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(a) Medication policy required. Each permittee shall establish a policy as to whether the permittee will or will not administer medication, and incorporate such policy in the program's health care plan component of the written safety plan required by 24 RCNY Health Code § 47.11. Notwithstanding any program's general policy not to administer medication, such policy shall indicate that the program may be required to administer medication to a child with a disability, pursuant to the Americans with Disabilities Act.
(b) Exempt staff. A program that employs staff who are also currently State licensed physicians, physician assistants, registered nurses, nurse practitioners, licensed practical nurses, or emergency medical technicians may administer medications without such staff obtaining additional qualifications or certification.
(c) Health care consultant and duties. All permittees that choose to administer medications to children shall designate a health care consultant of record, who shall be a health care provider as defined in this Article. The permittee shall confer with the health care consultant and shall obtain approval of the consultant for the portion of the health care plan regarding policies and procedures related to the administration of medications. The consultant shall review documentation of all staff authorized to administer medications and determine if staff have required professional licenses or certificates of completion of required training. A health care plan shall be valid for two years and shall be updated when designated staff has changed. The health care consultant shall visit the program at least once every two years and shall review the permittee's health care policies, procedures, documentation, practice and compliance with its health care plan for administering medications. If the consultant determines that the approved health care plan is not being reasonably followed by the permittee, the consultant may revoke his or her approval of the plan. If the consultant revokes his or her approval of the health care plan, the health care consultant shall immediately provide written notification to the permittee and the Department, upon which notification the program shall immediate cease administering medication, and immediately notify all parents and guardians of children in the program of such cessation, until such time as a new health care plan is approved. All relevant documentation shall be kept on site and made available to the Department upon request.
(d) Staff members certified to administer medications. Only a trained, designated staff person may administer medications to children, except where the only administration of medications will be over-the-counter ("OTC") topical ointments, including sunscreen lotion and topically applied insect repellant; and of asthma inhalers, nebulizers, and epinephrine auto-injectors to children whose parent or guardian has provided written consent, medical authorization, and training. The staff person administering medications to children shall be at least 18 years of age, possess current certifications in first aid, CPR, and medication administration training (MAT) in a course approved or administered by the Department or the State Office of Children and Family Services. MAT certificates shall be made available for inspection by the Department on request. MAT certifications shall be effective for a period of three years from the date of issuance. Recertification training shall extend certification for additional three-year periods. If a designated staff person ceases to work in a program for a continuous period of one year, certification shall automatically lapse. Where certification lapses, the person may be recertified after repeating initial MAT or recertification training, as required by the Department. Where a permittee has failed to comply with requirements for the administration of medications set forth in this section, the Department may require retraining or may prohibit the permittee from administering medications.
(e) Medication administration procedures. Except as provided in 24 RCNY Health Code § 47.29(c), permittees and designated staff may administer prescription and OTC medications for eyes or ears, oral medications, topical ointments and medications, and inhaled medications in accordance with the provisions of this section.
(1) A copy of the permittee's written policies regarding the administration of medications shall be reviewed, explained, and provided to parents at the time of enrollment.
(2) The permittee shall obtain from a child's parent and health care provider a statement in writing that indicates medicine to be administered and schedule of administration.
(3) A parent, or other adult authorized in writing by the parent, may administer medications to a child while the child is attending a program at any time.
(4) The permittee shall maintain a medication administration log, to be kept on site and made available to the Department upon request, to document the name of the child to whom medication was administered, the date and time of administration, the type and quantity of medication administered, and name of the staff member, parent, or other parentally authorized adult who administered the medication.
(5) Permittees and designated staff may not administer medications by injection, vaginally or rectally, except as follows:
(A) For a child with special health care needs where the parent, program and the child's health care provider have agreed on a plan, pursuant to which the permittee or designated staff may administer medications by injection, vaginally or rectally; or
(B) Where the permittee or designated staff hold a valid New York State license as a physician, physician's assistant, registered nurse, nurse practitioner, licensed practical nurse, or advanced emergency medical technician.
(6) Nothing in this section shall be deemed to require any permittee to administer any medication, treatment, or other remedy except to the extent that such medication, treatment or remedy is required under the provisions of the Americans with Disabilities Act.
(7) Permittees who agree to administer medications shall do so, unless they observe circumstances specified by a child's health care provider, if any, under which medication shall not be administered. In such instances, the permittee shall contact the parent immediately.
(8) Medication may only be administered with written consent of the parent in accordance with written instructions from the child's health care provider including, but not limited to circumstances, if any, under which the medication or prescription shall not be administered. Medication shall be returned to the parent when no longer required by the child.
(9) When the permittee has written parental consent and written instructions from a health care provider authorizing administration of a specified medication if the permittee observes a specific condition or change of condition in the child while the child is in the program, the permittee may administer the medication without obtaining additional authorization from the child's parent or health care provider.
(10) To the extent that such information is not included on the medication label, written instructions by the health care provider shall include:
(A) child's name;
(B) health care provider's name, telephone number, and signature;
(C) date authorized;
(D) name of medication and dosage;
(E) frequency the medication is to be administered;
(F) method of administration;
(G) date the medication shall be discontinued or length of time, in days, the medication is to be given;
(H) reason for medication (unless this information shall remain confidential, pursuant to law);
(I) most common side effects or reactions; and
(J) special instructions or considerations, including but not limited to possible interactions with other medications the child is receiving or concerns regarding the use of the medication as it relates to a child's age, allergies, or any pre-existing conditions.
(11) Medications shall be kept in the original labeled bottle or container. Over-the-counter medication shall be kept in the originally labeled container and shall be labeled with the child's first and last name. Prescription medications shall contain the original pharmacy label.
(12) If medication is to be given on an ongoing, long-term basis, the parent's consent and health care provider's written instructions shall be renewed in writing at least once every six months. Any changes in the original medication shall require a permittee to obtain new written instructions from the health care provider.
(13) A permittee may administer over-the-counter topical ointments, including sunscreen lotion and topically applied insect repellant, upon the written instructions of the parent. Such administration shall be consistent with any directions for use noted on the original container, including but not limited to precautions related to age and special health conditions, and no additional certifications to administer medications are required by the permittee or designated staff. If the only administration of medication offered by the program will be the administration of over-the-counter topical ointment, including sunscreen lotion and topically applied insect repellant, a designated health care consultant is not required. The permittee or designated staff shall record in the medication log applications of such topically applied ointments, sunscreen lotions and topically applied insect repellants, with the name of the child, date and time administered, and staff signature.
(14) For all children for whom the permittee administers over-the-counter medications, pursuant to this paragraph, copies of parental written consent and instructions shall be maintained in the child's medical record file.
(15) Medications shall be kept in a clean area that is inaccessible to children. If refrigeration is required, medications shall 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. Permittees shall comply with all applicable law for secure storage of all medications.
(16) Staff shall document dosages and times that medications are given, observable side effects, reasons for not giving medication and medication administration errors, and shall report to the parent and to the child's health care provider, in accordance with the provider's written instructions; medication errors shall be immediately reported to the Department.
(17) No children shall independently self-administer medications or assist in the administration of their own medications except under direct supervision of designated staff.
(18) Nothing in this section shall prevent a parent, guardian or other legally authorized individual in relation to a child from administering medication to a child while such child is in a program. In these circumstances, the permittee shall document the dosages and time that the medications were administered to the child by such individual. If the only administration of medication in such program is done by such individual, no certifications to administer medication are required by the permittee or staff.
(f) [Repealed.]
(Amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018)
(a) Staff to be excluded. The permittee shall exclude any staff person from work in accordance with 24 RCNY Health Code Article 11, if such staff person reports having an illness or symptoms of a communicable disease reportable, pursuant to 24 RCNY Health Code Article 11. Such staff person shall not be permitted to return to the program without a written statement of recovery from a health care provider if the staff person was a case of measles, mumps, rubella, pertussis (whooping cough), scarlet fever, meningitis (all types), or poliomyelitis, or if the staff person was a case of any other communicable disease reportable, pursuant to 24 RCNY Health Code Article 11.
(b) Physical examination certificates. No member of the teaching staff or shelter child supervision staff, or substitute, volunteer worker, office worker, kitchen worker, maintenance worker, or other staff member who regularly associates with children shall be permitted to work in a program unless such person is healthy and capable of carrying out the responsibilities of the job. Prior to commencing work, all such individuals shall present a certificate from a licensed health care provider certifying that, on the basis of medical history and physical examination, such individual is physically and mentally able to perform assigned duties. Such certificate shall be submitted every two years thereafter as a condition of employment. Certificates of required physical examinations and other medical or personal health information about staff shall be kept on file on paper or electronically, on the premises of the program, and shall be kept confidential and separate from all other personnel or employment records and made available for review by the Department upon request.
(c) Staff and volunteer immunizations.
