New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter C - Social Services
Article 2 - Family and Children's Services
Part 416 - Group Family Day Care Homes
Section 416.11 - Health and infection control

(1) No child may be accepted for care in a child care program unless the program has been furnished with a written statement signed by a health care provider verifying that the child is able to participate in child care and currently appears to be free from contagious or communicable diseases. A child's medical statement must have been completed within the 12 months preceding the date of enrollment.

(2) The written medical statement from the health care provider must also state whether the child is a child with special health care needs and, if so, what special provisions, if any, will be necessary in order for the child to participate in child day care. When the written statement from the health care provider advises the day care program that the child being enrolled is a child with special health care needs, the day care program must work together with the parent and the child's health care provider to develop a reasonable health care plan for the child while the child is in the child day care program. The health care plan for the child must also address how the day care program will obtain or develop any additional competencies that the caregivers will need to have in order to carry out the health care plan for the child.

(3) The program must keep documentation of immunizations the child has received to date, in accordance with New York Public Health Law.

(4) A program may admit any child not yet immunized provided the child's immunizations are in process, and the parent gives the program specific appointment dates for required immunizations in accordance with the requirements of New York Public Health Law.

(5) [Reserved].

(6) Any child who is missing one or more of the required immunizations may be admitted if a physician licensed to practice medicine in New York State furnishes the program with a signed, completed medical exemption form issued by the New York State Department of Health or New York City Department of Education. The medical exemption must be reissued annually.

(7) With the exception of children meeting the criteria of paragraph (6) of this subdivision, children enrolled in child day care must remain current with their immunizations in accordance with the current schedule for required immunizations established in the New York Public Health Law.

(8) The caregivers' children receiving care in the home must meet the health and immunization requirements of this section.

(9) The program must try to obtain a copy of a lead screening certificate for each child under the age of six years. If the parent does not have one, the program may not exclude the child from child day care, but must give the parent information on lead poisoning and prevention, and refer the parent to the child's health care provider or the local health department for a lead blood screening test.

(1) The provider, assistant(s), and substitute(s), must each submit a medical statement on forms furnished by the office or an approved equivalent from a health care provider:

(2) Thereafter a medical statement will be required when an event or condition reasonably calls into question a caregiver's ability to provide safe and suitable child care.

(3) Initial medical statements sent in with the application or as a result of a new hire must be dated within 12 months preceding the date of application or hiring date.

(4) The medical statement must give satisfactory evidence that the individual is physically fit to provide child day care and has no diagnosed psychiatric or emotional disorder which would preclude such individual from providing child day care.

(5) All providers, assistants, substitutes and household members must be free from communicable disease unless his/her health care provider has indicated that the presence of the communicable disease does not pose a risk to the health and safety of the children in care.

(6) The initial medical statement for providers, assistants, and substitutes must include the results of a Mantoux tuberculin test or other federally approved tuberculin test performed within the 12 months preceding the date of the application. Thereafter, tuberculin tests are only required at the discretion of the employee's health care provider or at the start of new employment in a different child care program.

(7) The program must retain on file in the program a medical statement, on forms furnished by the office or approved equivalents, from a health care provider for each person residing in the home.

(8) Consumption of, or being under the influence of alcohol by any caregiver, volunteer or employee is prohibited during child day care hours.

(9) Consumption of or being under the influence of an illegal drug by any caregiver, volunteer or employee is prohibited during child day care hours.

(10) Consumption of or being under the influences of a controlled substance by any caregiver, volunteer or employee is prohibited during day care hours, unless the controlled substance is prescribed by a health care provider is being taken as directed, and does not interfere with the person's ability to perform his or her child day care functions.

(11) Smoking in indoor or outdoor areas in use by children and in vehicles when children are occupying the vehicles is prohibited.

(12) All caregivers must have knowledge of and access to children's medical records and all emergency information.

(13) Caregivers must be aware of each child's special health care needs identified in the child's individual health care plan. This includes, but is not limited to, allergies, disabilities and medical conditions.

(14) Caregivers must obtain assistance as identified in the child's individual health care plan if the child has a medical emergency.

(1) The licensee must prepare a health care plan on forms furnished by the office. Such plan must protect and promote the health of children. The health care plan must be on site, followed by all caregivers and available upon demand by a parent or the office. In those instances in which the program will administer medications, the health care plan must also be approved by the program's health care consultant unless the only medications to be administered are:

(2) The health care plan must describe the following:

(1) Programs must demonstrate to the health care consultant how medications are administered in the program. A program is not required to schedule a visit with a health care consultant or include a schedule of visits by a health care consultant in their health care plan when:

(2) Should the health care consultant determine, after a visit to the day care program, that the approved health care plan is not being reasonably followed by the program, the health care consultant may revoke his or her approval of the plan. If the health care consultant revokes his or her approval of the health care plan, the health care consultant must immediately notify the licensee and the licensee must immediately notify the office, no longer than 24 hours later. In that instance, the health care consultant may also notify the office directly if he or she so desires.

