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 418 - Day Care Centers
Subpart 418-1 - Child Day Care Centers
Section 418-1.11 - 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 staff 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 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) Staff and volunteers must each submit a medical statement on forms furnished by the office or an approved equivalent from a health care provider:

(2) A medical statement will be required when an event or condition reasonably calls into question a staff person or volunteer'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 staff and volunteers 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 staff and volunteers 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.

(7) After the initial medical statement, tuberculin tests are only required at the discretion of the staff person's or volunteer's health care provider or at the start of new employment.

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

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

(10) Consumption of or being under the influences of a controlled substance by any staff person or volunteer 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) The director and all teachers must have knowledge of and access to children's medical records and all emergency information.

(13) Staff 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) Staff 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 staff 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 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.

(6) The health care plan must provide the following: the designation of a health care consultant of record for programs offering care to infants and toddlers or moderately ill children. The health care plan must describe the scheduling of visits by a health care consultant to day care center programs offering care to infants and toddlers or moderately ill children. At least once every two years, the health care consultant of record must visit the center and review the program's health care policies and procedures.

(1) All staff except those excluded pursuant to paragraph (5) of this subdivision, subdivisions (f) and (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 staff 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 staff may not be recertified unless the staff 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 staff person from being involved in the administration of medications.

(2) Staff 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 staff must receive a written certificate from the trainer that indicates that the trainee has successfully completed this training, 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) Staff may administer medication only in accordance with the following:

(2) If the licensee elects not to administer medications, the staff 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 staff 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) Staff 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) Staff may not administer medications by injection, vaginally or rectally except as follows:

(6) Staff 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 staff must contact the parent immediately.

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

(8) Staff 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) Staff 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 program.

(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 staff observes some specified condition or change of condition in the child while the child is in care, the staff person 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.

(22) Day care centers participating in the New York State Fluoride Tablet Program must remain in compliance with administration procedures, parental permissions, storage, labeling, dosage and frequency established by the Department of Health in conjunction with the attending health care provider. A person certified to administer medications in a day care program will administer all fluoride tablets. The center may only dispense fluoride tablets while they hold a license that authorizes them to administer medications.

(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) Day care centers may not stock prescription medication except for centers that participate in the New York State Fluoride Tablet Program, sponsored by the New York State Department of Health, will be permitted to stock prescription fluoride tablets.

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

(2) The program 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 program 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 staff 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 program is responsible for immediately notifying the parent.

(5) When a program has not been authorized to administer medications in a day care setting in accordance with the requirements of subdivision (f) of this section, a designated staff person 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) Staff 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) Staff 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) Staff must assist children in keeping clean and comfortable, and in learning appropriate personal hygiene practices.

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

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

(6) 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.

(7) 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.

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

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

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

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

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

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

(14) 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.

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

(16) 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.

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

(18) Hygiene, diapering and toileting.

(19) 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 program.

(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 48 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 paragraph (2) of this subdivision, 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 section 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 subdivision.

(5) Day care centers are prohibited from using pesticides on playgrounds, turf, athletic or playing fields except when approved by the local health department, or for a county not having a health department, such authority as the county legislature shall designate, the Commissioner of Health or his or her designee, the Commissioner of Environmental Conservation or his or her designee, or, in the case of a public school, the school board. The following are not included in the definition of pesticide for this provision only: