Current through Vol. 42, No. 1, September 16, 2024
(a)
Programs for sick children.
Programs for sick children serve children with illnesses or symptoms that:
(1) prevent them from comfortable
participation in activities in a program caring for well children;
and
(2) require more care than
personnel in a program caring for well children can provide without
compromising the health and safety of other children in care.
(b)
Common
requirements. Programs are required to meet the common requirements in
Oklahoma Administrative Code (OAC)
340:110-3-275 through
340:110-3-305,
unless the addendum requirements in this Section state otherwise.
(c)
Definitions. The following
words and terms when used in this Part shall have the following meaning unless
the context clearly states otherwise:
(1)
"Health professional" means a registered nurse, pediatric nurse
practitioner, physician's assistant, or physician with at least one year of
pediatric or public health experience.
(2)
"Level I program" :
(A) means a component of a regular child care
center licensed to care for no more than eight sick children and serves only
mildly ill children; and
(B) does
not serve children with illnesses or symptoms that meet the criteria for
exclusion in a Level I program as defined in OAC 340 Appendix JJ, Exclusion
Criteria for Children Who Are Ill.
(3)
"Level II program" means a:
(A) program licensed to care for nine or more
sick children;
(B) program licensed
to provide child care only for sick children; or
(C) component of a regular child care center
and serves both mildly and moderately ill children.
(4)
"Mildly ill" means children
with mild symptoms of an episodic minor childhood illness who do not present a
risk of serious infection to other children. Mildly ill children show interest
and involvement in program activities and are able to participate.
(5)
"Moderately ill" means
children with symptoms of an episodic illness preventing them from being cared
for in a program serving only well or mildly ill children due to the risk for
contagion and the need for increased care. Moderately ill children display more
severe symptoms than mildly ill children.
(d)
Inclusion and exclusion
criteria. A program for sick children may serve any child who exhibits
symptoms or illnesses for which they are excluded from a program caring for
well children unless prohibited by the exclusion criteria specified in OAC 340
Appendix JJ - Exclusion Criteria For Children Who Are Ill.
(e)
Admission criteria. The
guidelines for admission in a center for sick children are described in (1) and
(2) of this subsection. A provider is not obligated to admit a child if the
provider does not have adequate information about the child's condition or
diagnosis to determine whether he or she can be safely included in the program.
(1) For Level I programs a written physical
assessment of the child is conducted by the director or designated caregiver to
determine the appropriateness of the child's attendance that day or the need
for a medical evaluation prior to admission. The assessment includes:
(A) any pertinent information from parents or
authorized adults relevant to the child's condition and symptoms; and
(B) an evaluation of the child's general
appearance, including physical appearance, demeanor, mood and activity
level.
(2) For Level II
programs a written medical evaluation that includes a diagnosis from a licensed
physician indicating a child is eligible for admission is required before a
child can be admitted to a Level II program.
(f)
Policy and procedure. The
program has written policies and procedures approved in writing by a licensed
physician or by a pediatric nurse practitioner.
(1) In addition to the program policy
requirements in OAC
340:110-3-278(d),
the program policy must also include:
(A) the
criteria for admission in the program;
(B) intake and admission
procedures;
(C) plans for the daily
care of children including methods used to monitor the condition of
children;
(D) plans for personnel
training and communication with parents and health care providers;
and
(E) procedures for injury
prevention and infection control.
(2) A health professional provides ongoing
consultation to the program in its overall operation and the management of
illness for individual children.
(g)
Personnel qualifications. In
addition to the general personnel requirements per OAC
340:110-3-284
personnel caring for sick children are required to have completed:
(1) at least one year of satisfactory
full-time experience in a child care setting; or
(2) a minimum of 20 documented clock-hours of
professional development in child development, early childhood education, or a
closely related subject.
(h)
Personnel training. The
professional development requirements for personnel caring for sick children
are contained in (1) through (4) of this subsection.
(1) Personnel caring for sick children have
cardio-pulmonary resuscitation (CPR) and first aid certification per OAC
340:110-3-284(d).
(2) Prior to working with sick children,
personnel must complete the Licensing approved training for the care of sick
children conducted by a health professional. The training includes:
(A) policy and procedures relating to the
care of sick children;
(B)
recognizing signs and symptoms of illness;
(C) administration of medication;
(D) when and how to call for medical
help;
(E) taking children's
temperatures;
(F) infection control
procedures including hand washing, handling contaminated items, use of
disinfectants, and food handling;
(G) communicating with parents concerning a
child's illness; and
(H) any other
care that may be required for admissible illnesses and conditions.
