Bureau of Child Care Facilities

Mississippi Administrative Code

Section: 15-11

Jurisdiction: MS

Bluebook Citation: 15 Miss. Admin. Code Pt. 11

Title 15: Mississippi State Department of Health Part 11: Bureau of Child Care Facilities Subpart 55: Child Care Facilities Licensure CHAPTER 1: REGULATIONS GOVERNING LICENSURE OF CHILD CARE FACILITIES Subchapter 1:

GENERAL

Rule 1.1.1 Legal Authority The "Mississippi Child Care Licensing Law," Section 43- 20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child care facilities defined under the law. Source: Miss. Code Ann. §43-20-8. Rule 1.1.2

Purpose

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of child care facilities as defined herein to assure that certain minimum standards are maintained in such facilities. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing. This document and its appendices constitute the "Regulations Governing the Licensure of Child Care Facilities."

A child care facility may exceed the minimum quality standards required in these regulations, but may not operate without meeting the minimum standards set forth in these regulations.

The maximum capacity of a child care facility is determined by the indoor square footage, kitchen square footage, outdoor playground area, and the number of toilets, urinals, and hand washing lavatories, with the lowest capacity determination controlling. The maximum capacity of each room that is utilized by the children in a child care facility is calculated individually and may not be exceeded except when provided in these regulations.

A child care facility is subject to inspection at anytime at the discretion of the licensing agency. The Mississippi State Department of Health shall maintain a complaint hotline to accommodate reporting of complaints. The department shall investigate each complaint and maintain a log of such complaints. The identity of the reporting party shall not be disclosed to any other person than the Child Care Licensing Bureau staff unless upon order of a court of competent jurisdiction.

Source: Miss. Code Ann. §43-20-8. Rule 1.1.3 Severability If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable. Source: Miss. Code Ann. §43-20-8. Rule 1.1.4

Definitions

Act The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972.

Agency Representative An authorized representative of the Mississippi State Department of Health.

Caregiver A person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation.

Child Care Facility (Facility) A place which provides shelter and personal care for six or more children who are not related within the third degree computed according to the civil law to the operator and who are under 13 years of age, for any part of the twenty-four hour day, whether such place be organized or operated for profit or not. The term “child care facility” includes day nurseries, day care centers, child care centers, preschool programs, and any other facility that fall within the scope of the definition set forth above. EXEMPTIONS To the extent provided by law, including those facilities or programs which satisfy one or more of the requirements for exemption provided in Miss. Code Ann. § 43- 20-5(a), an exemption from the provisions of the Act shall be recognized by the licensing agency. Facilities or programs claiming exemption shall be required, upon the written request of the licensing agency, to provide documentation of the facts claimed to support the basis for the exemption, which documentation shall be provided within 30 days of the request by the licensing agency and shall be sworn by affidavit to be true and accurate under the penalties of perjury.

5. 6.

However, any entity exempt from the requirements to be licensed but voluntarily chooses to obtain a license is subject to all provisions of the licensing law and these regulations. Children with Special Needs A child needing adaptation in a particular child care facility to access programming and the physical environment Director Any individual, designated by the operator, who has met minimum state requirements and who has on-site responsibility for the operation of a child care facility. This person may or may not be the operator.

Director Designee Any individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. A director designee shall, at a minimum, be at least 21 years of age, have a high school diploma or GED, and 2 years paid experience in a licensed child care facility. Director Designees shall not retain sole director authority in a facility for more than 24 total hours per calendar week. EXCEPTION: A facility may have a Director Designee serve for a maximum of 14 consecutive calendar days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc.

Group The children assigned to a caregiver or team of caregivers, occupying an individual classroom, or well-defined physical space within a larger room.

Hazardous Condition A situation or place that presents a possible source of injury or danger.

10.

Health The condition of being sound in mind and body and encompassing an individual's physical, mental and emotional welfare.

11.

Infant

12.

Licensing Agency

Any child under the age of 12 months. The Mississippi State Department of Health.

13. Operator Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a child care facility. The child care facility license shall be issued in the name of the operator, or if there is more than one operator, in the name of one of the operators. In the event that there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all operators of a facility, including, but not limited to, a spouse who jointly owns, operates, or maintains the child care facility regardless of which operator is named on the license. 14.

Parent As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to which a court of competent jurisdiction has granted legal authority over the child.

15.

Person Any person, firm, partnership, corporation or association.

16. Personal Care Assistance rendered by personnel of the child care facility in performing one or more of the activities of daily living, which includes but is not limited to the feeding, personal grooming, supervising, and dressing of children placed in the child care facility. 17.

Physical Confines

18.

Safety

The space inside the walls of the child care facility.

The condition of being protected from hurt, harm, injury or loss.

19.

School Age Child A child of 5 years of age or older and eligible to be enrolled in public school. Note: A child that is five (5) years old age must have turned five (5) on or before September 1 to be considered a school age child.

20.

Service Staff A person who provides support services such as cooking, cleaning, or driving a vehicle, but is not a caregiver.

21.

Toddler Any child the age of 12 months and under the age of 24 months.

22.

Usable Space In measuring facilities for square footage per child, usable space shall mean space measured on the inside, wall-to-wall dimensions. These spaces are exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff rooms, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. Usable space shall be areas dedicated to children’s activities (play, learning, rest, and eating) and shall be utilized for those purposes on a daily basis. Furnishings shall be equipment that is both size and age appropriate for children receiving care. The space occupied by inappropriate or adult size equipment shall be deducted from the children’s usable space.

23.

Volunteer Any person who is not an employee who is at the facility or assists with children. Individuals who volunteer for 120 or more hours in a given licensure year shall meet the requirements of (1) criminal record and child abuse central registry checks to include being fingerprinted, and (2) valid Immunization Compliance Form #121. The facility shall document the time that a volunteer is at the facility. Further, any individual who has not been fingerprinted and received the Letter of Suitability for Employment shall never be left alone with children.

24.

Emergency Preparedness Plan: Each child care center is required to have an emergency preparedness plan – all activities and processes designed to prepare for an unsafe event and deal with the immediate emergency conditions created by or associated with the event, per the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42U.S.C. 5195a(a)(1 .

Source: Miss. Code Ann. §43-20-8. Subchapter 2:

LICENSURE

Rule 1.2.1

Requirement for Licensure

No person shall establish, own, operate, conduct, or maintain a child care

facility in this state without a license issued pursuant to these regulations. 2.

The licensing authority will require no entity exempt from the licensure requirement to apply for a license. However, should an exempt entity desire to obtain a license, it will be subject to these regulations.

Source: Miss. Code Ann. §43-20-8. Rule 1.2.2 1.

Types of Licenses Temporary License The licensing agency may issue a temporary license to any child care facility. This license will allow the child care facility to operate pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the facility is licensed. The license issue date is the actual date documentation is received and approval for initial temporary license is granted; the expiration date is the last day of the sixth month following the issue date; examples: January 01 through June 30 or January 15 through June 30. NOTE: Before a Temporary License is issued and the facility allowed to begin operation the following items must be submitted to and/or verified by the licensing authority, i.e., Mississippi State Department of Health: a.

License Application and $130.00 application fee.

License fee - the amount of fee is determined by the licensed capacity of the facility.

Documentation that the facility has a qualified director for the child care program that meets the standards set forth in Rule 1.5.3.

“Letter of Suitability for Employment” for every employee or volunteer as appropriate that is to begin work when the facility starts operation. The “Letter of Suitability for Employment” issued by the Mississippi State Department of Health verifies that a criminal records check, sex offender registry, and child abuse central registry check has been conducted on an individual.

An MSDH Certification of Immunization Form #121 or Medical Exemption Form #122 for every employee or volunteer that is to begin work when the facility starts operation and/or have documentation indicating that they comply with the immunization requirements of the Mississippi State Department of Health. Religious Exemption Form #122 does not apply to staff or volunteers

f. g.

Valid MSDH Fire Inspection Form #333. Verification of passing an American National Standards Institute – Conference for Food Protection (ANSI-CFP) Accredited food manager training. Currently the following providers are authorized by the MSDH to provide the required training: 5

National Restaurant Association, Inc., i.e., ServSafe®,

ii.

Environmental Health Testing, Inc., i.e., National Registry of Food Safety Professionals,

iii.

Prometic, Inc., or

iv.

Mississippi State University Extension Service, i.e., TummySafe©.

NOTE: For information on ServSafe® or TummySafe© contact the Mississippi State University Extension Service at www.msucares.com. In addition, the Mississippi Restaurant Association (MRA) also provides ServSafe® training. The MRA can be contacted at www.msra.org. For information on the National Registry of Food Safety Professionals or Prometric, contact the MSDH Office of Environmental Heath at 601.364.5780. h.

Wastewater disposal approval.

Potable water source approval - drinking water.

Zoning approval.

Lead Testing approval i. Building - if constructed before 1978. ii. Playground

Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the facility during all hours of operation.

Menu if applicable.

Floor Plan.

MSDH Maximum Capacity Worksheet (Form #28).

MSDH Child Care Facility Inspection Report (Form #281).

MSDH Child Care Facility Data Sheet (Form #286).

MSDH Food Service Inspection (Form #301-302) - if applicable.

Daily Schedule of Activities - developed by provider.

Arrival and Departure Procedures - developed by provider.

Emergency Policy – developed by provider.

Verification of Two Emergency Relocation Sites – developed by provider. i. One site must be a minimum of one mile distant from the facility. ii. One site must be a minimum of five miles distant from the facility.

Transportation Policy – not required if facility does not transport children.

NOTE: An emergency transportation policy is required even if the facility does not plan to transport children. An emergency transportation policy shall encompass such events as emergency evacuation of the facility and emergency transporting of a child to receive medical attention. x.

Proof of Vehicle Insurance – not required if facility does not transport children. y. Verification, in writing, that the operator has or does not have accident/liability insurance covering the business and the children enrolled in the facility. z. Verification that the owner/operator and director have completed mandatory training on: i. Regulations Governing Licensure of Child Care Facilities. ii. Directors Orientation. iii. Playground Safety. NOTE: Training classes provided by the Bureau of Child Care Licensure are listed under the heading “LIFT-ED Training Calendar and Courses.” Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH Approved Child Care Courses” and “Training Organizations with Standing Approval.” Only the Bureau of Childcare Licensure staff are allowed to conduct mandatory trainings except for the Health and Safety training which is also offered by MS Department of Human Services. Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH Approved Staff Development Trainers” and “Approved Child Care Staff Development Providers.” aa.

Discipline Policy – developed by the provider. NOTE: The discipline policy developed by the provider shall not allow any of the prohibited behaviors listed in Subchapter 14 of these regulations. bb. Emergency Policy – Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a mancaused event (such as violence at a child care facility), within the meaning of those terms under section 602(a)(1) of the Robert T. Stafford Disaster Relief and emergency Assistance Act (42 U.S.C. 5195a(a)(1 that shall include procedures for evacuation, relocation, shelter-in-place and lock down, staff and volunteer emergency preparedness training and practice drills, communication and reunification with families, continuity of operations, and accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions. 2.

Regular License The licensing agency may issue a regular license when all conditions and requirements for licensure have met compliance. 7

The duration of a regular license shall not exceed one year. Probational License The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period of time for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months. Restricted License The licensing agency may issue any type of license with conditions/restrictions when, at its discretion, the health or safety of the children require such a conditional/restrictive statement on the license. Such conditions/restrictions shall include but not be limited to certain individuals to be barred from the premises or any other situations that may endanger children and that should be so recorded on the license. Any violation of any such condition/restriction shall result in immediate emergency suspension of the license. When such conditions/restrictions no longer pose a threat to the children, the conditional/restrictive statement may be removed.

Source: Miss. Code Ann. §43-20-8. Rule 1.2.3 Application for License An application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require. Source: Miss. Code Ann. §43-20-8. Rule 1.2.4 License Fee: All application fees, licensure fees, renewal fees, and administrative charges shall be paid online at www.healthyms.com and are nonrefundable. Insufficient funds fee must be paid with money order. 1. Application Fee .............................................................................................. $130.00 2.

Initial Licensure Fee a.

Maximum capacity 12 or fewer ........................................................... $ 97.50

Maximum capacity 13 to 30 ................................................................... $195.00

Maximum capacity 31 to 50 ................................................................... $260.00

Maximum capacity 51 to 100 ................................................................. $390.00

Maximum capacity 101 to 150 ............................................................... $455.00

Maximum capacity 151 or more............................................................. $520.00

Renewal Fee

Maximum capacity 12 or fewer ........................................................... $ 97.50

Maximum capacity 13 to 30 ................................................................... $195.00

Maximum capacity 31 to 50 ................................................................... $260.00

Maximum capacity 51 to 100 ................................................................. $390.00

Maximum capacity 101 to 150 ............................................................... $455.00

Maximum capacity 151 or more............................................................. $520.00

Reinstatement Fee ......................................................................................... $260.00

Returned Check Fee .................................................................................. $ 50.00

LateFee…........................................................................................................$

Fingerprinting Fee (Per Fingerprint Card) .............................................. $ 50.00 NOTE: Except for the fingerprinting fee, no governmental entity or agency that operates a child care facility shall be required to pay the fees set forth in this section. Third party providers that contract with a state agency for the provision of child care services are subject to all fees, monetary penalties, etc. Further, should an entity exempt from licensure apply for a license it shall be subject to all fees listed in this section.

Source: Miss. Code Ann. §43-20-8. Rule 1.2.4 Certificate of Inspection by Fire Department A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection. Source: Miss. Code Ann. §43-20-8. Rule 1.2.5 Inspection An agency representative(s) shall inspect each child care facility prior to issuing or renewing a license to assure compliance with these regulations. Source: Miss. Code Ann. §43-20-8. Rule 1.2.6 Record of Inspection Whenever an inspection is made of a child care facility, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made. 9

25.00

Source: Miss. Code Ann. §43-20-8. Rule 1.2.7 1.

Renewal of License The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall email a renewal notice, at least 75 days prior to the expiration date of the license, to the email address of the operator registered with the licensing agency. The operator shall: a.

Complete the online renewal form.

Submit any and all certificates of inspection and approval required by the licensing agency.

Submit the renewal fee.

File the above with the licensing agency at least 30 days prior to the expiration date on the license.

Renewal applications submitted online less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. Applications and fees are to be paid online at Home - Mississippi State Department of Health (healthyms.com).

An operator who does not submit the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. Said license may be reinstated by the licensing agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one month of the expiration date of the license. After the one month reinstatement period, it shall be required that an application for an initial license be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met.

Source: Miss. Code Ann. §43-20-8. Rule 1.2.8 License Not Transferable or Assignable Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child care facility or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included. Source: Miss. Code Ann. §43-20-8. Rule 1.2.9 Display of Licenses The current license issued by the licensing agency to the named child care facility and operator shall be posted and displayed

in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. Source: Miss. Code Ann. §43-20-8. Subchapter 3:

RIGHT OF ENTRY AND VIOLATIONS

Rule 1.3.1 Right of Entry An agency representative may enter any child care facility for making inspections or investigations to determine compliance with these regulations. Source: Miss. Code Ann. §43-20-8. Rule 1.3.2 Violations If violations noted on the inspection form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations. Source: Miss. Code Ann. §43-20-8. Subchapter 4:

FACILITY POLICY AND PROCEDURES

Rule 1.4.1 Parental Information Before a child's enrollment, the parent shall be provided with the following: 1.

Operating information: a.

The child care facility's purpose, scope of service provided, philosophy, and any religious affiliation.

Name(s), business address, and home phone number of the operator, director or an individual in authority who can be reached after the facility’s normal hours of operation.

The business phone number of the child care facility.

Organization chart or other description of established lines of authority of persons responsible for the child care facility's management within the organization.

The program and services provided and the ages of children accepted.

The hours and days of operation and holidays or other times closed.

The procedures for admission and registration of children.

Tuition, plans for payment, and policies regarding delinquent payments.

Types of insurance coverage for children, or a statement that accident insurance is not provided or available.

If a facility does not provide liability insurance there shall be a 11

statement in the child’s record, signed by the parent indicating that the parent is aware that the facility does not carry liability insurance.

Reasons/circumstances and procedures for removal of children from rolls when parents are requested by facility staff to remove a child.

Procedures to include the amount of notice a parent is required to give the facility before removing a child.

Policy governing the maximum hours per day or week that a child can be left at the child care facility.

Arrival and departure procedures for children: a.

Procedure, approved by the licensing authority, for assuring a child's safe arrival and departure (All children shall be signed in and out of the facility by an authorized individual.).

Procedures for protecting children from traffic and other hazards during arrival and departure and when crossing streets.

Policy for release of children from the child care facility only to responsible persons for whom the child care facility has written authorization.

Policy governing a parent picking up a child after closing hours and procedures if a child is not picked up.

Program and activities information: a.

Policies and procedures about accepting and storing a child's personal belongings.

Discipline policies including acceptable and unacceptable discipline measures.

Transportation and safety policies and procedures.

Policies prohibiting the photographing of a child without parental consent.

Policies regarding a child's participation in extracurricular activities not sponsored by the child care facility, including but not limited to baseball, softball, soccer, ballet, or gymnastics.

Policies regarding water activities and safety procedures. These policies shall include those water activities that take place away from the child care facility property, e.g., taking children to a public swimming pool.

Policies encouraging sun safety practices and activities.

Health and emergency procedures:

Procedures for storing and giving a child medication.

Policy for reporting suspected child abuse.

Provision for emergency medical care, treatment of illnesses and accidents, which include: i.

A plan to handle a child in a medical crisis.

ii.

A plan to obtain prompt services of physician and hospitalization, if needed.

iii.

A plan for immediately notifying the parent of any illness, accident or injury to the child.

iv.

A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds.

Evacuation plan including procedures for notifying the parents of the relocation site.

Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering facility with weapons, bomb threats, or conditions posing an immediate threat to children.

State regulations: a.

A summary of the licensing regulations and any appendices thereto, provided by the licensing agency.

Each child's record shall contain a statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency for such distribution.

The name and phone number of the MSDH licensing official responsible for the inspection of the facility.

The toll free phone number (1-866-489-8734) of the Child Care Facility Complaint Hot Line.

Source: Miss. Code Ann. §43-20-8. Rule 1.4.2

Smoking, Tobacco Products, and Prohibited Substances

Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a child care facility at any time.

The use of alcohol, illegal use of prescription drugs, or use of illegal drugs is prohibited within the physical confines or the campus of a child care facility at any time. 13

Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. This definition includes volunteers and parents.

Source: Miss. Code Ann. §43-20-8. Rule 1.4.3 Parental Access Child care facilities shall assure the parent that they have welcome access to the child care facility at all times. Welcome access shall be defined as a parent having access to areas of the facility available to his child and non-disruptive to normal daily activities. Source: Miss. Code Ann. §43-20-8. Rule 1.4.4 Changes in Facility Operations The operator shall immediately notify the licensing agency of any major changes affecting areas of the child care facility's operations. Such major changes include, but are not limited to, operator, director, location, physical plant, or number of children served. Source: Miss. Code Ann. §43-20-8. Rule 1.4.5 Notice of Legal Action The licensing agency shall be notified within seven days, in writing, if notice is received of legal action against the child care facility. Source: Miss. Code Ann. §43-20-8. Rule 1.4.6 Posting of Information The following items shall be posted conspicuously in the child care facility at all times: 1.

Accessible to employees and parents: a.

License.

Daily activity schedule posted in each classroom.

Menus and Food Service Permit, if applicable.

Evacuation route.

The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. In kitchens: a.

Menus.

Evacuation route.

The evacuation route in all rooms utilized by children.

Source: Miss. Code Ann. §43-20-8. Rule 1.4.7

Weapons Prohibited

There shall be no firearms or other dangerous weapons allowed in a child care facility.

If a facility is located in an occupied dwelling, all firearms shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under lock in a room not accessible to children.

Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc.

Source: Miss. Code Ann. §43-20-8. Rule 1.4.8 Prevention of Shaken Baby syndrome and Abusive Head Trauma: Each child care center licensed to care for children up to five years of age shall develop and adopt policies to prevent shaken baby syndrome and abusive head trauma prior to licensure. The policy shall include the following: 1.

How to recognize, respond to, and report the signs and symptoms of shaken baby syndrome and abusive head trauma. Signs and symptoms include: irritability, difficulty staying awake, difficulty breathing, inability to lift the head, seizures, lack of appetite, vomiting, and bruises;

Strategies to assist staff members in coping with a crying, fussing, or distraught child;

Strategies to assist staff members in understanding how to care for infants;

Strategies to ensure staff members understand the brain development of children up to five years of age;

A list of prohibited behaviors that shall include, but not be limited to, shaking a child, tossing a child into the air or into a crib, chair, or car seat, and pushing a child into walls, doors, and furniture; and

Resources to assist staff members and families in preventing shaken baby syndrome and abusive head trauma.

Source: Miss. Code Ann. §43-20-8. Rule 1.4.9 Emergency Preparedness and Evacuation Planning: Each child care provider shall develop, implement, and maintain a comprehensive, written multi-hazard emergency preparedness, response, and recovery plan to ensure the safety and protection of all children in care during emergencies. This plan must 15

address the following components: 1. Multi-Hazard Emergency Plan Requirements: The plan shall: A. Address potential disasters and emergencies—natural or human-caused—that could affect the facility based on its geographic location B. Include procedures to control access to all buildings and outdoor play areas C. Include emergency procedures for: a. b. c. d. e. f.

Evacuation Relocation to a pre-determined safe location Shelter-in-place Lockdown Communication with families Continuity of operations

D. Include specific procedures and accommodation for: Infants and toddlers (including food and formula needs) b. Children with disabilities or chronic medical conditions, including medication, medical equipment, evacuation, and transportation E. Include a system for quickly accounting for all children during and after an emergency F. Include both a primary and backup communication system to contact parents and authorized third-party release caretakers G. Include procedures for reunification of children and parents following an emergency H. Include procedures for providing parents with information about the emergency plan upon enrollment and whenever changes or updates are made I. Be reviewed annually for accuracy and updated as necessary J. Be reviewed with all staff and volunteers: a. At the time of orientation b. At least once every six (6) months thereafter 1. K. Be available for review during inspections and at any time upon request by licensing staff. a.

L. Individualized Emergency Plan for Children with Special Health Care Needs: Child care providers shall develop an individual emergency plan for each child with special health care needs. This plan must include: a. Medical contact information; b. A list of necessary supplies, medications, and equipment specific to the child. M. Evacuation Pack: Child care providers must maintain an evacuation pack, accessible to all staff and containing at a minimum: a. A list of emergency phone numbers b. Updated emergency contact information and emergency medical authorizations for all enrolled children c. Emergency pickup forms d. First aid supplies, hand sanitizer, wet wipes, and tissue e. Diapers for non-toilet trained children and plastic bags for disposal f. A battery-powered or crank flashlight and radio with batteries g. Disposable cups and bottled water. h. A designated staff member must be assigned to maintain and ensure the pack is complete and that medications and other time-sensitive items are not expired. N. Records Retention and Backup: Child care providers shall maintain essential records, documents, and computer files necessary for the continuation of operations postemergency. These must be stored either in a portable file, or off-site, preferably with an electronic backup of all information. O. Emergency Drills: Child care providers shall: a. b. c. d.

Conduct monthly fire and tornado drills Conduct all other disaster drills at least once every six (6) months Vary the day and time of each drill to ensure readiness Maintain documentation on-site for the previous 12 months of all drills, including:

Type of drill (e.g., fire, tornado, flood, violence, power outage) ii. Date and time of the drill iii. Number of children participating iv. Name of staff member supervising the drill v. Total time to complete the drill vi. Any problems encountered and corrective actions taken. P. F. First Aid and CPR Certification: During all hours of operation, including arrival and departure, child care providers shall have at least one staff member present that: a. Holds a valid infant, child, and adult First Aid and CPR certification. b. Renewal certifications must be obtained through inperson, hands-on training (online-only courses are not acceptable). Rule 1.4.10 All policies and procedures referenced above in Subchapter 4 shall apply to all operators, staff and parents/guardians, as applicable. Source: Miss. Code Ann. §43-20-8. Subchapter 5: Rule 1.5.1

PERSONNEL REQUIREMENTS General Requirements For Personnel

Each employee or potential employee of a child care facility, whether full time, part time, temporary, substitute, or volunteer, shall be of good moral character and shall meet the minimum qualifications for the respective job classification, as set forth in these regulations.

Any individual who, in the opinion of the licensing authority, appears to be unable to physically or mentally care for children on a daily basis and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing authority, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a.

Physical ability to exit the children during a fire drill in under two minutes.

Ability to read medication directions and properly dispense medication to children (required only if the facility dispenses medication).

Source: Miss. Code Ann. §43-20-8.

Rule 1.5.2 Comprehensive Background Check: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant Act of 2014, and Federal Rules and Regulations 45 CFR 98.43, a comprehensive, finger-print based, criminal history records check, consisting of a FBI national criminal history records check (NCIC), state criminal history records check (MCIC), state child abuse registry check, National Sex Offender Registry check (NSOR), a state sex offender registry check and an interstate check, if applicable, must be completed on all operators, employees, and prospective employees of a licensed, regulated, and/or registered child care facility as well as all child care providers eligible to deliver services for which Child Care Development Funds assistance is provided. Further, a comprehensive background must be completed every five years. 1.

Before a prospective staff member may begin work in a child care facility, a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit.

Each licensed, regulated, and/or registered child care facility will electronically access, monitor, verify, and maintain the suitability status of any submitted employee through the agency maintained website.

If an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new comprehensive criminal history records check must be submitted and approved before the individual may begin work in a child care family home.

In the event a child care applicant has a disqualifying event a letter of non-suitability will be issued. Both the child care provider and the applicant will be notified through the agency- maintained website.

Individuals under the age of 18 who are employed by a child care provider for compensation are required to complete a comprehensive background check.

Volunteers a.

The facility shall maintain the following on any individual who volunteers in a child care facility for less than 120 hours per licensure year: i. A provider will maintain a timesheet on all volunteers indicating the number

of hours they worked each time they were at the facility. ii. Immunization Compliance Form 121. b.

The facility shall maintain the following on any individual who volunteers in a child care facility for 120 or more hours per licensure year: i. Letter of Suitability that reflects the completion of a full criminal records check, child abuse registry check, and sex offender check. Also, if required an out-of-state criminal records check, child abuse registry check, and sex offender check. ii. Immunization Compliance Form 121.

Source: Miss. Code Ann. §43-20-8. Rule 1.5.3

Child Care Director Qualifications

A child care director shall be least 21 years of age and shall have at a minimum: 1.

A bachelor’s degree in early childhood education, child development, elementary education, child care, special education, psychology (with emphasis on child psychology), or family and consumer sciences (with emphasis on child development), or equivalent degree from another childrelated field or course of study. OR

A two-year associate degree from an accredited community or junior college in child development technology which must include a minimum of 480 hours of practical training, supervised by college instructors, in a college operated child care learning laboratory. OR A two-year associate degree from an accredited community or junior college in child development technology or child care and two years paid experience in a licensed child care facility. OR

Two years paid experience as a caregiver in a licensed child care facility, and either (1) a current Child Development Associate (CDA) credential from the Council for Early Childhood Professional Recognition (CECPR), or (2) a Mississippi Department of Human Services (MDHS) Division of Early Childhood Care and Development (DECCD) Child Care Director’s Credential or MDHS OCY Child Care Director’s Credential, or

(3) 24 semester hours credit with a grade of “C” or better from an accredited college or university in courses specific to early childhood. OR 5.

