10A NCAC 09 .1720. SAFETY, MEDICATION, AND SANITATION REQUIREMENTS

(a)  To assure the safety of children in care, the operator shall:

(1)           empty firearms of ammunition and keep both in separate, locked storage;

(2)           keep items used for starting fires, such as matches and lighters, out of the children's reach;

(3)           keep all medicines in locked storage;

(4)           keep hazardous cleaning supplies and other items that might be poisonous, e.g., toxic plants, out of reach or in locked storage when children are in care;

(5)           keep first aid supplies in a place accessible to the operator;

(6)           keep tobacco products out of reach or in locked storage when children are in care;

(7)           ensure the equipment and toys are in good repair and are developmentally appropriate for the children in care;

(8)           have a working telephone within the family child care home. Telephone numbers for the fire department, law enforcement office, emergency medical service, and poison control center shall be posted near the telephone;

(9)           have access to a means of transportation that is always available for emergency situations; and

(10)         be able to recognize common symptoms of illnesses.

(b)  The operator may provide care for a mildly ill child who has a Fahrenheit temperature of less than 100 degrees axillary or 101 degrees orally and who remains capable of participating in routine group activities; provided the child does not:

(1)           have the sudden onset of diarrhea characterized by an increased number of bowel movements compared to the child's normal pattern and with increased stool water; or

(2)           have two or more episodes of vomiting within a 12 hour period; or

(3)           have a red eye with white or yellow eye discharge until 24 hours after treatment; or

(4)           have scabies or lice; or

(5)           have known chicken pox or a rash suggestive of chicken pox; or

(6)           have tuberculosis, until a health professional states that the child is not infectious; or

(7)           have strep throat, until 24 hours after treatment has started; or

(8)           have pertussis, until five days after appropriate antibiotic treatment; or

(9)           have hepatitis A virus infection, until one week after onset of illness or jaundice; or

(10)         have impetigo, until 24 hours after treatment; or

(11)         have a physician's or other health professional's written order that the child be separated from other children.

(c)  The following provisions apply to the administration of medication in family child care homes: 

(1)           No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream or powder shall be administered to any child:

(A)          without written authorization from the child's parent;

(B)          without written instructions from the child's parent, physician or other health professional;

(C)          in any manner not authorized by the child's parent, physician or other health professional;

(D)          after its expiration date; or

(E)           for non-medical reasons, such as to induce sleep.

(2)           Prescribed medications:

(A)          shall be stored in the original containers in which they were dispensed with the pharmacy labels specifying:

(i)            the child's name;

(ii)           the name of the medication or the prescription number;

(iii)          the amount and frequency of dosage;

(iv)          the name of the prescribing physician or other health professional; and

(v)           the date the prescription was filled; or

(B)          if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying:

(i)            the child's name;

(ii)           the names of the medication;

(iii)          the amount and frequency of dosage;

(iv)          the signature of the prescribing physician or other health professional; and

(v)           the date the instructions were signed by the physician or other health professional; and

(C)          shall be administered only to the child for whom they were prescribed.

(3)           A parent's written authorization for the administration of a prescription medication described in Paragraph (c)(2) of this Rule shall be valid for the length of time the medication is prescribed to be taken.

(4)           Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying:

(A)          the child's name;

(B)          the names of the authorized over-the-counter medication;

(C)          the amount and frequency of the dosages;

(D)          the signature of the parent, physician or other health professional; and

(E)           the date the instructions were signed by the parent, physician or other health professional.

                The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Subparagraphs (c)(6), (7), (8), and (9) of this Rule.  Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Subparagraphs (c)(6), (7), (8), and (9) of this Rule.

(5)           When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer the medication without signed, written dosage instructions from a licensed physician or authorized health professional.

(6)           A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions and for allergic reactions.  The authorization shall be in writing and shall contain:

(A)          the child's name;

(B)          the subject medical conditions or allergic reactions;

(C)          the names of the authorized over-the-counter medications;

(D)          the criteria for the administration of the medication;

(E)           the amount and frequency of the dosages;

(F)           the manner in which the medication shall be administered;

(G)          the signature of the parent;

(H)          the date the authorization was signed by the parent; and

(I)            the length of time the authorization is valid, if less than six months.