(3) Personnel caring for sick
children must obtain two hours of professional development annually related to
the care of sick children and the prevention and control of communicable
disease.
(4) All professional
development required for personnel who care for sick children counts toward the
annual training required for all personnel listed per OAC
340:110-3-284(d).
(i)
Indoors. In
addition programs meet the requirements listed in (1) through (7) of this
subsection.
(1) Toilets are in a restroom
that is adjacent to or opens directly into each room used to care for sick
children.
(2) Sinks for hand
washing are located in each room used for the care of sick children, or in a
restroom that opens directly into the room.
(3) The use of potty chairs is
prohibited.
(4) Rest equipment is
available and accessible for use by children throughout the day and is placed
three feet apart when in use.
(5)
Mats may not be used as rest equipment.
(6) The use of carpet is prohibited; however,
rugs may be used when they are washed daily.
(7) In Level I programs:
(A) rooms used for the care of sick children
are separated from other components of the program by floor to ceiling walls;
and
(B) rooms, fixtures, furniture,
equipment, and supplies used by sick children are not used by personnel or
children from any other component of the program when sick children are in
care.
(j)
Outdoor play areas. Programs are exempt from the outdoor play area
requirements per OAC
340:110-3-301(c).
However, when outdoor play areas are provided:
(1) all outdoor play area requirements are
met; and
(2) when the same area is
shared by well and sick children it is used at separate times.
(k)
Health. In
addition to the health requirements per OAC
340:110-3-294,
programs:
(1) require personnel to monitor
and record the condition of each child throughout the day. The monitoring
includes:
(A) temperature taking;
(B) amount of fluid and food
intake;
(C) output including urine,
vomit, and stools, as appropriate;
(D) medication administered; and
(E) sleeping patterns and general
behavior;
(2) notify
parents immediately of any significant change in a child's condition;
and
(3) take additional precautions
to prevent the spread of disease, including:
(A) cleaning and disinfecting floors, basic
and play equipment and furniture daily or more often when necessary, or before
use by another group of children;
(B) providing liquid soap from mounted
dispensers for hand washing;
(C)
using paper towels from a dispenser with waste containers provided for
disposal;
(D) providing play
equipment that is non-porous and easily washable; and
(E) prohibiting personnel and children who
begin the day in the area serving sick children to transfer to any other part
of the facility during that day.
(l)
Food and nutrition. In
addition to the nutrition and food service requirements per OAC
340:110-3-298 and
340:110-3-299,
programs:
(1) modify menus to meet the
individual physical condition of each child in care;
(2) prohibit personnel involved with food
preparation or service from changing diapers or assisting children with
toileting;
(3) use only single-use
and disposable eating and drinking utensils. Infant bottles and spill-proof
cups may be used when they are sent home daily;
(4) prohibit the use of drinking fountains;
and
(5) require personnel to
frequently offer drinking water and other fluids to each child.
(m)
Additional requirements
for Level II programs. In addition to the requirements in this Section,
Level II programs meet the requirements listed in (1) through (7) of this
subsection.
(1) A physical assessment of each
child is conducted by a health professional as the child is admitted to the
program.
(2) A health professional
or licensed practical nurse (LPN) with immediate, direct access to a health
professional remains on-site at all times when sick children are in
care.
(3) The LPN may not make the
determination whether to admit a child into the program. The LPN may provide
care and collect clinical information, and must report to the health
professional.
(4) Children are
cared for in separate rooms unless grouped with other children diagnosed with
the same illness.
(5) Separate
outside ventilation is required when care is provided for children diagnosed
with:
(A) measles;
(B) diphtheria, until five days of the
appropriate antibiotic therapy, that is to be given a total of 14
days;
(C) rubella;
(D) tuberculosis; or
(E) chicken pox.
(6) In a Level II program that is a component
of a program caring for well children:
(A)
rooms are separated from other components of the facility by floor to ceiling
walls; and
(B) rooms, furniture,
equipment, and supplies used by sick children are not used by children or
personnel from other components of the facility.
(7) A separate entrance is required for sick
children.