A verified certificate from the licensing agency certifying that the individual was qualified to be the director of a licensed child care facility prior to January 1, 2000 in the State of Mississippi.

Source: Miss. Code Ann. §43-20-8. Rule 1.5.4 Caregivers have at a minimum: 1.

Caregivers shall be at least 18 years of age, and shall

A high school diploma or equivalent (GED). OR

A current CECPR Child Development Associate (CDA) credential, a MDHS DECCD Child Care Director’s Credential, or MDHS OCY Director’s Child Care Credential. OR

Three years prior documented experience caring for children who are under 13 years of age and who are not related to the caregiver within the third degree computed according to civil law. Staff failing to meet the requirements of education and/or experience to act as a caregiver shall be designated as caregiver assistants.

Source: Miss. Code Ann. §43-20-8. Rule 1.5.5 Caregiver Assistants Caregiver assistants shall be at least 16 years of age. Caregiver assistants shall work under the direct on-site supervision of a director or caregiver at all times. They shall not have the direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children. Source: Miss. Code Ann. §43-20-8. Rule 1.5.6

Students

Students in a field study placement, a practicum, or vocational child care training program may assist in the care of the children when the following conditions have been met.

Students who are 18 years of age or older and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility which shall contain the following: a.

Name, date of birth, address, and phone number. 21

Name and phone number of a contact person from the school or university placing the student.

Date placement began and daily record of the hours a student is present.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

Documentation that the criminal records check (fingerprinting) and child abuse central registry check have been completed and no records found, i.e., Letter of Suitability for Employment.

Documentation of a minimum of one hour of orientation, within one week of placement, including but not limited to, the child abuse law and reporting procedures, emergency procedures, and facility discipline and transportation policies.

Students who are under 18 years of age and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility that shall contain all of the above listed material with the exception of Item e. The facility shall document the time that a student is at the facility. No student shall be left alone with children unless an approved Letter of Suitability is on file.

Source: Miss. Code Ann. §43-20-8. Rule 1.5.7 1.

Use of Director Designee A director designee is an individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. A director designee shall, at a minimum have a high school diploma or GED two years paid experience in a licensed child care facility or licensed/accredited kindergarten program. A director designee shall not retain sole director authority in a facility for more than 24 total hours per calendar week. EXCEPTION: Facility may have a Director Designee serve for a maximum of 14 consecutive days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. In addition, if a Director has a medical condition (illness, recovery from surgery, accident, etc.) that requires more than 14 consecutive day’s recovery time, the time a Director Designee may be utilized may be extended. The facility is responsible to notify the Child Care Division of such circumstances and provide documentation supporting the need to extend the time the Director Designee needs to be utilized. Approval of this exception is at the discretion of the Child Care Licensure Division.

When the director designee is in charge of the facility, they shall have

full access to all documents of the facility that are necessary for the licensing agency to conduct an inspection or complaint investigation. These documents shall include, but are not limited to, staff records, children’s records, safety inspections, and any other material or documents required by the inspecting official. Source: Miss. Code Ann. §43-20-8. Rule 1.5.8

Staff Development

Owners, Directors, and Director Designees - Before a new license to operate is issued, owners, directors and director designees of the child care facility shall complete mandatory training on courses covering Child Care Regulations, Director Orientation, and Playground Safety. If a new director or director designee is appointed by the child care facility after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first six months of appointment. In the sole discretion of the licensing agency, mandatory training may be waived upon the submission of documentation of the individual’s prior completion of relevant training.

All child care staff, directors, director designees, and caregivers shall be required to complete 15 contact hours of staff development, accrued during the licensure year, annually. The National Association for the Education of Young Children (NAEYC), a leading organization in child care and early childhood education recommends annual training based on the needs of the program and the pre-service qualifications of the staff. Training should address the following:

Health and safety.

Child growth and development.

Nutrition.

Planning learning activities.

Guidance and discipline techniques.

Linkages with community services.

Communications and relations with families.

Detection of child abuse.

Advocacy for early childhood programs.

Professional issues.

Contact hours for staff development shall be approved by the 23

licensing agency. The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual. No more than five contact hours of approved in-service training provided by the child care facility may be counted toward the total number of hours required each year. More than five hours of in-service training may be provided by the child care facility but no more than five hours may be counted toward the required total of 15 hours. All volunteers shall receive, at a minimum, one hour of orientation by the facility director. Such orientation at a minimum shall include a review of the child abuse law and reporting requirements, emergency exit procedures, and the facility transportation policy.

Source: Miss. Code Ann. §43-20-8. Rule 1.6.2

Records Retention:

All records, unless otherwise specified, shall be kept for a period of at least three years.

A child's records shall be retained for a period of one year after the child is no longer in attendance at the facility.

Source: Miss. Code Ann. §43-20-8. Rule 1.6.3 3.

Facility Records: Attendance records for children and employees.

A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth.

A current alphabetical roster of staff employed or volunteers in the child care facility.

Current license.

Records of monthly fire/disaster evacuation drills.

A record shall be maintained of any medication administered by the director or caregiver showing the date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication.

A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

10.

Licensed child care facilities shall require proof of vaccination or 24

a valid exemption for all children enrolled, as specified by the Mississippi State Department of Health (MSDH) through forms 121 and 122. a. Each child care facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121or MSDH Form #122) for both staff and/or children. The notebook shall contain separate current alphabetical rosters of both staff and children. All children must have one of the following forms before enrollment in a licensed child care facility: Certificate of Immunization Compliance (Form 121) or Certificate of Medical/Religious Exemption (Form 122) b. An MSDH Certificate of Immunization Religious Exemption Form #122 does not apply to staff. c. The MSDH Office of Immunizations shall provide assistance to licensed child care facilities, case workers, foster families, and families experiencing hardship and/or homelessness. For additional information contact the MSDH Office of Immunization.

11.

Each licensed child care provider is required to enter into the Child Care LARS Database the hourly rate that they charge to care for a child in a particular age group they serve, i.e., Infant, Preschool, School Age. The following is used for calculating the hourly rate for each age group. Calculation of the daily rate Current Monthly Rate (CMR) Calculated Yearly Rate = (CMR X 12 months) Calculated Weekly Rate = (Calculated Yearly Rate ÷ 52) Calculated Daily Rate = (Calculated Weekly Rated ÷ 5) Age Group

Current Monthly Rate (CMR)

Yearly Rate Weekly Rate

Daily Rate Daily Rate Before Rounded CMR X 12 Yearly Rate ÷ Rounding Up to the 52 Next Cent Weekly Rate ÷ 5

Infant

$480.00

$5,760.00

110.7692308

22.15385

$22.16

Preschool

$440.00

$5,280.00

101.5384615

20.30769

$20.31

School Age

$320.00

$3,840.00

73.84615385

14.76923

$14.77

Source: Miss. Code Ann. §43-20-8. Rule 1.6.4

Personnel Records:

Employee Records: Each employee's personnel record shall contain the following: a. Name, date of birth, address, and phone number. b.

Documentation of education, training, and experience necessary for employment.

c. Records of staff development accrued during each licensure year, beginning with the date employed. d.

Date of employment and date of separation.

e. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. f. Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted (Letter of Suitability for Employment); and the information shall be included in each employee's personnel file. NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks.

Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect.

Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment.

Required Employee information to be entered into the Child Care Database – Licensure and Reporting System (LARS)

The following information will be entered in the Child Care LARS Database for the Owner, Director, and all staff of the child care facility. The information will be entered during the Child Care Initial Application, Renewal Application, and Provider Portal “Manage Contacts” sections. a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address h. Contact Phone Number The required information entered into the LARS Child Care Database under this rule is confidential and not viewable by the general public. The information will be used to authenticate the required contact hours taken by staff each licensure year. This information will also provide the ability for the child care operator to retrieve information regarding whether an employee is up-to-date or deficient regarding the required staff development hours (15 hours required) each licensure year. Further, this information will allow an individual employee or a supervisor of an employee, i.e., Owner and/or Director to register an employee for courses to maintain the continuing education hours required for the continued licensing of the child care facility. Source: Miss. Code Ann. §43-20-8. Rule 1.6.5 Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1.

Name, date of birth, address, and phone number.

Documentation of education, training, and experience that may help them in their role as a volunteer.

Date individual began volunteering and last date individual volunteered at the facility.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

Documentation that the criminal records check (fingerprinting), child abuse central registry check, and sex offender registry check has been conducted (Letter of Suitability for Employment), and the information is included in each volunteer’s file.

Documentation of a minimum of one hour of volunteer orientation, within one week of volunteering, including but not limited to, the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy.

A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility.

A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

Source: Miss. Code Ann. §43-20-8. Rule 1.6.6 Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 9.

Documentation of a minimum of one hour of volunteer orientation within one week of volunteering, including but not limited, to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy and special needs of children.

10. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 11. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service. 12. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. Source: Miss. Code Ann. §43-20-8. Rule 1.6.7 Child Records The facility shall maintain an individual file for each child under its current care, and for any withdrawn child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: 1.

Identification and Contact Information a.

The name of the child and names of parents/guardians.

Home address and home phone number. 28

The parent’s business name, address and phone number.

The child’s date of birth.

Date of acceptance at facility and date of withdrawal, if any, with the parent’s stated reason for withdrawal.

Other contact information required to be maintained in accordance with the facility’s policy manual.

Parental Instructions a.

If the parent provides written instructions to the facility, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and kept updated.

Written identification of an authorized, responsible person(s) for pickup of the child.

Documentation of any limitation of parental rights of the other parent or stepparent.

Documentation of any limitation or restriction, if any, on activities of child, or other participation by the child in certain events such as holiday celebrations or being photographed or other parental concerns.

Authorizations a.

Signed written authorization to obtain emergency medical treatment and to administer medication.

A parent may choose either (a) to give written consent allowing their child to participate in all field trips, excursions, or series of events outside the child care facility, or (b) to give written consent only for specific trips or events that include an approved date, time, and location.

c. 4.

Signed acknowledgment by parent that the written policies and procedures described in subchapter 4 have been received. Signed acknowledgment by parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent.

Documents Required by Policy Manual or Contract a.

If agreed by the facility in its policy manual or caregiver contracts, method in which facility will inform the parent or contact person if a child does not arrive at the facility within a 29

reasonable time after a scheduled drop-off. b. 6.

Any other documents or identification records agreed to be maintained by the facility. Confidentiality of Records and Information

Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent.

Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee.

Source: Miss. Code Ann. §43-20-8. Subchapter 7:

REPORTS

Rule 1.7.1 Serious Occurrences Involving Children The child care facility shall document any serious occurrences involving a child in the child’s record and immediately notify the child’s parent and the licensing agency either verbally or in writing, such as email. If the facility is unable to reach the parent or the licensing agency immediately, this must be noted in writing in the child’s record. All verbal notifications must be followed by written confirmation, sent within two days of the occurrence. Serious occurrences include, but are not limited to, accidents or injuries requiring significant medical attention (e.g., the child is taken to a doctor or hospital), alleged abuse or neglect, fires, or other emergencies. Source: Miss. Code Ann. §43-20-8. Rule 1.7.2 Child Abuse Any operator or employee of a child care facility who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Human Services in accordance with the state's Youth Court Act. (Appendix "A") Source: Miss. Code Ann. §43-20-8. Rule 1.7.3 Communicable Disease: The child care facility shall promptly report any known or suspected case or carrier of any reportable disease to the Mississippi State Department of Health, as published in the Mississippi Reportable Disease List. Source: Miss. Code Ann. §43-20-8. Rule 1.7.4 Infants and Toddlers For infants and toddlers, the child care facility shall provide, to the child's parent, daily written reports that include liquid intake, child’s disposition, bowel movements, and eating and sleep patterns.

Source: Miss. Code Ann. §43-20-8. Subchapter 8:

STAFFING

Rule 1.8.1

General

The staff-to-child ratio shall be maintained at all times, to include when children are arriving and departing the facility.

Children shall not be left unattended at any time. Video monitors cannot be used as a substitute for the physical presence of a caregiver in a room.

During all hours of operation, including arrival and departure of children, a child care facility employee shall be present to whom administrative and supervisory responsibilities have been assigned. This child care facility employee shall meet the minimum qualifications of a director or director designee. Note: Operators of child care facilities shall provide to the licensing official a list of all individuals who meet the qualifications of a director or director designee and may be assigned administrative and supervisory responsibility for the facility when the director is absent. Documentation that an individual meets the qualifications of a director shall be submitted to and approved by the local licensing official. Director designee qualifications shall be maintained on site and available to the licensing official during site visits.

During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present who holds a valid Adult, Child/Infant CPR and First Aid certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing authority. Note: When initially acquiring or renewing the Adult, Child/Infant CPR and First Aid CPR certifications required in rule number 4, online training is not acceptable. Training must be face-to-face and hands-on.

Source: Miss. Code Ann. §43-20-8. Rule 1.8.2 1.

Ratio The minimum ratio of caregiver staff-to-children present at all times shall be as follows: Age of Children

Number of Children to Caregiver Staff

Less than 1 year

1 year

2 years

3 years

4 years

5 through 9 years

10 through 12 years

Staff-to-child ratios shall be met at all times, including during opening/closing, field trips and swimming or water activities whether at the child care premises or off-site.

In mixed age groups, the age of the youngest child in the group determines the staff-to-child ratio. Preschool children shall not be grouped with school age children in any single area during normal classroom and playground or water activities.

With the exception of children under two years of age, children may be under the direct supervision (staff in the same room) of 50 percent of the staff required by this section during rest period times, provided the required staff-to-child ratio is maintained on the premises.

At no time will a single individual be responsible for the supervision of children located in more than one classroom at any given time.

Compliance with group sizes is not required during normal arrival and departure time periods, or during special events. However, the ageappropriate staff-to-child ratio shall be maintained at all times.

Source: Miss. Code Ann. §43-20-8. Rule 1.8.3

Grouping When children are placed in groups, the maximum group size shall be determined by the following chart.

Age of Children in the Group

MAXIMUM number of children ALLOWED in a group of children this age

Infant (Birth through12 months)

10 infants

MINIMUM number of caregivers REQUIRED for a group of children this age

2 caregivers

MINIMUM square footage REQUIRED for a group of children this age

40 square feet per child

Toddler (12 months to under 24 months)

18 toddlers

2 caregivers

45 square feet per child

2 years

24 children

2 caregivers

35 square feet per child

3 years

28 children

2caregivers

35 square feet per child

4 years

32 children

2 caregivers

35 square feet per child

2 caregivers

35 square feet per child

2 caregivers

35 square feet per child

5-9 years

40 children

10-12 years

50 children

Source: Miss. Code Ann. §43-20-8. Subchapter 9:PROGRAM OF ACTIVITIES Rule 1.9.1

General

The child care facility shall provide a basic program of activities geared to the age levels and developmental needs of the children served.

The child care facility shall provide for the reading of ageappropriate materials to children.

The child care facility shall incorporate programs to encourage sun safety practices, into activities for all age levels.

Source: Miss. Code Ann. §43-20-8. Rule 1.9.2 Daily Routines All daily routines, such as eating and rest periods, shall be scheduled for the same time each day. Source: Miss. Code Ann. §43-20-8. Rule 1.9.3 Eating Meal periods are breakfast, lunch, dinner, and snacks. A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period. Source: Miss. Code Ann. §43-20-8. Rule 1.9.4

Rest Periods

1. For preschool children, rest periods shall be scheduled for a minimum period of one hour and shall not exceed two and one-half (2½) hours. Infant and

toddler nap times shall be individualized to meet each child’s needs as sleeping patterns can vary greatly. Half-day programs must provide for rest periods as is appropriate when the children/child indicates or is observed to require some rest time. 2.

Physical force shall not be used in requiring children to lie down or go to sleep during rest periods.

3. Rest periods are not required for children in attendance for less than six hours. 4. Rest periods are not required for school age children. 5.A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: a. An infant shall be placed on his/her back for sleeping unless written physician orders to the contrary are in the child's record. Sleeping infants shall be within the view of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. b. Infants shall be dressed in clothing appropriate for sleeping that is designed to keep the infant warm without the possible hazard of head covering or entrapment. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. c. Facilities shall use a firm mattress covered by a fitted sheet. d. Items such as but not limited to pillows, blankets, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib. Source: Miss. Code Ann. §43-20-8. Rule 1.9.5

Outdoor Activities

Each infant shall have a minimum of 30 minutes of outdoor activities per day, weather permitting.

Toddler, preschool, and school age children shall have a minimum of two hours of outdoor activities per day, weather permitting. Children who attend at a facility for seven hours per day or less shall have a minimum of 30 minutes of outdoor activity per day, weather permitting.

Sun safe practices shall be used during outdoor activities. Refer to sun safe practices available on the MSDH Sun and Heat Safety webpage. 34

Sun safe practices shall be evident in the planning of all outdoor events.

Outdoor activities shall be held in areas providing shade or covered spaces.

Source: Miss. Code Ann. §43-20-8. Rule 1.9.6 1.

Infant and Toddler Activities Infants and toddlers shall be free to creep, crawl, toddle, and walk as they are physically able. a. Cribs, car seats, and high chairs are to be used only for their primary purpose, i.e. cribs for sleeping, car seats for vehicle travel, and high chairs for eating. b. Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they are awake. c. Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time. d. Providers should use strollers for toddlers and preschoolers only when necessary.

Infants and toddlers shall be taken outdoors every day, weather permitting.

For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about.

Television viewing, including video tapes and/or electronic media, is not allowed for children under the age of two or for staff in the infant and toddler area. The playing of soothing music in the infant and toddler area is acceptable.

Television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to one hour per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable.

In half-day programs, television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to 30 minutes per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable.

Television viewing by staff is not permitted in areas occupied by 35

children except for the purposes as described in item 5 and 6, above. Source: Miss. Code Ann. §43-20-8. Rule 1.9.7 Indoor or Outdoor Physical Activity: Child care providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. 1.

Toddlers and preschool children will be provided the opportunity for light physical activity for at least 15 minutes per hour when children are not involved in their scheduled rest period.

Toddlers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day.

Preschoolers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day.

Caregivers should join in and lead the structured moderate to vigorous physical activities in which the children participate.

Structured physical activity should involve the performance of large muscle activities.

Half-day programs are only required to provide for physical activity for one-half (½) the time as stated above.

NOTE: Examples of “light physical activity” may be found in the Child Care Licensure section of the MSDH website at www.HealthyMS.com. Examples of “moderate physical activity” are aerobic dancing, light calisthenics, getting up and down from the floor, dancing, playing on school ground equipment, singing while actively moving about, etc. Examples of “vigorous physical activity” are running, jumping rope, performing jumping jacks, playing soccer, skipping, etc. Regardless of the activity, it should be age appropriate and within the physical ability limits of the child. Please, understand the above requirement does not mean 60 minutes vigorous activity at one time. The 60 minutes of vigorous physical activity can and should be spread out in short time intervals, (e.g., 5-15 minute intervals) throughout the day. Source: Miss. Code Ann. §43-20-8. Subchapter 10:

EQUIPMENT, TOYS, AND MATERIALS

Rule 1.10.1

General

Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served.

Developmentally age-appropriate toys shall be available and accessible for infants, and shall include but not be limited to the following: 36

Simple, lightweight, open-ended, easily washable toys such as containers, balls, large pop-beads, and nesting cups.

Rattles, squeak toys, action/reaction toys.

Cuddly toys.

Toys to mouth such as teethers and rings.

Pictures of real objects.

A crawling area with sturdy, stable furniture for pulling up self.

Developmentally age-appropriate toys shall be available and accessible for toddlers, and shall include but not be limited to the following: a.

Push and pull toys.

Stacking toys, large wooden spools/beads/cubes.

Sturdy picture books, music.

Pounding bench, simple puzzles.

Play phone, dolls, and toys to appeal to child’s imagination.

Large paper, crayons.

Sturdy furniture to hold on to while walking.

Sand and water toys.

Developmentally age-appropriate toys shall be available and accessible for preschoolers, and shall include but not be limited to the following: a.

Active play equipment for climbing and balancing.

Unit blocks and accessories.

Puzzles and manipulative toys.

Picture books, records, and musical instruments.

Art materials such as finger and tempera paints, clay, play dough, crayons, collage materials, markers, scissors, and paste.

Dramatic play materials such as dolls, dress-up clothes and props, child- sized furniture, and puppets. 37

Sand and water toys.

Children's original work shall be displayed in the child care facility.

Books shall be on shelves and tables for children to look at and read. Every child shall have age-appropriate materials (including picture books) read to and discussed with him or her every day. Where appropriate, the materials should cover topics with which the children are involved.

Television viewing by preschool children shall be limited to one hour per day and shall be educational programming only. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described herein.

The daily activity schedule shall demonstrate that preschoolers are given opportunities to do a variety of activities, including both quiet and active, such as block play, art activities, puzzles, books, and learning games, and that stories are read to and discussed with each child every day.

Source: Miss. Code Ann. §43-20-8. Rule 1.10.2 1.

Playground Equipment All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission.

Playground equipment shall be of safe design and in good repair. Outdoor playground climbing equipment and swings shall be set in concrete footings located at least six inches below ground surface. Indoor playground equipment shall be installed according to the manufacturer's specifications. Swings shall have soft and/or flexible seats. Access to playground equipment shall be limited to age groups for which the equipment is developmentally appropriate.

Equipment designed for outdoor use by infants and toddlers shall be accessible to shaded areas to ensure sun safe practices.

Source: Miss. Code Ann. §43-20-8. Rule 1.10.3 Paint Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous. Source: Miss. Code Ann. §43-20-8. Rule 1.10.4 Chairs and Tables Chairs and tables shall be of a size appropriate to the size and age of the children. There shall be an adequate number of chairs and tables to accommodate the children present at the facility.

Source: Miss. Code Ann. §43-20-8. Rule 1.10.5 Hooks and Compartments Individual hooks or compartments shall be provided for each child for hanging or storing outer and/or extra clothing as well as for personal possessions. Hooks shall be spaced well apart so that clothes and belongings do not touch those of another child. Hooks shall also be placed at a height suitable to prevent an injury to a child. Source: Miss. Code Ann. §43-20-8. Rule 1.10.6

Sand Boxes

1. Sand boxes shall be constructed to permit drainage, shall be covered tightly and securely when not in use, and shall be kept free from cat or other animal excrement. 2. Sand contained in sand boxes shall not contain toxic or harmful materials. Source: Miss. Code Ann. §43-20-8. Rule 1.10.7 1.

Cribs The facility shall provide a crib or other similar commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. The use of stackable cribs is prohibited.

Source: Miss. Code Ann. §43-20-8. Rule 1.10.8 High Chairs High chairs, if used, shall have a wide base and a Tshaped safety strap. They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs). Source: Miss. Code Ann. §43-20-8. Rule 1.10.9 1.

Rest Period Equipment Individual beds, cots, mattresses, pads, or other acceptable equipment shall be used for rest periods, and children shall not be placed directly on the floor for rest periods. Bed linens, such as blankets or sheets, cannot be used in place of a bed, cot, mattress, or pad. These shall be kept in a sanitary condition. Once a sheet or blanket has been used by a child, it shall 39

not be used by another child until it has been laundered. 2.

Rest period equipment shall be clean and covered with a waterproof cover.

Nap pads/cots are designed for use by one child only at a time. No child is allowed to sleep in shared space.

Nap pads utilized by more than one child shall be sanitized after each child’s use. Nap pads utilized by only one child shall be sanitized immediately when soiled or at least weekly.

Nap pads and nap cots without mattresses are not acceptable for use in 24 hour programs. Beds, cribs, or roll away cots are the only acceptable bedding for 24 hour centers.

The facility shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. Cribs, cots, and mats are to be a minimum of 24” apart or separated by a solid barrier. A minimum of 36 inches is recommended

Source: Miss. Code Ann. §43-20-8. Rule 1.10.10

Play Equipment

Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. Play equipment, toys, and materials shall be found to be appropriate to the development needs, individual interests, and ages of the children as identified as age-appropriate by a label provided by the manufacturer on the product package.

Projectile toys, i.e., dart guns, toy guns, etc., are prohibited.

Water play tables, if used, shall be cleaned and sanitized daily.

Tricycles and other riding toys used by the children shall be spokeless, steerable, and of a size appropriate for the child, and shall have low centers of gravity. All such toys shall be in good condition and free of sharp edges or protrusions that may injure the children. When not in use, such toys shall be stored in a location where they will not present a physical obstacle to the children and employees. Riding toys shall be inspected at

least monthly for protrusions and rough edges that could lead to injury. Source: Miss. Code Ann. §43-20-8. Rule 1.10.11

School Age Programs

The foregoing provisions in Subchapter 10 shall not be applied to any facility licensed solely for School age children unless specifically required in Subchapter 10, Rule 1.10.11.

All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations.

Projectile toys are prohibited. Projectile toys are toys which, when projected, have the ability to penetrate body or eye tissue. Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products.

Possessions, belongings, and extra clothing for each school age child must be stored in such a manner as to not touch those of another child.

Source: Miss. Code Ann. §43-20-8. Subchapter 11: Rule 1.11.1 1.

BUILDINGS AND GROUNDS

Building A child care facility shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the child care facility for the purpose of entering the building or exiting the building or passing through the child care facility for the purpose of gaining access to another part of the building.

All child care facility buildings shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances.

No house trailers, relocatable classrooms, or portable buildings shall be used to house a child care facility unless such structure was originally designed specifically for educational purposes and meet the Mississippi State Department of Education’s current standards for a relocatable classroom. Further, such portable structure shall meet all applicable fire safety codes.

Current licensees operating facilities housed in such structures are exempted from this provision. Any change of ownership, need for major

renovation, or other significant change in the facility’s status shall revoke such exemption. 5.

Plans and specifications shall be submitted to the licensing agency for review and approval on all proposed construction and/or major renovations.

A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent. Space shall be located in an area that is supervised at all times by an employee.

The ceiling, floor, and/or floor covering shall be properly installed, kept clean and in good condition, and maintained in good repair. Carpeting is prohibited in kitchen areas.

All parts of the child care facility used by children shall be lead-safe, well lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as but not limited to, open stairs and unprotected low windows. a. All buildings intended for use as a child care facility constructed before 1978 shall be tested for lead. It is the responsibility of the facility applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be leadsafe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. b. All buildings intended for use as a child care facility, constructed prior to 1978, shall utilize MDEQ Lead Safe Certified individuals or companies for all renovation, repair and maintenance activities which disturb painted surfaces unless the paint to be disturbed has been documented to be lead- free by an individual or company that is MDEQ Lead Safe Certified as a risk assessor or inspector. NOTE: It is recommended that child care facility operators contact the Mississippi Department of Environmental Quality at 601-961-5630 regarding any questions they may have about compliance with the laws and regulations related to lead and lead based paint.

10.

All buildings intended for use as a child care facility constructed before 1978 shall be tested for lead. It is the responsibility of the facility

applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be lead-safe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. 11.

All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safety-grade glass or polymer (e.g., Lexan®) are not required to have a protective barrier. Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be so certified by the installer and the statement kept on file at the child care facility.

12.

Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork.

13.

All ceiling lighting shall be shielded completely and encased in shatterproof materials.

14.

A child care facility shall have a working phone available to all staff at all times. Telephones shall also be available for incoming calls and shall not be unplugged or disconnected during business hours.

15.

All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician.

16.

Unused electrical outlets shall be protected by a safety plug cover.

17.

All child care facilities are to be kept clean and in good repair.

18.

Every child care facility which uses nonelectric heating and/or cooling systems, cooking stoves, and/or hot water heaters or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the child care facility.

19. No extension cords shall be used in areas accessible to children. Source: Miss. Code Ann. §43-20-8. Rule 1.11.2

Indoor Square Footage

a. During group activity periods such as film viewing, parties, dining, and sleeping, provided child-to-staff ratio is maintained; b.During periods when child pick-up or delivery is normally done, provided child-to staff ratio is maintained; c. In infant and toddler rooms as required in subsections 2-7 below; d.

In school age only and summer day camp programs as outlined in Subchapter 23 and Subchapter 24 of these regulations.

The usable space in determining the facility’s maximum licensed capacity is measured exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff room, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. 2.

Rooms in which infants both play and sleep shall have a minimum of 40 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to- end.

Rooms where infants play but do not sleep shall have a minimum of 15 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than infant play.

Rooms where infants sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least two feet between each crib. Cribs with solid ends may be placed end-to-end.

Rooms in which toddlers both play and sleep shall have a minimum of 45 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. However, if stackable cots, mats, or other storable sleeping equipment is utilized for sleeping the room shall be measured using the standard of 35 square feet per child. Should it be determined that the sleeping equipment is not properly stored when not in use the capacity of the room will be determined using 45 square feet per child

Rooms where toddlers play but do not sleep shall have a minimum of 25 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than toddler play.

Rooms where toddlers sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be 44

placed end-to- end. 8.

The licensing agency may re-measure the play of licensed operating child care facilities, or such parts impacted by the following circumstances, for purposes of determining licensed facility or classroom capacity only under the following circumstances: a.

Major renovations;

Significant change in layout and use of space;

c. 9.

A change of ownership of an existing facility should the layout or use of space change.

“Grandfather Provision” for regulatory changes regarding maximum facility capacity or room capacity. Whenever the Mississippi State Board of Health amends these rules regarding square footage and/or licensed maximum capacity of child care facilities, and such change would result in a reduction in the number of children to be served in a licensed and operating facility or any of its classrooms, any such facility in operation at the time of final adoption of said rule change, and in compliance with all other child care regulations, shall be “grandfathered” in and exempt from application of the new regulation regarding capacity. This exemption shall continue for said facility through changes of ownership so long as the building is used continuously as a licensed child care facility and so long as there is no change in the layout or use of the space, as set out in subsection 8 above. Any break in use of the building as a licensed child care facility shall moot the grandfather exemption, and thereafter, any child facility opened and operated in said building shall be required to comply with the square footage/capacity regulation in affect at the time of the new license.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.3

Openings

Each window, exterior door, and basement or cellar hatchway shall be weather tight and watertight.

All windows above ground level in areas used by children under five years of age shall be constructed, adapted, or adjusted to limit the exit opening accessible to children to less than six inches, or be otherwise protected with guards that do not block outdoor light.

Openable windows shall be of a safety type (not fully openable) that are child proofed and screened when open. When there are no openable windows, or when windows are not kept open, rooms shall be adequately ventilated.

All openings used for ventilation shall be screened.

The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities.

Exit doors shall open outward. Boiler room doors shall swing inward.

Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room.

The hand contact and splash areas of doors and walls shall be covered with an easily cleanable finish, at least as cleanable as an epoxy finish or enamel paint.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.4

Kitchens

Children are not allowed in the kitchen area. In School Age/After School programs, children may be allowed in the kitchen but not during times when food is being cooked. Supervision in the kitchen when children are present must meet the staffing requirements as referenced in Subchapter 8 of the regulations.

Barriers, approved by the local fire authority, shall be erected and doors shall be closed at all times.

The kitchen area shall be designed and constructed to be totally enclosed with walls, doors, and/or barriers. Serving counter openings that conform to local fire codes and MSDH food service regulations are permitted.

Kitchens shall have the following minimum square footage, based upon the maximum number of children allowed pursuant to the license: Licensed Capacity 1-50

Minimum Sq. Footage 90 sq. ft.

51-70

150 sq. ft.

71-100

210 sq. ft.

over 100

300 sq. ft.

Child care facilities serving 50 or more children shall have a separate, stand alone freezer for storage of frozen foods.

All kitchens providing food for child care facilities with 13 or more children, and all kitchens in child care facilities not located in occupied dwellings, shall comply with the Mississippi State Department of Health's 46

10.0 Regulation Food Code, with the exception that kitchens in facilities located in an occupied dwelling that are licensed for 13 or more children need not have a separate kitchen to serve the child care facility. 7.

All kitchens and/or food/snack preparation areas in a child care facility shall be inspected as part of the child care inspection process.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.5

Toilets and Hand Washing Lavatories

Toilets and hand washing lavatories shall be located within the physical confines of child care facility and shall be convenient to outside playground areas.

The following ratios shall apply: Toilets, urinals, and hand washing lavatories shall be apportioned at a ratio of 1:15. Urinals shall not exceed 33 percent of the total required toilet fixtures. When the number of children in the ratio is exceeded by one, an additional fixture shall be required.

The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity. Diaper changing sinks shall not be used for any other purpose such as, but not limited to, rinsing or washing baby bottles, pacifiers, teething rings, or for food preparation.

All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit.

Toilets, urinals, hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.6 Water The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1.

Fountain.

Disposable paper cups.

Labeled cup for each child, which shall be washed and sanitized daily.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.7

Exits

At least two separate exit doors shall be provided from every floor level.

Exit doors shall be remote from each other.

Dead end corridors shall not exceed 20 feet in length.

Exit doors necessitating passage through a kitchen shall not be counted as one of the two remote exits.

Exit doors shall be a minimum of 32 inches wide and open outward. No single leaf in an exit door shall be less than 28 inches wide or more than 48 inches wide.

Any latch or other fastening device on an exit door shall be provided with a knob, handle, panic bar, or other simple type of releasing device. Dual action door fasteners are not permitted.

The force required to open fully exit doors shall not exceed 50 pounds applied to the latch stile (panic bar).

An exit door shall not reduce the effective width of a landing.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.8

Heating, Cooling, and Ventilation

A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained.

All rooms used by children shall be heated, cooled, and adequately ventilated to maintain the required temperatures, and air exchange, and to avoid the accumulation of objectionable odors and harmful fumes.

Ventilation may be in the form of openable windows as specified in these regulations.

Areas where art and craft activities are conducted shall be well ventilated. In areas where substances are used that create toxic fumes, exhaust hood systems or other devices shall be installed.

Electric fans, if used, shall be mounted high on the wall or ceiling or shall be guarded to limit the size of the opening in the blade guard to less than one-half (½) inch.

When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children.

Filters on recirculation systems shall be checked and cleaned or replaced monthly.

Window draft deflectors shall be provided if necessary.

Thermometers that do not present a hazard to children shall be 48

placed on interior walls in every activity area at children's height. 10.

Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating.

11.

Electric space heaters shall be UL-approved; inaccessible to children; and stable; shall have protective covering; and shall be placed at least three feet from curtains, papers, and furniture.

12.

Fireplaces and fireplace inserts shall be screened securely or equipped with protective guards while in use. They shall be properly drafted. The child care facility shall provide evidence of cleaning the chimney at least once a year, or as frequently as necessary to prevent excessive buildup of combustibles in the chimney. Records of chimney cleaning shall be retained in the center files.

13.

Heating units that utilize gas shall be installed and maintained in accordance with the manufacturer’s instructions, are vented properly to the outside, and be supplied with sufficient combustion air as required by the International Fuel Gas Code.

14.

If the area of the state where the facility is located does not utilize the International Fuel Gas Code, the installation and maintenance of any heating units that utilize gas shall be in accordance with the manufacturer’s instructions and any local ordinances that apply.

15.

It is the responsibility of the licensee to provide to the licensing authority documentation that the heating units meet the above stated standards.

16.

Heating units, including water pipes and baseboard heaters hotter than 110 degrees Fahrenheit, shall be made inaccessible to children by barriers such as guards or other devices.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.9 Outdoor Playground Area All licensed child care facilities are required to have an adequate outdoor playground area. All playgrounds and playground equipment intended for use by children 2-12 years of age shall meet the standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission. 1.

The child care facility shall be equipped with an outdoor playground area that directly adjoins the indoor facilities or that can be reached by a route free of hazards and is no farther than 1/8 mile (660 feet) from the child care facility. The outdoor playground area shall comprise a minimum of 75 square feet for each child using the outdoor playground area at any one time.

The total outdoor playground area shall accommodate at least 33 percent of the licensed capacity at one time.

A rooftop used as an outdoor playground area shall be enclosed with a fence not less than six feet high and designed to prevent children from climbing it. An approved fire escape shall lead from the roof to an open space at the ground level that meets safety standards for outdoor playground areas.

The outdoor playground area shall be well arranged so that all areas are visible to staff at all times.

The outdoor playground area shall be free of hazards and not less than 30 feet (measured horizontally parallel to the ground) from electrical transformers, high- voltage power lines, electrical substations, railroad tracks, or sources of toxic fumes or gases. Hazards, including but not limited to air conditioner units and utility mains, meters, tanks, and/or cabling shall be inaccessible to children. Fencing at least four feet high shall be provided around the outdoor playground area. Fencing higher than four feet but not to exceed eight feet may be required if the licensing authority determines that a hazard exists. Fencing twist wires and bolts shall face away from the playground. As an alternative, exposed bolt ends may be cut to no more than two exposed threads. Then the bolt ends shall be ground/sanded smooth or capped.

Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, quarries, canals, excavations, fishponds, or other bodies of water.

Sunlit areas and shaded areas shall be provided by means of open space and tree plantings or other cover in outdoor spaces. Outdoor spaces shall be laid out to ensure ample shaded space for each child.

The outdoor playground area shall be enclosed with a fence. The fence shall be at least four feet in height and the bottom edge shall be no more than three and

one-half (3½) inches off the ground. There shall be at least two exits from such areas, with at least one remote from the buildings. The gate latch or securing device shall be high enough or of such a type that it cannot be opened by small children. The openings in the fence shall be no greater than three and one-half (3½) inches, e.g., between the building and the fence. The fence shall be constructed to discourage climbing. 9.

The soil in outdoor playground areas shall not contain hazardous levels of any toxic chemical or substances. The child care facility shall have soil samples and analyses performed where there is good reason to believe a problem may exist.

10.

The soil in outdoor playground areas shall be analyzed for lead content initially. It shall be analyzed at least once every two years where the exteriors of adjacent buildings and structures are painted with leadcontaining paint. Lead in soil shall not exceed 400 ppm. Testing and analyses shall be in accordance with procedures specified by the licensing agency.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.10 Indoor Playground Area In addition to the required outdoor playground area a licensed child care facility may also provide an indoor playground area. Child care facilities licensed prior to July 1, 2009 that have been granted permission to have an indoor playground area in lieu of an outdoor playground area shall be not be required to have an outdoor playground. However, it is highly recommended that if possible an outdoor playground area should also be provided. For child care facilities which provide such an indoor playground area the following items apply: 1.

The total indoor playground area shall accommodate at least 33 percent of the licensed capacity at one time.

The indoor playground area shall be well arranged so that all areas are visible to staff at all times.

The indoor playground area shall be free of hazards.

Indoor playground areas shall be laid out to ensure ample clearance space for the use of each item: nine feet around fixed items and 15 feet around any moving part. Equipment shall be situated so that clearance space allocated to one piece of equipment does not encroach on that of another piece of equipment.

Swings shall have a clearance area of nine feet in all directions beyond the swing beam.

All fixed playground equipment shall have a minimum of nine feet clearance space from walkways and other structures that are not used as part of play activities. 51

All equipment shall be arranged so that children playing on one piece of equipment will not interfere with children playing on or running to another piece of equipment.

Moving equipment (e.g., swings, merry-go-rounds) shall be located toward the edge or corner of an indoor playground area or shall be designed in such a way as to discourage children from running into the path of moving equipment.

All pieces of indoor playground equipment shall be surrounded by a resilient surface of an acceptable depth or by rubber mats manufactured for such use, consistent with the guidelines of the Consumer Product Safety Commission, and the Standard of the American Society for Testing and Materials, extending beyond the external limits of the piece of equipment for at least four feet beyond the fall zone of the equipment. These resilient surfaces shall conform to the standard stating that the impact from falling from the height of the structure will be less than or equal to peak deceleration 200G. Organic materials that support colonization of molds and bacteria shall not be used.

10.

Indoor space designated as playground may be used by other individuals when the area is not in use by children attending the facility. However, children of the child care facility shall have priority use of the indoor playground area and the area may not be used by others when children are using it. The indoor playground space shall not count as additional classroom space when determining the maximum capacity of the facility.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.11

Grounds

The grounds, including the outdoor playground area, shall be free of hazardous or potentially hazardous objects.

In-ground swimming pools are prohibited unless protected by a sixfoot fence and a locked gate. All fencing shall be placed at a minimum five feet from the pool edge.

Above ground pools, including decking and pool structures, are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum ten feet from the pool/deck edge.

All paved surfaces shall be well drained to avoid water accumulation and ice formation.

All walking surfaces, such as walkways, ramps, and decks, shall have a non- slip finish, and shall be free of holes and sudden irregularities in the surface.

Source: Miss. Code Ann. §43-20-8. 52

Rule 1.11.12 Garbage Removal Garbage and trash shall be removed from the child care facility daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children, and in insect and rodent resistant containers. Source: Miss. Code Ann. §43-20-8. Rule 1.11.13 Environmental Health The child care facility shall comply with all regulations promulgated by the Division of Sanitation of the Mississippi Department of Health for: 1.

Food Service.

On-site Wastewater Systems.

Vector (pest) Control.

Source: Miss. Code Ann. §43-20-8. Rule 1.11.14 Pest Control All child care facilities are to use a contractor licensed by the State of Mississippi to control pests, e.g., rats, mice, insects, etc. Before a pest control contractor is used, it is the responsibility of the operator to ensure that the pest control contractor is properly licensed. Use of agricultural chemicals for pest control is strictly prohibited. Source: Miss. Code Ann. §43-20-8. Subchapter 12:

HEALTH, HYGIENE, AND SAFETY

Rule 1.12.1

Employee Health

Employees manifesting symptoms or otherwise suspected of having upper respiratory, gastrointestinal, skin, or other serious contagious conditions shall be excluded from work until either free from symptoms or certified by a physician to be no longer infectious.

Staff shall use universal precautions when changing diapers or being exposed to biocontaminants to include blood, body fluids, or excretions that may spread infectious disease. Refer to Caring for Our Children: National Health and Safety Performance Standards for guidelines on cleaning bodily fluids.

Staff shall follow the procedures noted on the MSDH Handwashing website to prevent the spread of infection. 53

Source: Miss. Code Ann. §43-20-8. Rule 1.12.2

Child Health

A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible.

A child having a serious contagious condition shall not be allowed to return to the child care facility until they have been certified by a physician to be no longer contagious.

Parents of all children shall be notified of a contagious illness in the child care facility as soon as possible.

A child with a physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority. A child with a serious physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority and transported to a hospital or medical facility as soon as appropriate.

Source: Miss. Code Ann. §43-20-8. Rule 1.12.3

Child Hygiene

A child's wet or soiled clothing shall be changed immediately.

A child's hands shall be washed:

Immediately before and after eating.

After using the toilet or having their diapers changed.

After playing on the playground.

After handling pets, pet cages, or other pet objects.

Whenever hands are visibly dirty.

Before going home. A child shall have a shower, tub, or sponge bath to

. 54

ensure bodily cleanliness when necessary. 4.

Individual toilet articles (e.g., combs, brushes, toothbrushes, towels, and wash cloths) used by children shall be provided by the parent or child care facility and plainly marked and stored individually in a sanitary manner in areas which promote drying. Single use and disposable articles are acceptable. Grooming accessories, including but not limited to brushes, combs, barrettes, or picks, shall not be used jointly by children or on children.

Source: Miss. Code Ann. §43-20-8. Rule 1.12.4 Toys and Equipment Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution. A resource regarding sanitation of equipment and toys can be located on the National Resource Center for Health and Safety in Child Care and Early Education website. Chapter 3: Health Promotion and Protection; Cleaning, Sanitizing, and Disinfecting (nrckids.org). Source: Miss. Code Ann. §43-20-8. Rule 1.12.5

First Aid Supply

A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children.

A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children.

Medicine shall be kept out of the reach of the children.

All vehicles used by the facility in transporting children shall be equipped with a first aid kit.

It is recommended that first aid kits contain at a minimum the following items: scissors; tweezers; gauze pads; adhesive tape; thermometer; band-aids, assorted sizes; antibacterial ointment; insect-sting preparation; an antiseptic cleansing solution; triangular bandages; rubber gloves; protective eye wear; a protective face mask; and cold pack. The first aid kit, together with a first aid instruction manual which must be always kept with the

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kit, shall be stored so that it is not accessible to children but is easily accessible to employees. 6.

All first aid kits should be periodically inspected for contents. Depleted and out of date materials should be replaced.

Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs.

For additional information on supplies for first aid kits contact your local office of the American Red Cross.

Source: Miss. Code Ann. §43-20-8. Rule 1.12.6

Animals and Pets

Any pet or animal present at a child care facility, indoors or outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children.

Dogs or cats, where allowed, shall be immunized for any disease that can be transmitted to humans, and shall be maintained on a flea, tick, and worm control program.

All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the child care facility, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the child care facility where the pet is kept. a.

A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when in close proximity to these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space with the children.

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Each child’s hands shall be properly washed after being exposed to animals.

Source: Miss. Code Ann. §43-20-8. Subchapter 13: General Nutritional Standards: Proper nutrition and healthy eating habits are essential to a child's overall development, as well as their long-term health. Cultivating healthy habits by choosing a variety of well-planned, balanced meals and snacks helps lower the risk of chronic disease and supports a healthy, active lifestyle. Source: Miss. Code Ann. §43-20-8. Rule 1.13.1 Meals and Snacks: All meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA). The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and offer a minimum standard by which a facility shall follow. A copy of the Meal Patterns for Children in Child Care Programs is available online at Nutrition Standards for CACFP Meals and Snacks | Food and Nutrition Service. When children bring their own food for meals or snacks to the center, if the food does not meet the nutritional requirements specified above, the center must provide a food substitution necessary to meet the minimum requirements. Source: Miss. Code Ann. §43-20-8. Rule 1.13.2 Feeding Infants and Children: A signed written feeding plan for children less than one (1) year of age shall be obtained from Parent(s). Instructions from the parent(s) shall be updated 2x annually or as new foods are added, or as other dietary changes are made. The feeding plan shall be posted in the child's assigned room and must include the child's feeding schedule, the amount of formula or breast milk to be given, instructions for the introduction of solid foods, the amount of food to be given and notation of any type(s) of commercially premixed formula which may not be used in an emergency because of food allergies. 1. Employees shall wash their hands prior to preparing or serving food. 2. Center personnel shall hold and feed infants less than six (6) months of age and older children/infants who require assistance with feeding. Baby bottles shall never be propped; the infant's . 57

head shall be elevated while feeding. 3. Honey shall not be served to children less than one (1) year of age. 4. Age-appropriate solid foods (including cereal) shall not be given to infants or children less than one (1) year of age until recommended as developmentally appropriate by the child’s primary care physician and indicated in writing by the Parent(s). As soon as the feeding plan indicates that a child is ready for solid foods, the child shall be fed from individual spoons and individual containers or dishes. A child shall not be fed directly from the original baby food container if the contents are to be fed to the child at more than one (1) meal. 5. As soon as the child exhibits a desire to feed him/herself, the child shall be assisted and encouraged to use their fingers for self-feeding, eat with a spoon, and drink from individual cups. 6. The Center shall encourage and support breastfeeding. Centers shall have a designated area set aside for breastfeeding mothers to breastfeed. 7. Food for infants or children less than one (1) year of age shall be cut into pieces one-quarter inch or smaller, and food for toddlers shall be cut into pieces one-half inch or smaller to prevent choking. 8. Center Personnel shall ensure that children do not have excessive amounts of food in their mouths while eating and are chewing their food appropriately to prevent instances of choking. 9. Children shall always be seated when eating and shall not be allowed to lie down or be put to sleep while food is present in their mouths. Source: Miss. Code Ann. §43-20-8. Rule 1.13.3 Baby Bottles and Formula: All baby bottles shall be clearly labeled with the individual child's name and date. Formula or breast milk shall be supplied by the Parent daily in bottles. Only the current day's formula or breast milk shall be served. Bottles shall be . 58

refrigerated at a temperature of forty-one (41) degrees Fahrenheit or less. If formula must be provided by the Center, only commercially prepared, ready-to-feed formula shall be used. Refrigerated or frozen breast milk shall only be heated or thawed under warm running water or in a container of warm water. Do not use microwaves to heat breast milk or formula. Source: Miss. Code Ann. §43-20-8. Rule 1.13.4 Feeding Chairs: A feeding chair or similar equipment designed for feeding children shall be provided for the use of each child being fed who can sit up but who is unable to sit unassisted at a table. The chair or similar equipment must be cleaned with a disinfectant after each use. Such chair or similar equipment shall have a broad base to prevent tipping; a surface that the child cannot raise; a strap or other device which prevents the child from sliding out of the chair; and a feeding surface free of cracks. Source: Miss. Code Ann. §43-20-8. Rule 1.13.5 Menus: The Center shall provide a menu listing all meals and snacks to be served during the current week. Meal and/or snack substitutions shall be recorded on the posted menu. Menus shall be retained at the Center for six (6) months. Use the following when planning menus: 1. Offer a variety of nutrient dense foods. 2. Serve meals and snacks that help maintain a healthy weight. 3.

Serve a variety of vegetables, fruits, and whole grain-rich products.

4 . Avoid foods high in sugar and saturated fat. Limit fried food to one time e a c h w e e k . 5. Limit high sodium products and the use of added salt. 6. Promote and encourage daily physical activity. Source: Miss. Code Ann. §43-20-8. Rule 1.13.6 Meal Service: Children shall be served all meals and snacks scheduled for the period during which they are present. Meals and snacks shall be scheduled and served by the Center when . 59

appropriate: breakfast or a morning snack, lunch, an afternoon snack, supper if the Center operates evening care and an evening snack prior to bed time if a Center operates night time care. In those Centers where the Parent(s) of children enrolled provide the meals and snacks, the Center shall ensure that no child remains at the Center without receiving the scheduled nutritious meals and snacks. 1. There shall be a period of at least two (2) hours and no more than four (4) hours between each required meal or snack. 2. Food and beverages shall be served in individual plates or bowls and with individual glasses or cups. 3. Children shall be encouraged but not forced to eat. 4. Caregivers shall not use food to punish or reward children. 5. Children shall be given necessary assistance in feeding and encouraged to develop good nutritional habits. 6. Hot food shall not be served at a temperature which would cause the children to burn their mouths upon consuming the food. 7. Drinking water shall be offered to all children regularly throughout the day, including during meals and snacks, as well as before, during, and after physical activity. 8. Meals shall be served at tables where each child may be seated. 9. Children shall not share food. 10. Each individual child’s lunch brought from home shall be clearly labeled with the child’s name and date. 11. All food brought from home shall be stored at an appropriate temperature until eaten. Source: Miss. Code Ann. §43-20-8. Rule 1.13.7 Restrictions: Food shall be served according to the manufacturer’s instructions and recommendations. Foods that are associated with young children’s choking incidents, such as, but not limited to, peanuts, hot dogs, raw carrots, popcorn, fish with bones, cheese cubes, grapes, chunks of peanut butter, and any other food that . 60

is of similar shape and size of the trachea/windpipe shall not be served to children less than four (4) years of age. Children older than four (4) years of age may be served these foods provided that the food is cut in such a way as to minimize choking. Food shall not be accessible or served to children until it has been chopped, diced, cut or mashed and is appropriate for each child’s age and individual eating, chewing and swallowing ability. Source: Miss. Code Ann. §43-20-8. Rule 1.13.8 Beverages: Food and drink with little or no nutritional value, i.e., sweets, soft drinks, sport drinks, fruit-flavored drinks, artificially sweetened drinks, etc. shall be served only on special occasions and only in addition to the required nutritious meals and snacks. Breast milk or formula is served until 12 months of age at each meal and/or snack. Twelve-twenty-four month olds must be offered whole milk at each meal and/or snack, while children aged two and older must be provided non-fat or 1% milk. Powdered nonfat dry milk shall only be used for cooking purposes. Source: Miss. Code Ann. §43-20-8. Rule 1.13.9 Modified Diets: When a child requires a modified diet for medical reasons, a written statement from a physician, RDN, or physician assistant shall be on file. When a child requires a modified diet for religious reasons, a written statement to that effect from the child's Parent(s) shall be on file. All caregiver personnel shall be informed of the diet restrictions for the child and only food that complies with the prescribed dietary regimen but still meets the food and nutrition requirements shall be served to the child. Source: Miss. Code Ann. §43-20-8. Rule 1.13.10 Unconsumed Food: Any portions of food or drink which are served to children or placed on the table for service and are not consumed at that meal or snack by the children to whom the portions are served shall be thrown away. Any formula or breast milk remaining one hour from the beginning of the feeding shall be discarded or returned to Parent(s). Source: Miss. Code Ann. §43-20-8. Rule 1.13.11 Catered Food: Food purchased from a caterer shall be prepared in a facility with a current food service permit and shall be maintained at a safe temperature until served. [Forty-one (41) degrees Fahrenheit or below for foods requiring refrigeration or one hundred forty (140) degrees Fahrenheit for foods which must be heated prior to . 61

serving]. Source: Miss. Code Ann. §43-20-8. Rule 1.13.12 Vending Machines: Soft drink or snack vending shall not be maintained on Center premises for children's use. Vending machines and dispensers for staff shall be outside of the children's areas. Rule 1.13.13 Food Safety and Food Manager 1. All kitchens and/or food/snack preparation areas in a child care facility must be inspected as part of the child care inspection process. 2.

Each child care facility must have a Certified Food Manager meeting the standards set forth in Rule 1.2.2 (1)(g) The only exception would be if two facilities had different operating hours. If this situation exists, then one Certified Food Manager could serve more than one facility and documentation to that effect must be in each facility’s file.

A Certified Food Manager shall be present during meal preparation. In the absence of the Certified Food Manager, an individual trained in food service must be present.

Citation: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 20202025. 9th Edition. December 2020. Available at DietaryGuidelines.gov. Source: Miss. Code Ann. §43-20-8. Subchapter 14: DISCIPLINE AND GUIDANCE Rule 1.14.1 Prohibited Behavior The following behaviors are prohibited by anyone (i.e., parent, caregiver, or child) in all child care settings: 1.

Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain.

Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities.

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Abusive or profane language to include but not limited to yelling at, and/or using harsh tones toward the children or in close proximity (hearing distance) to children.

Any form of public or private humiliation, including threats of physical punishment.

Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating (out of view of a caregiver), or corrupting a child.

Use of any food product or medication in any manner or for any purpose other than that for which it was intended.

Inappropriate disciplinary behavior includes, but is not limited to, putting soap or pepper in a child's mouth.

Any acceptable disciplinary action that is not ageappropriate for the child or is excessive in time or duration.

Source: Miss. Code Ann. §43-20-8. Rule 1.14.2 Restraint of a Child Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs. Source: Miss. Code Ann. §43-20-8. Rule 1.14.3 Time Out "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, taking into account the child's developmental stage and the usefulness of "time out" for the particular child.“Time out” means that the child is given time away from an activity which involved inappropriate behavior. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than three years of age. Source: Miss. Code Ann. §43-20-8. Rule 1.14.4

Children Shall Not Discipline Other Children:

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Children shall neither be allowed nor be instructed to discipline other children. Source: Miss. Code Ann. §43-20-8. Subchapter 15:

TRANSPORTATION

Rule 1.15.1 General Regardless of transportation provisions, the child care facility is responsible for the safety of the children. Source: Miss. Code Ann. §43-20-8. Rule 1.15.2

Requirements:

All drivers are appropriately licensed.

