Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes health requirements
for child care providers and children in license-exempt child care
facilities.
(1) Facility
staff shall meet the following health requirements:
(A) The director or other caregiver shall
report to the local health department when any child in a facility is suspected
of having a reportable communicable disease listed in 19 CSR 20-20.020(1)-(5).
In the event of an unusual outbreak of a reportable communicable disease,
caregivers shall implement control measures recommended by the department or
local health department;
(B)
Caregivers shall use proper handwashing techniques with soap and warm, running
water after toileting, after assisting a child with toileting, after diapering
a child, and at other times as needed. Good hygiene practices shall be followed
during food preparation. These practices include, but are not limited to,
washing hands properly after smoking, eating, drinking, using the restroom,
after touching raw food products and before preparing and serving food. Hands
shall be dried with single-service towels. Caregivers shall teach and see that
children wash their hands at appropriate times: before eating, after toileting
and as needed when hands are soiled;
(C) Caregivers shall not work when ill and
likely to transmit an illness that might endanger the health or well-being of
children. This may include symptoms such as fever, coughing, upper respiratory
infection, vomiting or diarrhea;
(D) All caregivers working in a facility
during child care hours shall be in good health. They shall have a physical
assessment, including a tuberculosis status assessment by a licensed physician
or registered professional nurse. A physical assessment report, signed by a
licensed physician or registered professional nurse, shall be on file at the
time of employment or within thirty (30) days following employment.
1. Physical assessment reports shall be
completed not more than twelve (12) months before beginning work in the
facility. The reports may be transferred to another facility for future
employment.
2. The facility may use
the department's physical assessment form, MO 580-1879 (6-94), or the facility
may use its own form if it contains all the information on the department's
form.
3. After the initial physical
assessment, all caregivers working in a facility during child care hours shall
be tested for tuberculosis at least every two (2) years. Caregivers with
previously positive tuberculin tests shall be under the management of a
physician; and
(E) No
person shall smoke or use tobacco products in any area of a child care facility
while children are in care.
(2) Within thirty (30) days following the
admission of an infant, toddler or preschool child, a physical assessment
report signed by a licensed physician or registered professional nurse shall be
on file at the facility. The facility may use the department's physical
assessment form, MO 580-1878 (6-94), or the facility may use its own form if it
contains all the information on the department's form. The report shall have
been completed not more than twelve (12) months before admission.
(3) Child care facilities shall meet
immunization requirements for children as defined by section
210.003,
RSMo.
(4) A parent of a school-age
child shall provide a statement at the time of enrollment indicating the
child's health history, any current health problems and any restrictions
necessary for the child's care.
(5)
Each child shall be observed for contagious diseases and other signs of illness
on arrival and throughout each day.
(6) A parent or guardian shall be contacted
when signs of illness are observed.
(7) When a child exhibits any of the
following in subsections (7)(A)-(O) of this rule, the parent(s) shall be
contacted and the child shall be sent home. Parental contact shall be recorded
and filed in the child's records. Symptoms that require parental contact and
sending a child home are-
(A) More than one
(1) abnormally loose stool;
(B) Red
or blue in the face or makes high-pitched croupy or whooping sounds after
coughing;
(C) Difficult or rapid
breathing-especially important in infants under six (6) months of
age;
(D) Yellowish skin or
eyes;
(E) Tears, redness of eyelid
lining or irritation, followed by swelling or discharge of pus;
(F) Unusual spots or rashes;
(G) Sore throat or swallowing
difficulty;
(H) An infected skin
patch-crusty, bright yellow, dry or gummy areas of the skin;
(I) Unusually dark, tea-colored
urine;
(J) Gray or white
stool;
(K) Fever over one hundred
one degrees Fahrenheit (101oF) by mouth or one
hundred degrees Fahrenheit (100oF) under the
arm;
(L) Headache and stiff
neck;
(M) Vomiting more than
once;
(N) A child is in the
contagious period of a disease; or
(O) Severe itching of the body or scalp or
scratching of the scalp which may be symptoms of lice or scabies.
(8) An ill child shall be kept
isolated from the other children and a caregiver shall be in close proximity to
the child until a parent arrives. Close proximity means that a care-giver is
close enough to hear any sounds a child might make that indicate a need for
assistance.
(9) A parent of each
child shall be notified when any reportable communicable disease in 19 CSR
20-20.020(1)-(5) occurs in the facility.
(10) Providers are not required to administer
medication, but may if they choose.
(A) All
medication shall be given to a child only with the dated, written permission of
a parent, stating the length of time the medication may be given.
(B) Prescription and nonprescription
medication shall be in the original container and labeled with the child's
name, instructions for administration, including the times and amounts for
dosages, and the physician's name. Sample medication provided by a physician
may be used.
(C) All medication
shall be stored out of reach of children or in a locked container.
(D) Medication shall be returned to storage
immediately after use.
(E)
Medication needing refrigeration shall be kept in the refrigerator in a
container separate from food.
(F)
Unused medication shall be returned to the parent or disposed of immediately
after it is no longer needed.
(G)
The date and time(s) of administration, the name of the individual giving the
medication and the quantity of medication given shall be recorded promptly
after administration. This form shall be filed in the child's record after the
medication is no longer necessary.
(11) In case of an accident or injury to a
child, the provider shall notify a parent immediately. If a child requires
emergency medical care, a parent's prior written instructions shall be
followed. A form shall be completed indicating the circumstances and the date
and time of the injury. The form shall be signed by the caregiver and his/her
supervisor. A copy of the form shall be given to the parent the day of the
accident or injury and necessary explanations shall be given. The form shall be
filed in the child's record.
Click to view
pdf
*Original authority: 210.221, RSMo 1949, amended 1955,
1987, 1993, 1995, 1999; 210.252, RSMo 1993, amended 1999.