(7)           A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, and powders --- such as sunscreen, diapering creams, baby lotion, and baby powder --- to a child, when needed.  The authorization shall be in writing and shall contain:

(A)          the child's name;

(B)          the names of the authorized ointments, repellents, lotions, creams, and powders;

(C)          the criteria for the administration of the ointments, repellents, lotions, creams, and powders;

(D)          the manner in which the ointments, repellents, lotions, creams, and powders shall be applied;

(E)           the signature of the parent;

(F)           the date the authorization was signed by the parent; and

(G)          the length of time the authorization is valid, if less than 12 months.

(8)           A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached.  The authorization shall be in writing and shall contain:

(A)          the child's name;

(B)          the signature of the parent;

(C)          the date the authorization was signed by the parent;

(D)          the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing.

(9)           A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee.  The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain:

(A)          the child's name;

(B)          the signature of the parent;

(C)          the date the authorization was signed by the parent; and

(D)          the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing.

(10)         Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider.

(11)         A parent may withdraw his or her written authorization for the administration of medications at any time in writing.

(12)         Any medication remaining after the course of treatment is completed or after authorization is withdrawn shall be returned to the child's parents.  Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded.

(13)         Any time prescription or over-the-counter medication is administered by a caregiver to children receiving care, including any time medication is administered in the event of an emergency medical condition without parental authorization as permitted by G.S. 110-102.1A, the child's name, the date, time, amount and type of medication given, and the name and signature of the person administering the medication shall be recorded.  This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information.  This information shall be available for review by a representative of the Division during the time period the medication is being administered and for at least six months after the medication is administered.  No documentation shall be required when items listed in Subparagraph (c)(7) of this Rule are applied to children.

(d)  To assure the health of children through proper sanitation, the operator shall:

(1)           collect and submit samples of water from each well used for the children's water supply for bacteriological analysis to the local health department or a laboratory certified to analyze drinking water for public water supplies by the North Carolina Division of Laboratory Services every two years. Results of the analysis shall be on file in the home;

(2)           have sanitary toilet, diaper changing and handwashing facilities. Diaper changing areas shall be separate from food preparation areas;

(3)           use sanitary diapering procedures. Diapers shall be changed whenever they become soiled or wet. The operator shall:

(A)          wash his or her hands before, as well as after, diapering each child;

(B)          ensure the child's hands are washed after diapering the child; and

(C)          place soiled diapers in a covered, leak proof container which is emptied and cleaned daily;

(4)           use sanitary procedures when preparing and serving food. The operator shall:

(A)          wash his or her hands before and after handling food and feeding the children; and

(B)          ensure the child's hands are washed before and after the child is fed;

(5)           wash his or her hands, and ensure the child's hands are washed, after toileting or handling bodily fluids.

(6)           refrigerate all perishable food and beverages. The refrigerator shall be in good repair and maintain a temperature of 45 degrees Fahrenheit or below. A refrigerator thermometer is required to monitor the temperature;

(7)           date and label all bottles for each individual child, except when there is only one bottle fed child in care;

(8)           have a house that is free of rodents;

(9)           screen all windows and doors used for ventilation;

(10)         have all household pets vaccinated with up-to-date vaccinations as required by North Carolina law and local ordinances. Rabies vaccinations are required for cats and dogs; and

(11)         store garbage in waterproof containers with tight fitting covers.

(e)  The operator shall not force children to use the toilet and the operator shall consider the developmental readiness of each individual child during toilet training.

(f)  The operator shall not use tobacco products at any time while children are in care.  Smoking or use of tobacco products shall not be permitted indoors while children are in care, or in a vehicle when children are transported.

 

History Note:        Authority G.S. 110-88; 110-91(6);

Eff. July 1, 1998;

Amended Eff. May 1, 2004; April 1, 2003; April 1, 2001.