(3) A program authorized to administer medications, which has had the authorization to administer medications revoked, or otherwise loses the ability to administer medications, must advise the parent of every child in care before the next day the program operates that the program no longer has the ability to administer medications.

(4) A child care program, whose health care consultant terminates his or her relationship with the program, will be granted a 60 day grace period to hire another health care consultant, obtain approval of a health care plan from the new health care consultant and submit the plan to the office without the child care program losing the ability to administer medications as long as:

(5) Once the 60-day period has expired if no health care plan approval is issued, the child care program will be issued a new license, which will state that it is no longer able to administer medications other than over-the-counter topical medications and emergency medications.

(1) All caregivers, except those excluded pursuant to paragraph (5) of this subdivision, subdivision (f), and paragraph (h)(5) of this section who have agreed to administer medication must complete the office-approved medication administration training or an office-approved equivalent before administering medications to children in day care. The certification of training in the administration of medications to children in day care shall be effective for a period of three-years from the date of issuance. The caregiver must complete a recertification training approved by the office in order to extend the certification for each additional three year period. Where a certification lapses, the caregiver may not be recertified unless the caregiver completes the initial medication administration training or the recertification training, as required by the office. Where enforcement action has been taken against the licensee based on a failure by the program to comply with requirements for the administration of medications set forth in this section, the office may require retraining or may prohibit a caregiver from being involved in the administration of medications.

(2) Caregivers who will be responsible for administering medications must receive training in the methods of administering medications prior to administering any medications in a child day care setting. Upon completion of the training, the caregiver must receive a written certificate from the trainer that indicates that the trainee has successfully completed this training program, as required, and demonstrated competency in the administration of medications in a day care setting.

(3) The training in the administration of medications must be provided by a health care provider or registered nurse who has been certified by the office to administer the office approved curriculum.

(4) The training must be documented and must include, but need not be limited to the following:

(5) A person who can produce a valid New York State license as a physician, physician's assistant, registered nurse, nurse practitioner, licensed practical nurse or advanced emergency medical technician will not be required to attend the training required by this subdivision in order to administer medications in a day care program. Documentation establishing the person's credentials in one of the above fields will be required and a copy of the documentation must be provided to the office.

(1) Caregivers may administer medication only in accordance with the following:

(2) If the licensee elects not to administer medications, the caregiver must still document the dosages and time as per paragraph (9) of this subdivision that the medications were given to the child by the child's parent, or relative within the third degree of consanguinity of the parents or step-parents of the child.

(3) No child in care will be allowed to independently administer medications, except for those medications administered pursuant to paragraph (h)(6) of this section, without the assistance and direct supervision of caregivers that are authorized to administer medications pursuant to this section. Any program that elects to offer the administration of medication to children when children who attend the program independently administer medications or when children assist in the administration of their own medications must comply with all the provisions of this section.

(4) Caregivers may administer prescription and non-prescription (over-the-counter) medications for eyes or ears, oral medications, topical ointments, creams, lotions, sprays and medication patches and inhaled medications in accordance with this section.

(5) Caregivers may not administer medications by injection, vaginally or rectally except as follows:

(6) A caregiver authorized to administer medication who agrees to administer medications to a child must do so, unless they observe the circumstances, if any, specified by the health care provider or the medication label, under which the medication must not be administered. In such instances, the caregiver must contact the parent immediately.

(7) Permissions needed from parent and/or health care provider in order to administer medications.

(8) Caregivers who are authorized to administer medications must administer medication as follows:

(9) Documentation of medication administration.

(10) The parent must be notified immediately and the office must be notified within 24 hours of any medication administration errors. Notification to the office must be reported on a form provided by the office or on an approved equivalent.

(11) All verbal permissions received pursuant to this subdivision must be documented.

(12) Caregivers who are authorized to administer medications must be literate in the language for which the permissions and instructions for use are written.

(13) Medication must be returned to the parent or guardian when it is no longer required by the child or, with the permission of the parent or guardian, be properly disposed of by the caregiver.

(14) Where the program has received written permission of the parent and written instructions from the health care provider authorizing administration of a specified medication if the caregiver observes some specified condition or change of condition in the child while the child is in care, the caregiver may administer the specified medication, without obtaining additional authorization from the parent or health care provider.

(15) Prescription and over-the-counter medications must be kept in their original bottles or containers.

(16) Prescription medication labels must include the following information or be available through the licensed authorized prescriber on the form provided by the office or equivalent form:

(17) Medications must be kept in a clean area that is inaccessible to children.

(18) If refrigeration is required, the medication must be stored in either a separate refrigerator or a leak-proof container in a designated area of a food storage refrigerator, separated from food and inaccessible to children.