All vehicles have current safety inspection stickers, licenses, and registrations.

Insurance adequately covers the transportation of children.

Children board or leave the vehicle from the curb-side of the street and/or are safely accompanied to their destinations.

A parent is present if the child is delivered home.

Seat restraints are used.

Source: Miss. Code Ann. §43-20-8.. Rule 1.15.3 1.

Occupant Restraints All children will be properly restrained whenever they are being transported in a motor vehicle. a. Every person transporting a child under the age of four (4) years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, e.g., child safety seat. b. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or

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highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five (65) pounds. c. Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above. 2.

No vehicle shall be occupied by more individuals than its rated capacity.

No children shall be transported in the front seat of vehicles equipped with passenger-side air bags.

All vehicles under 10,000 lbs. GVWR (Gross Vehicle Weight Rated) shall be equipped with occupant restraints appropriate for the age and/or weight of the children being transported. A child under the age of four shall be transported only if the child is securely fastened in a child safety seat that meets Federal Motor Vehicle Safety Standards (FMVSS, 49 CFR 571.213), which shall be indicated on the child safety seat. The child safety seat shall be appropriate to the child's weight and be installed and used according to the manufacturer's instructions.

Vehicles (e.g., school buses) with a GVWR 10,000 lbs. or more at a minimum shall meet the current Federal Motor Vehicle Safety Standards (FMVSS) for buses of that size. It is the responsibility of the child care facility operator to have documentation verifying that a bus meets the current FMVSS. NOTE: Federal Motor Vehicle Safety Standards (FMVSS) means the National Highway and Traffic Safety Administration's standards for motor vehicles and motor vehicle equipment established under Section 103 of the Motor Vehicle Safety Act of 1966 (49 CFR Part 571) as they apply to school buses.

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An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed.

Source: Miss. Code Ann. §43-20-8. Rule 1.15.4

Staff-to-Child Ratio

On vehicles with a GVWR of less than 10,000 lbs., the staff-to-child ratio shall be maintained at all times. The driver of the vehicle shall not be counted as a caregiver while transporting the children.

On vehicles with at GVWR of 10,000 lbs. or more, the staff-to-child ratio shall be one caregiver to each 25 children or fraction thereof. The driver of the vehicle shall not be counted as a caregiver while transporting the children. In facilities that are dually licensed, i.e., licensed to provide care for both preschool and school age children, if the vehicle is only transporting school age children (no preschool children, infants, or toddlers are being transported), the driver may be counted as a caregiver while transporting the school age children.

Source: Miss. Code Ann. §43-20-8. Subchapter 16:

DIAPERING AND TOILETING

Rule 1.16.1 Diaper Changing Area Each room in which diaperwearing children play shall contain a diapering area. A diapering area shall contain a hand washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plasticlined, covered garbage receptacle, and sanitizing solution. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity nor shall they be used for any other purpose. Example: The diaper-changing sink may not be used for washing/rinsing cups, baby bottles, food, dishes, utensils, pacifiers, etc. In addition, the diaper changing area is not to be used as a storage area for anything other than those items used when changing diapers, such as but not limited to, gloves, towels, soap, etc. Diapering changing procedures can be located in the following resource, National Resource Center for Health and Safety in Child Care and Early Education. Source: Miss. Code Ann. §43-20-8. . 66

Rule 1.16.2 Non-Disposable Diapers and Training Pants The fecal contents of non- disposable diapers or training pants shall be disposed of into a toilet. The soiled non- disposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container. Source: Miss. Code Ann. §43-20-8. Rule 1.16.3 Disposable Diapers Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle. Source: Miss. Code Ann. §43-20-8. Rule 1.16.4 Potty Chairs Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use. Source: Miss. Code Ann. §43-20-8. Rule 1.16.5 Hand Washing Employees shall wash their hands with soap and running water before and after each diaper change. Individual or disposable towels shall be used for drying. Hand washing sinks at diaper changing stations shall not be used for any other purpose. Example: The diaper changing sink may not be used for washing cups, baby bottles, food, dishes, utensils, etc. Source: Miss. Code Ann. §43-20-8. Rule 1.16.6 Parental Consultation A parent consultation is required prior to toilet training.

caregiver

Source: Miss. Code Ann. §43-20-8. Subchapter 17:

REST PERIODS

Rule 1.17.1 Equipment Each child shall be placed on a separate bed, crib, cot, or mat. Cribs shall be labeled so that the child's name is visible. Source: Miss. Code Ann. §43-20-8. Rule 1.17.2 Cleaning of Linens and Bed Coverings Linens and bed coverings shall be changed immediately when soiled. All linens and bed coverings shall be changed, at a minimum, two times per week. Source: Miss. Code Ann. §43-20-8. . 67

Rule 1.17.3 Cleaning of Rest Period Equipment All rest period equipment shall be wiped clean immediately when soiled. All rest period equipment shall be cleaned twice a week with a germicidal solution. Additional cleaning may be required by the licensing authority if there is an outbreak of a communicable disease. Source: Miss. Code Ann. §43-20-8. Rule 1.17.4 Sharing of Rest Period Equipment At no time will two or more children be allowed to share the same bed, crib, cot, or mat during their time of enrollment, unless it is cleaned with a germicidal solution between each child's use. Source: Miss. Code Ann. §43-20-8. Subchapter 18:

FEEDING OF INFANTS AND TODDLERS

Rule 1.18.1 Hand Washing Employees shall wash their hands with soap and water, and dry their hands with individual or disposable towels, before and after each feeding. The infant and toddler's hands shall be washed with soap and water, and dried with individual or disposable towels, before and after each feeding. Source: Miss. Code Ann. §43-20-8. Rule 1.18.2 Bottle Feeding Infants shall be held while being bottle fed. Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep. Source: Miss. Code Ann. §43-20-8. Rule 1.18.3 Formula Storage Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival. Source: Miss. Code Ann. §43-20-8. Rule 1.18.4 Baby Food Any food left over from the serving dish shall be discarded. Leftovers remaining in a jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or be discarded. Source: Miss. Code Ann. §43-20-8. Rule 1.18.5 Refrigerator A refrigerator shall be available and easily accessible to the infant or toddler's room(s). . 68

Source: Miss. Code Ann. §43-20-8. Rule 1.18.6 Heating Unit A heating unit for warming bottles and food shall be accessible only to adults. Source: Miss. Code Ann. §43-20-8. Rule 1.18.7 Breast-Feeding Accommodations and Staff Training This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1.

Breast-feeding mothers, including employees, shall be provided a sanitary place that is not a toilet stall to breastfeed their child or to express milk. This area shall provide an electrical outlet, comfortable chair, and nearby access to running water.

A refrigerator must be available to accommodate storage of expressed breast milk. It is acceptable to store expressed milk in the same refrigerator as other milk/bottles provided each bottle is appropriately labeled with the child’s name and the time of expected expiration of the milk. Milk must be stored in accordance with the American Academy of Pediatrics and Centers for Disease Control guidelines. Universal precautions are not required in handling human milk.

Child care staff shall be trained in the safe and proper storage and handling of human milk. Although other training materials may be utilized, training materials will be available through MSDH. Guidelines for Milk Storage and Use for All Infants

Storage Method and Temperature Maximum Amount of Time For Storage Room (25 C or 77 F) 4 hours Refrigerator (4 C or 39 F) 48 hours Previously thawed – 24 hours Refrigerated milk 3 months Freezer (-20 C or 0 F) From the ACOG/AAP publication: Breastfeeding Handbook for Physicians Source: Miss. Code Ann. §43-20-8. Subchapter 19:

SWIMMING AND WATER ACTIVITIES

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Rule 1.19.1 General This section shall apply to any child care facility that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on site or at any other location during the time staff has responsibility for children enrolled. Source: Miss. Code Ann. §43-20-8. Rule 1.19.2 1.

Lifeguard Supervision Swimming pools, lakes, etc. a.

A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities.

One lifeguard is required for every 25 children or any portion thereof (i.e., two lifeguards are required for groups of 26 - 50, three for 51 - 75, etc.). This required ratio also includes activities that occur near water such as fishing or beach activities.

Lifeguards are not counted in the staff-to-child ratio.

The staff-to-child ratio shall be maintained at all times.

It is the child care facility operator’s responsibility to provide adequate certified lifeguards if the pool or lake operator does not.

Each child will be tested by a certified lifeguard prior to participating in swimming lessons or any pool activities. Children will be assigned to swim groups according to the results of the test.

Staff, as well as lifeguards, shall be responsible for enforcing general safety rules.

Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can understand what is expected.

2. Wading pools For activities taking place in wading pools with a water depth of one foot or less the following is . 70

required: a.

There shall be a person(s) with a valid Adult, Child/Infant CPR and First Aid certification present at all times.

The staff-to-child ratio shall be maintained at all times.

Wading pools shall be cleaned after each use.

Source: Miss. Code Ann. §43-20-8. Rule 1.19.3

Health and Safety

All piers, floats, and platforms shall be in good repair, and where applicable, the water depth shall be indicated by printed numerals on the deck or planking.

There shall be a minimum water depth of 10 feet for a one-meter diving board and 13 feet for a three-meter board or diving tower.

For outdoor swimming areas in natural bodies of water, the bottom shall be cleared of stumps, rocks, and other obstacles.

Diving boards shall be mounted on a firm foundation and never on an insecure base, such as a float that can be affected by shifting weight loads and wave action. The entire length of the top surface of diving boards shall be covered with nonskid material. The diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines for the board by professional swimming pool installers who shall certify in writing to the facility that the diving board is adequately installed in accordance with manufacturer’s guidelines for the board, in a commercially reasonable manner, located so as to allow a child to safely enter the water from the diving board, and that the diving board is safe for its intended use. Facilities with existing pools equipped with diving boards that are unable to obtain the required certification within 60 days of the adoption of this regulation shall have the diving boards removed.

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Swimming pools, when in use, shall be continuously disinfected by a chemical that imparts an easily measured free available residual effect. When chlorine is used, a free chlorine residual of at least 0.4 ppm shall be maintained throughout the pool whenever it is open or in use. If other halogens are used, residuals of equivalent disinfecting strength shall be maintained.

A testing kit for measuring the concentration of the disinfectant, accurate within 0.1 ppm, shall be provided at each swimming pool. Swimming pool water shall be maintained in an alkaline condition as indicated by a pH of not less than 7.2 and not over 8.2. A pH testing kit accurate to the nearest 0.2 pH unit shall be provided at each swimming pool. The alkalinity of the water shall be at least 50 ppm, as measured by the methyl-orange test. The following chart may be used for pH

Minimum Free Available Residual Chlorine-mg/L

0.40 0.40 0.40 0.40 0.50 0.60 0.70 0.80 1.00

7.2. 7.3. 7.4. 7.5. 7.6. 7.7. 7.8. 7.9.

8.0. reference:

If cyanuric acid is used to stabilize the free available residual chlorine, or if one of the chlorinated isocyanurate compounds is used as the disinfecting chemical in a swimming pool, the concentration of cyanuric acid in the water shall be at least 30 mg/L but shall not exceed 100 mg/L. The free available residual chlorine, of at least the following concentrations, depending upon the pH of the water, shall be maintained:

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Minimum Free Available Residual Chlorine-mg/L

7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 8.0

1.00 1.00 1.00 1.00 1.25 1.50 1.75 2.00 2.50

The water in a swimming pool shall have sufficient clarity at all times so that a black disk, six inches in diameter, is readily visible when placed on a white field at the deepest point of the pool. The pool shall be closed immediately if this requirement cannot be met.

For natural bodies of water (e.g., lakes, rivers, streams, etc.), sewage treatment plants or other discharge lines shall not be within 750 feet of swimming areas.

Source: Miss. Code Ann. §43-20-8. Subchapter 20:

CHILDREN WITH SPECIAL NEEDS

Rule 1.20.1

Facility Adaptation

The child care facility areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate.

A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures.

Source: Miss. Code Ann. §43-20-8. Rule 1.20.2 Activity Plan A child with special needs shall have an individual activity plan. The individual activity plan shall have . 73

been developed by a person with a bachelor’s or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months. Source: Miss. Code Ann. §43-20-8. Rule 1.20.3 Caregiver Staff Development Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served. Source: Miss. Code Ann. §43-20-8. Rule 1.20.4 Staffing Caregiver staffing shall be appropriate and adequate to meet the specific physical and/or developmental needs of the special needs children served at the child care facility. Staff-to-child ratio shall be determined by the needs of the child rather than the child’s chronological age as based upon the child’s individual plan (i.e., individual education plan, individual habilitation plan, individual family service plan, etc.). The facility is encouraged to be an active participant in the child’s individual plan development. Source: Miss. Code Ann. §43-20-8. Subchapter 21:

NIGHT CARE

Rule 1.21.1 General This section shall apply to any child care facility that is open past 11:30 p.m., as part of their regular hours of operation. Source: Miss. Code Ann. §43-20-8. Rule 1.21.2

Nutrition

A child care facility that is open prior to 7:00 p.m. shall provide a dinner meal period.

A child care facility that remains open after 5:00 a.m. shall provide a breakfast meal period.

A snack period shall be provided to children in attendance for more than two and one-half (2½) hours prior to bedtime.

Menu plans for lunch and dinner meals shall be varied. No single menu shall be repeated in a 24 hour period.

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Source: Miss. Code Ann. §43-20-8. Rule 1.21.3

Sleeping

Mats shall not be used for sleeping.

Bedtime schedules shall be established in consultation with the child's parent.