(1) Each staff and volunteer must obtain a report from a health care provider who is a licensed physician, nurse practitioner, physician's assistant, or doctor of osteopathy certifying that such person has been immunized with 2 doses of measles-containing vaccine; 2 doses of mumps-containing vaccine; 1 dose of rubella-containing vaccine; 2 doses of varicella-containing vaccine (chicken pox); 1 dose of tetanus, diphtheria and acellular pertussis (Tdap). Persons born on or before December 31, 1956 are not required to have measles, mumps or rubella vaccines. A history of having health care provider documented varicella or herpes zoster disease is acceptable in place of varicella vaccine. A history of having measles, mumps or rubella disease shall not be substituted for the measles, mumps or rubella vaccine. A laboratory test demonstrating detectable varicella, measles, mumps, or rubella antibodies is also acceptable in place of varicella, measles, mumps and rubella vaccine. A staff or volunteer may be exempted from this immunization requirement for medical contraindications in accordance with ACIP or other nationally recognized evidence-based guidelines upon submission of appropriate documentation from a treating licensed physician. Each staff and volunteer must submit such report of immunization to the permittee.
(2) Reports of immunizations shall be confidential and must be kept by the permittee in a paper or electronic file with other staff and volunteer health information, except that such reports must be made available to the Department immediately upon request. Documentation of exemption from immunization must also be kept on site and made available to the Department immediately upon request. If such records are maintained electronically, Department staff must be allowed to access such records while on-site.
(3) No permittee or person in charge of a childcare program shall permit any staff or volunteer to attend such program without appropriate documentation of the immunizations required pursuant to paragraph (1) of this subdivision.
(d) Test for tuberculosis infection. The Department may require testing for tuberculosis at any time of any persons in a program when such testing is deemed necessary for epidemiological investigation.
(Amended City Record 9/20/2016, eff. 10/20/2016; amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018; amended City Record 12/26/2019, eff. 1/25/2020)
(a) Hand washing. Staff and children shall wash hands before and after toileting or diaper changes, after contact with a child in ill health, and prior to handling or preparing any food and after playing outdoors.
(b) Signs. Hand washing signs provided by or approved by the Department shall be prominently posted in each lavatory and by each sink.
(c) Individual personal care. Hair brushes or cloth towels shall not be provided for use. If toothbrushes, combs, or washcloths are provided, each child shall have items for his/her exclusive use and they shall be stored in an individually labeled container.
(d) Changes of clothing. At least one change of weather-appropriate clothing shall be available so that any child who soils clothing may receive a change. Soiled clothing and cloth diapers shall be handled in a manner that protects occupants from exposure to wastes and maintains an appropriately sanitary environment.
(e) Bathing. Children shall not be regularly bathed on premises; but shall be washed in case of accidents.
(f) Self-care/hygiene routines for night care programs. Permittees shall establish procedures and policies that require children to brush teeth at bedtime and after meals; comb hair upon awakening, and follow a routine for toileting, dressing and undressing.
(g) Safety precautions relating to blood. Permittees shall implement the following safety precautions for all staff having any exposure to, or contact with blood:
(1) Disposable gloves shall be immediately available and worn whenever there is a possibility for contact with blood, including but not limited to:
(A) Changing diapers where there is blood in the stool;
(B) Touching blood or blood-contaminated body fluids;
(C) Treating cuts that bleed; and
(D) Wiping surfaces stained with blood.
(2) In an emergency, a child's safety and well-being shall take priority. A bleeding child shall not be denied care because gloves are not immediately available.
(3) Disposable gloves shall be discarded after each use.
(4) If blood is touched accidentally, exposed skin shall be thoroughly washed with soap and running water.
(5) Clothes contaminated with blood shall be placed in a securely tied plastic bag and returned to the parent at the end of the day.
(6) Surfaces that have been blood stained shall be cleaned and disinfected with a germicidal solution.
(h) Smoking prohibited. There shall be no smoking of tobacco or other substances, or use of e-cigarettes, in any indoor or outdoor area of any premises on which a program is located.
(Amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018)
(a) Education director/shelter child supervision liaison responsibility. The education director of a child care program and the shelter child supervision liaison of a family shelter-based drop-off child supervision program shall arrange for and verify all required training of all teaching staff and shelter child supervision staff. The education director or the shelter child supervision liaison may be certified to conduct such training or may designate other teaching staff or shelter child supervision staff to obtain such certification and conduct such training. The education director or shelter child supervision liaison shall maintain copies of certificates verifying completion of all required training; shall document written safety plan training, including dates and times that emergency response drills were conducted, evaluation of staff performance, and recommendations for improvements in training or amendments to the safety plan. All documents relevant to compliance with this section shall be kept on site and made available to the Department upon request.
(b) Employees.