(19) Day care programs must comply with all Federal and State requirements for the storage and disposal of all types of medications, including controlled substances.

(20) In the case of medication that needs to be given on an ongoing, long-term basis, the authorization and consent forms for children five years of age or older must be reauthorized at least once every 12 months. Any changes in the medication authorization related to dosage, time or frequency of administration shall require a program to obtain new instructions written by the licensed authorized prescriber. All other changes to the original medication authorization require a change in the prescription.

(21) In the case of medication that needs to be given on an ongoing, long-term basis, the authorization and consent forms for children under the age of five years of age must be reauthorized at least once every six months. Any changes in the medication authorization related to dosage, time or frequency of administration shall require a program to obtain new instructions written by the licensed authorized prescriber. All other changes to the original medication authorization require a change in the prescription.

(1) A child care program may keep a supply of over-the-counter medications at a program site to be used in the event that a child in the program develops symptoms while in care that indicate the need for over-the-counter medication.

(2) Child care programs that store and administer medication that is not labeled for a specific child must have an over-the-counter stock medication policy in place before beginning to store any over-the-counter medications. The over-the-counter stock medication's policy must address the safe storage and proper administration of the stored over-the-counter medication and must address the need for strict infection control practices as they pertain to stock medication.

(3) Stock medication must be kept in a clean area that is inaccessible to children and any stock medication must be stored separate from child specific medication.

(4) Stock medications must be kept in the original container and have the following information on the label or in the package insert:

(5) Child care programs that stock supplies of over-the-counter medication, which are not in single dose packaging, must provide a separate mechanism to administer the medication for each child that may need the medication. Once a device has been used for a specific child in care, that specific device must be disposed of or reused only for that specific child and must be labeled with the child's first and last name. The program must include the procedure in the over-the-counter stock medication policy for dispensing the stock medication from the container to the device, or directly administering to the child, without contaminating the stock medication.

(6) All stock medication must be administered using best practice techniques in accordance with the directions for use on the medication package.

(7) Group family day care programs may not stock prescription medication.

(1) The caregivers must immediately call 911 for children who require emergency medical care for children who require such care and also must:

(2) The home must be equipped with a portable first aid kit which is accessible for emergency treatment. The first aid kit must be stocked to treat a broad range of injuries and situations and must be restocked as necessary. The first aid kit and any other first aid supplies must be kept in a clean, covered container or cabinet inaccessible to children.

(3) Rectal thermometers may not be used.

(4) The caregivers must provide a child who has or develops symptoms of illness a place to rest quietly that is in the view of, and under the supervision of a caregiver until the child receives medical care or the parent or approved parental designee arrives. In the event that a child has or develops symptoms of illness, the caregiver is responsible for immediately notifying the parent.

(5) When a caregiver has not been authorized to administer medications in a day care setting in accordance with the requirements of subdivision (f) of this section, such caregiver may administer emergency care through the use of epinephrine auto-injector devices, diphenhydramine, when prescribed in combination with the auto injector, asthma inhaler and asthma nebulizer when necessary to prevent anaphylaxis or breathing difficulty for an individual child but only when the parent and the child's health care provider have indicated such treatment is appropriate. In addition:

(6) When a program is approved to administer an inhaler to a child with asthma or other diagnosed respiratory condition, or an epinephrine auto injector for anaphylaxis, a school-aged child may carry and use these devices during day care hours if the program secures written permission of such use of a duly authorized health care provider, parental consent and completes a special health care plan for the child.

(7) The special health care plan, parental consent and health care provider consent documenting permission for a school-age child to carry an inhaler or auto injector must be maintained on file by the program.

(1) Caregivers and volunteers must thoroughly wash their hands with soap and running water at the beginning of each day, before and after the administration of medications, when they are dirty, after toileting or assisting children with toileting, after changing a diaper, before and after food handling or eating, after handling pets or other animals, after contact with any bodily secretion or fluid, and after coming in from outdoors.

(2) Caregivers and volunteers must ensure that children thoroughly wash their hands or assist children with thoroughly washing their hands with soap and running water when they are dirty, after toileting, before and after food handling or eating, after handling pets or other animals, after contact with any bodily secretion or fluid, and after coming in from outdoors.

(3) For diapered children, caregivers and volunteers must ensure that adequate steps are taken to clean the child after each change of diaper.

(4) Caregivers must assist children in keeping clean and comfortable, and in learning appropriate personal hygiene practices.

(5) Children in night care shall have a routine that encourages good personal hygiene practices.

(6) Each child shall have an individual washcloth, towel and toothbrush. When evening or night care is provided each child shall have the opportunity to change into night clothes and wash before bed. The caregiver will give each child a shower, bath, or sponge bath in a manner agreed between the parent and the program.

