program agrees to take certain steps or make changes above and beyond the regulations in order to retain their license. The operator shall ensure compliance with the conditions.

Rule Not given.

Notification of Change: The operator shall notify the Office of Early Childhood, the parent(s) and staff of any changes in programs or services. Notification of personnel changes shall be made within five (5) business days after the change. If the change is for a head teacher, a plan for interim head teacher coverage shall be submitted to the Office of Early Childhood. A qualified head teacher or a plan approved by the commissioner shall be in place within thirty (30) days of change of a qualified head teacher. Notification of changes related to the licensed capacity, fees, services or voluntary closing shall be made at least thirty (30) days prior to the effective date of the proposed change. A change of location, change of operator or a change of ownership requires a new initial application.

Rule 19a-79-3a(c)(1-4). From a complaint.

Respond to OEC- No false, misleading statements or documents: The operator shall respond to Office requests for information or documentation related to compliance within the time period and in the manner specified by the Office. The operator shall not furnish any false or misleading documents or make any false or misleading statements to the Office in order to obtain or retain the license.

Rule 19a-79-3a(o). From a complaint.

Designated head teacher - 60%: A designated head teacher shall be on site for sixty percent (60%) of the time the child care center or group child care home is in operation on a weekly basis. The head teacher shall be approved by the Office.

Rule 19a-79-4a(d)(1)-(e)(2). From a complaint.

Ensuring the safety & health of children: The operator of the child care center or group child care home shall be responsible for compliance with the requirements of the Regulations of Connecticut State Agencies and applicable endorsements in such a manner as to ensure the safety, health and development of the children while in the operator’s care.

Rule 19a-79-3a(a). From a complaint.

Daily Attendance Records: Children/Staff: Daily attendance records for both children and program staff, recorded daily at the time of arrival and departure and kept on file at the facility for at least one year, showing the specific times of arrival and departure.

Rule 19a-79-3a(d)(1). From a complaint.

Staff Health Records: A file shall be kept on the licensed premises for each employee of the child care center or group child care home which shall include an acceptable medical statement, completed within 12 months before the date of employment for new program staff, and every 36 months for current program staff. Such statement shall document the presence of any known medical or emotional illness or disorder that would currently pose a risk to children.

Rule 19a-79-4a(a)(1). From a complaint.

Comprehensive background checks: The operator shall ensure that all program staff have completed a comprehensive background check before they have unsupervised access to children. The operator shall provide to the Office of Early Childhood any information obtained concerning substantiated child abuse or neglect records or criminal convictions upon request. The operator shall obtain from each prospective employee, who is eighteen years of age or older, for a position that requires the provision of care to a child or involves unsupervised access to a child, a listing of all employment held in the United States for an organization that provides care or services to children in the preceding five years. The operator shall take reasonable steps to contact each previous employer provided by the prospective employee to verify at a minimum the prospective employee�s job title, description of his/her regular duties, confirmation of employment dates, and whether such previous employer would recommend the prospective employee for rehire. This information shall be made accessible to the Office upon request. The operator shall not employ program staff, including volunteers, who have a record that the commissioner reasonably believes renders such program staff unsuitable to be employed in a child care center or group child care home.

Rule 19a-79-4a(b). From a complaint.

Ratios: Proper staff child ratios shall be maintained at all times, indoors and outdoors. There shall be at least one program staff for every ten children, or fraction thereof in attendance. When there is a mixed age group, the lower required ratio for the age of the youngest child shall prevail. During nap time, when all of the children in the group are sleeping, the overall staff child ratios shall be maintained on the licensed premises. At no time shall a group of children be left unsupervised.

Rule 19a-79-4a(d)(4)(A-B) and (d)(6). From a complaint.

Licensed premises-clean, good repair, hazard free-maintenance program: For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

Rule 19a-79-7a(c)(2). From a complaint.

Potentially hazardous substances, materials � labeled, inaccessible to children: Potentially hazardous substances and materials in the child care centers and group child care homes shall be stored in a labeled container identifying the exact contents and dilutions, used according to the manufacturer�s instructions and for the intended purpose, handled in a safe manner and inaccessible to children.