(1) Child abuse, maltreatment and neglect. All staff must receive at least 2 hours of training every 24 months in preventing, identifying, and reporting child abuse, maltreatment and neglect, and requirements of applicable statutes and regulations. Such training must be provided by a New York State Office of Children and Family Services-certified trainer. New teaching and shelter child supervision staff must receive such training within 3 months of hire or of the effective date of this rule, whichever is later. Training completed while employed at a different program holding a permit under this Article shall count for purposes of compliance with this subsection. Certificates of completion of all training required pursuant to this subsection must be kept on site and made available to the Department upon request.
(2) Infection control, administration of medication, protection from hazards, and additional safety topics. Within three months of hire or of the effective date of this rule, whichever is later, all teaching staff and shelter child supervision staff shall receive training in infection control, reporting infectious diseases; administration of medication; protection from hazards; handling and storage of hazardous materials; appropriate disposal of biocontaminants; building and physical premises safety; including protection from hazards, bodies of water, and vehicular traffic; and, if applicable, safe transportation of children. Training completed while employed at a different program holding a permit under this Article shall count for purposes of compliance with this subsection. Certificates of completion of all training required pursuant to this subsection shall be kept on site and made available to the Department upon request.
(3) Emergency procedures.
(A) Except as provided in 24 RCNY Health Code § 47.37(b)(3)(A)(ii)(aa), all new teaching staff and shelter child supervision staff shall receive, within three months of hire or of the effective date of this rule, whichever is later, and, all staff, volunteers, and other individuals regularly providing services shall receive on an annual basis, training in the emergency procedures contained in the approved written safety plan, including:
(i) In-depth review of the provisions of the plan;
(ii) Announced and unannounced real-time drills demonstrating competency of all staff members in:
(aa) Emergency medical response, including:
(1) Pediatric CPR and pediatric first aid training approved by the Department. Such training is required only for staff and must be completed before staff begin providing services or within three months of the effective date of this rule, whichever is later, and every two years thereafter. Upon application for a new permit or for renewal of an existing permit, for those staff whose presence will be used for compliance with 24 RCNY Health Code § 47.23, such training must include successful completion of hands-on skill tests and certification; and
(2) Administration of epinephrine auto-injector. Such training is required only for those staff selected by the permittee for compliance with 24 RCNY Health Code § 47.29(c); and
(bb) Emergency preparedness and response planning for emergencies resulting from natural disasters or a human-caused events, including procedures for evacuation other than the monthly fire drills required by 24 RCNY Health Code § 47.59(d), relocation, shelter-in-place and lockdown, staff and volunteer emergency preparedness training and practice drills, communication and reunification with families, continuity of operations, and accommodation of infants, toddlers, and children with disabilities or chronic medical conditions. This training shall include response to critical incidents such as:
(1) Loss of a child;
(2) Situation requiring lockdown;
(3) Gas, sewer, or water main break; and
(4) Extreme weather event; and
(B) Training completed while employed at a different program holding a permit under this Article shall count for purposes of compliance with this subsection. Certificates of completion of all training required by this subsection shall be kept on site and made available to the Department upon request.
(4) SIDS, safe sleep practices, and abusive head trauma ("shaken baby syndrome"). All child care program staff and shelter child supervision staff shall complete sudden infant death syndrome ("SIDS"), safe sleep practices, and "shaken baby syndrome" identification and prevention training before beginning to provide services or within three months of the effective date of this rule, whichever is later. Certificates of completion of such training shall be kept on site and made available to the Department upon request.
(5) Allergic reactions. All teaching staff and child supervision staff shall receive training in prevention and control of allergic reactions.
(6) Additional topics.
(A) All teaching staff and shelter-based child supervision staff shall receive training every 24 months on the following topics:
(i) Cognitive social, emotional, and physical development;
(ii) Family engagement; and
(iii) Mental health first aid for children.
(B) All teaching staff shall complete at least 15 hours of training every 24 months, at least five hours of which shall be completed in each 12-month period, including the mandatory child abuse prevention and identification training in paragraph (1), and other subjects related to child health and safety, and early childhood development. The educational director shall develop a training curriculum based on assessment of the professional development needs of individual assistant teachers. The curriculum shall include, but not be limited to, the following topics:
(i) Preventing, recognizing signs of, and reporting injuries, infectious diseases, lead poisoning, asthma, and other illnesses and medical conditions;
(ii) Providing first aid and CPR;
(iii) Scheduling and conducting guided and structured physical activity;
(iv) Setting up and maintaining staff and child health records including records of immunizations;
(v) Growth and child development; including:
(aa) Early intervention;
(bb) Early childhood education curriculum development and appropriate activity planning;
(cc) Appropriate supervision of children;
(dd) Meeting the needs of children with physical or emotional challenges;
(ee) Behavior management;
(ff) Meeting nutritional needs of young children;
(gg) Parent, staff, and volunteer, communication and orientation regarding roles and responsibilities;
(hh) The selection of appropriate equipment and classroom arrangement; and
(ii) Safety and security procedures for fire safety, emergency evacuation, playgrounds, trips, and transportation.