(7) When soap and running water is not available, hand sanitizer may be used by children and caregivers and volunteers on visibly clean hands. Package directions must be followed including supervision of children so that ingestion does not occur.

(8) Safety precautions relating to blood must be observed by all caregivers and volunteers as follows:

(9) Sufficient and suitable clothing must be available so that children who dirty or soil their clothing may be changed. All such clothing must be returned to parents for washing or must be washed by the caregiver.

(10) Children must be kept clean and comfortable at all times. Diapers must be changed when wet or soiled. The diaper changing area must be as close as possible to a sink with soap and hot and cold running water. This area or sink must not be used for food preparation. Diaper changing surfaces must be cleaned and disinfected after each use with an Environmental Protection Agency (EPA) registered product that has an EPA registration number on the label.

(11) The program must make arrangements with the parent to provide an adequate supply of disposable or cloth diapers. When cloth diapers are used they must be supplied by a parent or commercial diaper service.

(12) When disposable diapers are used, soiled diapers must be disposed of immediately into an outside trash disposal, or placed in a tightly covered plastic-lined trash can inaccessible to children until outdoor disposal is possible.

(13) Non-disposable diapers must not be laundered in the group family care home, and must be stored in a securely covered receptacle until returned to the diaper service. When parents provide non-disposable diapers, soiled diapers must be placed in a securely tied plastic bag and returned to the parent at the end of the day.

(14) Toilet facilities must be kept clean at all times, and must be supplied with toilet paper, soap and towels accessible to the children.

(15) Toileting equipment, such as potty chairs, appropriate to the toilet training level of the children in the group must be provided.

(16) When more than one child in the program is being toilet trained, potty chairs must be emptied, cleaned and then sanitized or disinfected after each use with an Environmental Protection Agency (EPA) registered product that has an EPA registration number on the label.

(17) If only one child in the program is being toilet trained, potty chairs must be emptied and rinsed after each use and cleaned and then sanitized daily with a sanitizer or disinfectant with an Environmental Protection Agency (EPA) registered product that has an EPA registration number on the label.

(18) Potty chairs must not be washed out in a hand washing sink, unless that sink is cleaned, then sanitized or disinfected after such use.

(19) Either disposable towels or individual cloth towels for each child must be used. If individual cloth towels are used, they must be laundered daily.

(20) Sharing personal hygiene items, such as washcloths, towels, toothbrushes, combs and hairbrushes, is prohibited.

(21) All rooms, equipment, surfaces, supplies and furnishings accessible to children must be cleaned and then sanitized or disinfected, using an EPA registered product, as needed to protect the health of children, and in a manner consistent with the program's health care plan approved by the office.

(22) The premises must be kept clean and free from dampness, odors and the accumulation of trash.

(23) The premises must be kept free of vermin.

(24) Equipment that is frequently used or touched by children on a daily basis must be cleaned and then sanitized or disinfected, using an EPA registered product, when soiled and at least once weekly.

(25) Carpets contaminated with body fluids must be spot cleaned.

(26) Extensive cleaning, such as shampooing carpets or washing windows and walls, must occur when children are not present.

(27) Garbage receptacles must be covered, and cleaned as needed after emptying.

(28) Thermometers and toys mouthed by children must be washed and disinfected using an EPA registered product before use by another child.

(29) Individual drinking cups or disposable cups must be provided daily. Once a drinking cup or eating utensils have been used by a child they may not be used by another child unless they are washed first.

(30) Between uses, dishes and utensils must be washed with soap and hot water and rinsed in hot running water.

(31) Linens, blankets and bedding must be cleaned at least weekly and before use by another child. Cribs, cots, beds, mats and mattresses must be cleaned thoroughly between uses by different children and at least monthly.

(32) Sanitizers and disinfectants must be used as directed on the product label.

(1) Any application of pesticides (as the term pesticide is defined in section 33-0101 of the Environmental Conservation Law) shall be completed in accordance with the requirements of section 390-c of the Social Services Law and sections 33-1004 and 33-1005 of the Environmental Conservation Law.

(2) In addition to the requirements of section 390-c of the Social Services Law, each day care facility must send a notice home with each child or otherwise provide notification to the parent of each child not less than forty-eight hours prior to the application of pesticides. Such notice must include:

(3) Any day care program that fails to send the appropriate notice of pesticide application as set forth in this section, for a first such violation, shall be issued a written warning in lieu of penalty. For a second violation, such program shall be subject to a penalty not to exceed $100. For any subsequent violation, such program shall be subject to a penalty not to exceed $250 for each violation. No penalty may be assessed by the commissioner without affording the licensee with notice and an opportunity for a hearing pursuant to section 413.5 of this Title.

(4) Any finding by the Department of Environmental Conservation of a violation by the program of the requirements set forth in sections 33-1004 or 33-1005 of the Environmental Conservation Law shall be deemed a safety hazard to children in care and a violation of this section.