Rule 19a-79-7a(e)(10). From a complaint.

Garbage/rubbish - disposed of daily, containers in good repair: Garbage and rubbish shall be kept in containers constructed of durable material approved by the local health director. Receptacles shall be in good repair to prevent infestations by rodents, insects and other pests and to prevent odors, injuries and other nuisance conditions. The garbage and rubbish shall be moved to an exterior waste storage area at least daily.

Rule 19a-79-7a(e)(11). From a complaint.

Program space- adequate sq. ft. per child: An operator of a child care center or group child care home operating in a facility first licensed after January 1, 1986 shall provide a minimum of thirty-five (35) square feet of total indoor usable program space per child. An operator of a child care center or group child care home operating in a facility first licensed before January 1, 1986 shall provide a minimum of thirty (30) square feet of total indoor usable program space per child.

Rule 19a-79-7a(f)(1)(A). From a complaint.

Adequate sinks-handwashing-diapering/other use-food prep: In child care centers there shall be a sink with hot and cold running water designated for diaper changing and hand washing of program staff and children. This sink shall be located in the program space. Child care centers which have three program staff for a group of infants or toddlers may use an accessible diaper changing facility if it is immediately adjoining the program area. Separate sinks shall be available for purposes other than hand washing after diaper changing within child care centers. Group child care homes shall have a sink accessible for hand washing other than the sink used for food preparation.

Rule 19a-79-10(d)(1)(A-C).

Authorized prescriber/parent permission: Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least three years after the child is no longer attending the program.

Rule 19a-79-9a(b)(3)(A-B).

Unused/Expired meds-destroyed/returned: All unused or expired medication, except for controlled substances, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

Rule 19a-79-9a(b)(5)(D).

Adequate sinks-handwashing-diapering/other use-food prep: In child care centers there shall be a sink with hot and cold running water designated for diaper changing and hand washing of program staff and children. This sink shall be located in the program space. Child care centers which have three program staff for a group of infants or toddlers may use an accessible diaper changing facility if it is immediately adjoining the program area. Separate sinks shall be available for purposes other than hand washing after diaper changing within child care centers. Group child care homes shall have a sink accessible for hand washing other than the sink used for food preparation.

Rule 19a-79-10(d)(1)(A-C).

Ensuring the safety & health of children: The operator of the child care center or group child care home shall be responsible for compliance with the requirements of the Regulations of Connecticut State Agencies and applicable endorsements in such a manner as to ensure the safety, health and development of the children while in the operator’s care.

Rule 19a-79-3a(a).

Individual care plan- signed by parents/staff: An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child’s parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

Rule 19a-79-5a(a)(2)(E).

Authorized prescriber/parent permission: Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least three years after the child is no longer attending the program.

Rule 19a-79-9a(b)(3)(A-B).

Labeling and storage: Medication shall be stored in the original child-resistant safety container and appropriately labeled. Medication shall be stored in a locked area or a locked container in a refrigerator in keeping with the label directions away from food and inaccessible to children. Only personnel authorized to administer medication may be provided with the means to access such medication. Controlled drugs shall be stored in accordance with state law.

Rule 19a-79-9a(b)(5)(A-B).

Unused/Expired meds-destroyed/returned: All unused or expired medication, except for controlled substances, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

Rule 19a-79-9a(b)(5)(D).

Ratios- 1:4 (6wks-24mths), 1:5 (24-36mths): There shall be at least one program staff qualified under section 19a79-4a(e) of the Regulations of Connecticut State Agencies for every four children or fraction thereof who are under the age of two years in attendance and for every five children or fraction thereof who are two years old in attendance, indoors and outdoors.

Rule 19a-79-10(c)(2).

Ratios- 1:4 (6wks-24mths), 1:5 (24-36mths): There shall be at least one program staff qualified under section 19a79-4a(e) of the Regulations of Connecticut State Agencies for every four children or fraction thereof who are under the age of two years in attendance and for every five children or fraction thereof who are two years old in attendance, indoors and outdoors.