(C) Certificates of completion of such training shall be kept on site and made available to the Department upon request.
(c) The Department may provide the training required by this section, or any part thereof, or accept training provided by others found satisfactory to the Department. All trainers' qualifications must be submitted for review to an agency designated by the Department. Persons who enroll in workshops conducted by the Department may be charged a reasonable fee to defray all or part of the costs incurred by the Department for workshop registration materials, training, testing, and certificate issuance.
(d) The Department may promulgate rules to specify how permittees shall comply with this section.
(Amended City Record 9/20/2016, eff. 10/20/2016; amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018; amended City Record 12/26/2019, eff. 1/25/2020)
(a) Space for children's exclusive use. Rooms, areas and other spaces utilized by children in a program, including bathrooms, shall be reserved for their exclusive use and shall not be shared with other children or adults while the program is in operation.
(b) Minimum square footage/child. The minimum allowance of space for each child in a room/area separated from other rooms/areas by a physical barrier shall be 30 square feet of wall to wall space.
(Amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018)
(a) Egress. All buildings in which child care or supervision is provided by programs that received their first permit after January 1, 1989, shall have two unobstructed means of egress, separated by at least half the diagonal dimension of the occupied space of the building or as otherwise specified by applicable building code. Fire escapes shall not be counted as means of egress.
(b) No child care or child supervision provided above third floor. No programs receiving a first permit after January 1, 1989, shall allow children to utilize any rooms, areas or other spaces above the third floor of a building, except that the Department may allow programs to occupy spaces above the third floor where DOB and FDNY or other appropriate government entities have approved such use and the Department has approved the applicant or permittee's evacuation plan.
(c) Infant/toddler child care or supervision limited to first floor. No infant/toddler child care program, or family shelter-based drop-off child supervision program that supervises infants or toddlers, receiving a first permit on or after September 1, 2008, shall provide services in any room, area or other space above the first floor or below the ground level floor of a building, except that the Department may allow such programs to occupy spaces above the first floor or one level below the ground level floor of a building, where DOB and FDNY or other appropriate government entities have approved such use and the Department has approved the applicant or permittee's evacuation plan.
(d) Basements. A program receiving a first permit on or after September 1, 2008, shall not allow children to utilize any rooms, areas or other spaces lower than one level below the ground level floor of a building.
(e) Window guards. Windows guards shall be installed in accordance with specifications provided or approved by the Department on all windows in all rooms, hallways, and stairwells, except windows giving access to fire escapes.
(f) Passageways free of obstruction. All corridors, doorways, stairs, and exits shall be kept unobstructed at all times.
(g) Protective barriers in stairways. Protective barriers shall be provided in all stairways used by children. Stairways shall be equipped with low banisters or handrails for use of children. Protective barriers providing visual access shall be installed in lofts used by children.
(h) Shielding required. Columns, radiators, pipes, poles, and any other free-standing or attached structures in classrooms and play areas shall have protective guards.
(i) Door locks. No door to a bathroom, closet or other enclosed space shall be equipped with a lock that allows the door to be locked from inside the space, except that such devices may be used to secure privacy if they can be overridden from the outside in an emergency, and may otherwise be used as required for compliance with applicable law or regulations regarding lockdown procedures.
(j) Finishes and maintenance. Walls, ceilings and floors shall be finished with non-toxic finishes, constructed of materials enabling thorough cleaning, and maintained in good repair, with no holes, missing tiles, peeling plaster, or other defects.
(k) Securing entrances and exits.
(1) Monitoring. All interior entrances and exits of the facility must be monitored and kept secure by individual staff, contractors, and/or electronic or other surveillance providing unobstructed views of entrances and exits at all times during operation of the program. Panic bars must be installed on all exterior doors of the facility. When used in this paragraph a "panic bar" means a door latching assembly incorporating a device that releases the latch upon the application of a force in the direction of egress travel.
(2) Entry access. All entrances providing access to the facility must be secured with pass key identification or other means that effectively limit access to staff, parents and other authorized persons.
(Amended City Record 9/20/2017, eff. 10/10/2017; amended City Record 6/12/2018, eff. 7/12/2018)
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