Rule 19a-79-10(c)(2).

Program space- adequate sq. ft. per child: An operator of a child care center or group child care home operating in a facility first licensed after January 1, 1986 shall provide a minimum of thirty-five (35) square feet of total indoor usable program space per child. An operator of a child care center or group child care home operating in a facility first licensed before January 1, 1986 shall provide a minimum of thirty (30) square feet of total indoor usable program space per child.

Rule 19a-79-7a(f)(1)(A).

Ratios- 1:4 (6wks-24mths), 1:5 (24-36mths): There shall be at least one program staff qualified under section 19a79-4a(e) of the Regulations of Connecticut State Agencies for every four children or fraction thereof who are under the age of two years in attendance and for every five children or fraction thereof who are two years old in attendance, indoors and outdoors.

Rule 19a-79-10(c)(2).

Adequate sinks-handwashing-diapering/other use-food prep: In child care centers there shall be a sink with hot and cold running water designated for diaper changing and hand washing of program staff and children. This sink shall be located in the program space. Child care centers which have three program staff for a group of infants or toddlers may use an accessible diaper changing facility if it is immediately adjoining the program area. Separate sinks shall be available for purposes other than hand washing after diaper changing within child care centers. Group child care homes shall have a sink accessible for hand washing other than the sink used for food preparation.

Rule 19a-79-10(d)(1)(A-C).

No toys/objects less than 1 � ‶ diameter: Toys and other objects with a diameter of less than one and one-quarter inches, objects with removable parts that have a diameter of less than one and one-quarter inches, balloons and Styrofoam objects shall not be accessible to children under three years of age unless such objects are part of a designated and directly supervised activity.

Rule 19a-79-10(h)(2).

Annual policy training for program staff: The operator shall assure annual training for all current program staff on the child care center or group child care home policies, plans and procedures.

Rule 19a-79-3a(b)(6).

Documentation of Behavioral Management Techniques Discussed with Parents: The operator shall document that the techniques used to manage child behaviors in the facility have been discussed with the child’s parent(s) prior to enrollment and reviewed as needed during the period of the child’s enrollment.

Rule 19a-79-3a(b)(7)(B).

Ratios: Proper staff child ratios shall be maintained at all times, indoors and outdoors. There shall be at least one program staff for every ten children, or fraction thereof in attendance. When there is a mixed age group, the lower required ratio for the age of the youngest child shall prevail. During nap time, when all of the children in the group are sleeping, the overall staff child ratios shall be maintained on the licensed premises. At no time shall a group of children be left unsupervised.

Rule 19a-79-4a(d)(4)(A-B) and (d)(6).

Children’s Enrollment information: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. The record shall include enrollment information signed and dated by the parent(s) that shall include, but not be limited to: the child�s name, address, date of birth and date enrolled, the residence, business address(es) and telephone number(s) of the parent(s) and the name and telephone number of the child�s physician or other primary health care provider.

Rule 19a-79-5a(a)(1)(A)-(C).

Parent Permissions: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. It shall include specific written permission forms signed by the parent(s) authorizing the operator to use the programs emergency policies which shall accompany the child on trips away from the premises, authorizing one responsible person other than the parent(s) who can remove the child from the child care center or group child care home, authorizing any activity away from the premises, and authorizing transportation services.

Rule 19a-79-5a(a)(1)(D)(i-iv).

Child Health Records: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. It shall include a health record that shall include date of birth, a signed physical examination form including the child’s date of birth, a statement about the child’s general health and the presence of any known medical or emotional illness or disorder that would currently pose a risk to other children or which would currently affect this child�s functional ability to participate safely in a child care setting.

Rule 19a-79-5a(a)(2)(A)-(E).

Individual care plan- signed by parents/staff: An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child’s parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

Rule 19a-79-5a(a)(2)(E).

Proper Refrigeration -41 degrees: There shall be proper refrigeration of no more than forty-one (41) degrees Fahrenheit for perishable foods in all child care centers and group child care homes and on field trips.

Rule 19a-79-6a(a)(3).

Licensed premises-clean, good repair, hazard free-maintenance program: For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

Rule 19a-79-7a(c)(2).

Potentially hazardous substances, materials � labeled, inaccessible to children: Potentially hazardous substances and materials in the child care centers and group child care homes shall be stored in a labeled container identifying the exact contents and dilutions, used according to the manufacturer�s instructions and for the intended purpose, handled in a safe manner and inaccessible to children.

Rule 19a-79-7a(e)(10).

Walls/ceilings/floors/rugs-clean, good repair: Walls, ceilings, floors and rugs shall be maintained in a state of good repair and be washable or easily cleanable. Rugs, if used, shall not present a tripping or slipping hazard.

Rule 19a-79-7a(e)(5).

Medication Trainings: Prior to the administration of any medication, the director(s), head teacher(s), program staff or group child care home provider(s) who are responsible for administering the medications shall first be trained by a pharmacist, physician, physician assistant, advanced practice registered nurse or registered nurse in the methods of administration of medications and shall receive written approval from the trainer which indicates that the trainee has successfully completed a training program as required herein. In addition to being trained in the methods of medication administration, such trained staff may administer injectable medications by a premeasured, commercially prepared auto-injector used to treat allergic reactions or other type of injectable medication and rectal medications, only after he or she has successfully completed a training program on the administration of such type of medication. After completing such training, the director, head teacher, program staff or group child care home provider shall annually have his or her skills and competency in the administration of such medication reviewed and/or validated in accordance with the regulations. The facility shall have program staff trained in the use such medications on site during all hours when a child who has orders to receive such medication is on-site. Upon completion of the required training program or the review and validation of the required training, the written training approval for staff shall be on file at the facility. Approval for the administration of oral, topical, inhalant medications, rectal medications and injectable medications other than by a premeasured commercially prepared auto-injector shall remain valid for three years. Approval for the administration of injectable medications by a premeasured commercially prepared auto-injector shall be valid for one year. A copy of the approval shall be on file at the facility for a period of three years and shall be available to Office staff upon request. The operator shall ensure that the trainer provides the trainee with an outline of the curriculum content which verifies that all mandated requirements have been included in the training program. A copy of said outline shall be on file at the facility for a period of three years for Office review. The Office may require at any time that the operator obtain the full curriculum from the trainer for review by the Office.

Rule 19a-79-9a(b)(1)(A-F)-(2)(A-C).

Authorized prescriber/parent permission: Except for nonprescription topical medications, no medication shall be administered to a child without the written order of an authorized prescriber and the written permission of the child’s parent(s) which shall be on file at the facility. Individual written medication administration records for each child shall be written in ink, reviewed prior to administering each dose of medication and kept on file at the facility for at least three years after the child is no longer attending the program.

Rule 19a-79-9a(b)(3)(A-B).

Labeling and storage: Medication shall be stored in the original child-resistant safety container and appropriately labeled. Medication shall be stored in a locked area or a locked container in a refrigerator in keeping with the label directions away from food and inaccessible to children. Only personnel authorized to administer medication may be provided with the means to access such medication. Controlled drugs shall be stored in accordance with state law.

Rule 19a-79-9a(b)(5)(A-B).

Emergency medication inaccessible: Equipment and medications prescribed to treat asthma, administer glucagon, control seizures, or as an emergent first line of defense medication against an allergic response or a diabetic reaction shall be stored in a safe manner, inaccessible to other children, to allow for quick access in an emergency.

Rule 19a-79-9a(b)(5)(C).

Unused/Expired meds-destroyed/returned: All unused or expired medication, except for controlled substances, shall be returned to the parent(s) or disposed of if it is not picked up within one week following the termination of the order, in the presence of at least one witness. The facility shall keep a written record of the medications destroyed for three years which shall be signed by both parties.

Rule 19a-79-9a(b)(5)(D).