Provisions shall be made in sleeping areas for the use and storage of clothing and personal belongings and they shall be within easy reach of the child using them.

A child shall be provided with a bed or cot equipped with a comfortable mattress (a minimum of three inches thick), sheets, a pillow with a pillowcase, and a blanket.

The upper level of double-deck beds shall not be used for children under ten years of age. The upper level of double-deck beds are allowed for children ten years of age or older if a bed rail and safety ladder is provided.

Each child shall have clean and comfortable sleeping garments.

Source: Miss. Code Ann. §43-20-8. Rule 1.21.4 1.

Bathroom Facilities There shall be a bathtub or shower available for children of toddler age or older.

Bathtubs and showers shall be equipped to prevent slipping.

If night care is provided for infants, there shall be age appropriate bathing facilities for these children.

Bathrooms shall be located near the sleeping areas.

No children under six years of age shall be left alone or with another child while in the bathtub or shower.

All children shall be bathed separately.

All children shall be provided with an individual washcloth, towel, and soap for bathing, with fresh water for each child.

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Source: Miss. Code Ann. §43-20-8. Subchapter 22:

SCHOOL AGE CARE & SUMMER DAY CAMP

Rule 1.22.1 General For a child care facility operating pursuant to a license for "School Age Care,” or Summer Day Camp, the regulations for child care facilities shall apply, except when inconsistent with the requirements of this section and then the requirements of this section take precedence. Source: Miss. Code Ann. §43-20-8. Rule 1.22.2

Definition

A summer day camp is defined as a child care facility serving children ages 5 to 12 that operates during May, June, July, and/or August only, for a minimum of 22 days and a maximum of 16 weeks.

A school age program is defined as a child care facility that operates during the school year serving children ages 5 to 12. These programs may also operate 12 months a year. School age programs that operate 12 months a year shall meet “School Age Program” space requirements for determining maximum capacity.

Source: Miss. Code Ann. §43-20-8. Rule 1.22.3 Indoor Square Footage and Grouping A minimum of 25 square feet of usable indoor floor space, per child per room, shall be maintained for each child. This shall not include hallways, bathrooms, closets, storage rooms, offices, or kitchens. When a room is used during meals time, the minimum square footage requirement will not apply. When children are placed in groups, the maximum group size shall be determined by the following chart

Age of Children in the Group

MAXIMUM number of children ALLOWED in a group of children this age

MINIMUM number of caregivers REQUIRED for a group of children this age

MINIMUM square footage REQUIRED for a group of children this age

5-9 years

40 children

2 caregivers

25 square feet per child

10-12 years

50 children

2 caregivers

25 square feet per child

When Summer Day Camp activities for children are routinely conducted outdoors or off the premises for six or more hours each day, the following requirements shall apply: a.

There shall be a permanent structure that serves as a home base where parents deliver and pick up children.

There shall be a minimum of ten square feet per child usable indoor space available in the event of inclement weather.

School age programs require that a minimum of 25 square feet of usable indoor floor space, per child per room shall be maintained for each child. This shall not include hallways, bathrooms, closets, storage rooms, offices, or kitchens. When a room is used for meals, the minimum square footage per child requirement will not apply.

Source: Miss. Code Ann. §43-20-8. Rule 1.22.4

Nutrition

1. In School Age and Summer Day Programs meals and/or snacks may be provided by parents/guardians. 2. Parents/Guardians must be given and adhere to the policies regarding acceptable nutritional standards, as in Subchapter 12. 3. When nutritional standards are not met by meals and/or snacks provided by the parent/guardian, it is the program’s responsibility to see that children are provided an acceptable meal and/or snack. 4. For Summer Day Camps operating primarily as an outdoor program, the following exceptions may apply: a.

Milk is not required.

b. If food is brought from home or catered, cold storage must be available.

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All School Age/Summer Day Programs shall have an adequate supply of potable fresh water from a Mississippi State Department of Health approved source.

Source: Miss. Code Ann. §43-20-8. Rule 1.22.5

Transportation

The staff-to-child ratio shall be maintained at all times.

The driver of the vehicle may be counted as a caregiver while transporting school age children only.

A licensed child care program must never leave children unattended inside or outside of a vehicle.

Source: Miss. Code Ann. §43-20-8. Rule 1.22.6

Toilets and Lavatories

For every thirty (30) children, one (1) toilet and one (1) lavatory is required.

Urinals shall count as one-half (½) a toilet.

Separate facilities for boys and girls shall be provided.

School age programs that are located in schools are exempt from the requirements of hot water at sinks utilized by the children in attendance.

Source: Miss. Code Ann. §43-20-8. Rule 1.22.7 Playgrounds: School age programs serving only school age children that are located in schools are exempt from the requirements Subchapter 9, Rule 1.9.2 Playground Equipment and Subchapter 10, rule 1.10.9 Indoor Playground Area of these regulations except that playground equipment shall be in good repair. Rule 1.22.8 In after school programs, screen time is limited to one hour per day. Screen or media used for educational purposes is acceptable. Source: Miss. Code Ann. §43-20-8. Rule 1.22.9 1.

Summer Day Camp & School Age Program Director Qualifications

A summer day camp director shall be at least 21 years of age, and

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shall have, at a minimum: a.

A bachelor's degree with a minimum of 18 semester hours in elementary or secondary education or a field such as recreation, physical education, psychology (with emphasis in child/adolescent psychology), or special education, or one related to day camp or school age program operations. OR b.

A two-year associate degree in child development technology or related field. OR

A Mississippi Department of Human Services Office for Children and Youth Director’s Child Care Credential, or 15 semester hours credit with a grade of “C” or better from an accredited college or university in courses listed in #1 above with an additional two years of experience as a caregiver or caregiver assistant in a licensed child care facility (Any college course(s) submitted for consideration are subject to approval by the licensing authority). OR

A high school diploma or equivalent (GED) and four years’ experience in a school age program or four summers in a day camp program.

2. Transcripts shall be provided for review by the licensing agency. Source: Miss. Code Ann. §43-20-8. Rule 1.22.10 Caregiver CPR and First Aid Certification 1. All caregivers in summer day camps are required to have current CPR and first aid certification, copies of which shall be kept with their personnel records. 2. In school age programs that operate in a central location there . 79

shall be at least one caregiver on the premises at all times the facility is in operation that has a current certification in CPR and first aid. When groups of children are away from the central location for field trips etc., there shall be at least one caregiver with the group that holds a current certification in CPR and first aid. Source: Miss. Code Ann. §43-20-8. Rule 1.22.11 Facility Record Storage Facility records may be retained in the administrative office. Source: Miss. Code Ann. §43-20-8. Rule 1.22.12 Equipment Archery equipment, firearms (e.g., skeet shooting, target practice, etc.), power equipment, and other potentially hazardous items shall be stored in a locked area when not in use. These items shall be used by children only under the direction and supervision of a program staff member. Source: Miss. Code Ann. §43-20-8. Rule 1.22.13 Immunization Requirements Children properly enrolled in a Summer Day Camp or School Age Program are not required to have a Certificate of Immunization Compliance (MSDH Form 121) in their record. Source: Miss. Code Ann. §43-20-8. Subchapter 24:

HOURLY CHILD CARE

Rule 1.24.1 General For a child care facility operating pursuant to a license for an "Hourly Child Care,” the regulations for child care facilities shall apply, except when inconsistent with the requirements of this section, and then the requirements of this section take precedence. Source: Miss. Code Ann. §43-20-8. Rule 1.24.2 1.

Definition An "Hourly Child Care Facility" is defined as a facility that meets the provisions of these regulations for a "Child Care Facility" and: a.

Limits the care of a child to no more than eight hours per stay not to exceed a total of

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45 hours in any calendar month period. b.

Provides supervised, short term, hourly care on a temporary basis in conjunction with a specific facility or business complex such as, but not limited to, hotels; shopping malls; recreational, sporting, or entertainment facilities.

Hourly child care facilities are not appropriate for full time child care and will not be allowed to provide that type of service. When it is determined by the licensing agency that a facility provides child care services on a full time basis, the facility shall meet all requirements for a regular child care facility as set forth in the preceding sections of these regulations.

Source: Miss. Code Ann. §43-20-8. Rule 1.24.3

Facility Policy and Procedures

Parents shall be provided a written statement of policies pertaining to emergencies, meals, snacks, procedures for releasing a child to parent, and any other information regarding hourly child care facility operation. All policies and procedures will be submitted to the licensing agency and reviewed prior to a license being issued. Written guidelines will be provided to applicants as part of the application packet.

The care of a child shall be no more than eight hours per stay and shall not exceed a total of 45 hours in any calendar month period.

When business hours exceed 12 hours in a 24-hour period, the program will be reviewed on an individual basis for compliance with regulations addressing evening and overnight care.

Source: Miss. Code Ann. §43-20-8. Rule 1.24.4 Personnel Requirements Students in a field study placement, a practicum, or vocational child care training program may not assist in the care of the children in hourly child care facilities. Source: Miss. Code Ann. §43-20-8. . 81

Rule 1.24.5 Records and Reports In addition to all records and reports required in these regulations, hourly child care facilities shall maintain a log containing the name, address, and home phone number of each child along with the date and time of arrival and departure. The hourly child care facility shall maintain information necessary to contact local law enforcement officials and the Mississippi Department of Human Services when a child is left at the facility past its hours of operation, or for an extended period. Source: Miss. Code Ann. §43-20-8. Rule 1.24.6 Health Records Sample forms for duplication will be provided to operators to ensure adequate health information is taken on the children served. Only forms that substantially comply with the sample forms will be acceptable. Registration forms will include a signed statement that will serve as verification that a child has received all age-appropriate immunizations. Other information to be included on the form will be the home or forwarding phone numbers and addresses to be used when the parent must be informed of situations or conditions after the child is no longer at the hourly child care facility. Source: Miss. Code Ann. §43-20-8. Rule 1.24.7 Program of Activities Hourly child care facility programs are exempt from the requirement that a planned written program of activities be submitted as part of the licensing process. However, the facility shall provide adequate space and equipment to allow children to choose between quiet and active play. Appropriate toys and books for quiet play shall be maintained in a physically separate area that is a sufficient distance from active play to reduce noise and to assure a quiet, relaxed environment. Source: Miss. Code Ann. §43-20-8. Rule 1.24.8 1.

Buildings and Grounds A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fee. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards.

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The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection. 2.

In non-land-based facilities, only ground level space with exits directly to the outside will be approved.

A written emergency evacuation route shall be posted in a conspicuous location within each room used by children. The plan will be subject to review, evaluation, and approval by the licensing agency.

Space requirements shall comply with the standards set forth in these regulations. However, in the absence of adequate outdoor playground area, not less than 25 percent nor more than 50 percent of the space allocated for children three to 13 years of age shall be set aside and dedicated to large muscle development activities. Such areas shall contain appropriate play equipment for large muscle development. Such equipment may include but is not limited to indoor gyms specifically designed and approved for children in the three- to 13-year-old age group. Final approval of the appropriateness of the equipment to be located in the designated area shall be made by the licensing agency.

If outdoor playground space is provided, but inadequate for the maximum capacity of the building, a schedule shall be provided to show how outdoor playtime will be made available to all the children. At no time will there be more children on the playground than the maximum number allowed computed at 75 square feet per child. Maximum outdoor playground area capacity shall be posted and adhered to at all times the area is in use.

When kitchens are not on-site, the hourly child care facility is required to maintain adequate storage and refrigeration for snacks. In addition, food shall be served in disposable containers unless an acceptable method of dishwashing is available such as described in ( Appendix B). All food served shall come from a permitted kitchen or catering facility. Food service shall comply with the standard

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set in the current 10.0 Regulation Food Code as published by the Mississippi State Department of Health. 7.

The ratio of one hand washing lavatory and one toilet for every 30 children shall be maintained. Separate facilities are required for boys and girls.

Facilities must meet the requirements of Rule 1.2.2 (1)(k) and Rule 1.11.1 (8) of these regulations. Referenced Rule 1.2.2 (1)(k) and Rule 1.11.1 (8) refer to required testing for lead in child care facilities.

Source: Miss. Code Ann. §43-20-8. Rule 1.24.9 Nutrition Parents of children being cared for in an hourly child care facility shall be informed in writing of the availability of meals and the following requirements: 1.

When a child is in a facility for three or more hours, a snack shall be provided.

Children under five years of age will be provided snacks on request, regardless of the length of time spent in the facility.

At regular meal times, all children present shall be offered a meal. Regular meal times are defined as follows:

Breakfast - between 7 a.m. and 9 a.m.

Lunch - between 11 a.m. and 1 p.m.

Supper - between 5 p.m. and 7 p.m.

All meals shall meet the minimum nutritional standards.

Source: Miss. Code Ann. §43-20-8. Rule 1.24.10

Abuse and Neglect Reports

All employees will be informed by the hourly child care facility director of the individual's responsibility in reporting suspected abuse and neglect. Copies of the child abuse law shall be provided to each employee (Appendix "A").

Reports of suspected child abuse or neglect will be made to the Mississippi Department of Human Services and/or local law enforcement officials in accordance with

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state law. Because abused or neglected children requiring immediate attention are often identified after traditional business hours of the Mississippi Department of Human Services, reports of this nature shall also be made to local law enforcement. 3.

Hourly child care facility operators and/or directors are encouraged to establish a working relationship with local law enforcement authorities and the Mississippi Department of Human Services. In extreme situations where local county Department of Human Services staff cannot be reached, operators and/or directors will report to the statewide 24-hour Child Abuse Hotline at 1-800-222-8000.

Operators and/or directors will work in conjunction with the local law enforcement and the Mississippi Department of Human Services to establish a workable procedure for reporting cases when a child has been left at the hourly child care facility for an extended period of time after business hours or when allowing a child to leave the hourly child care facility will place that child at risk or in potential danger.

Source: Miss. Code Ann. §43-20-8. Subchapter 25: HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES Rule 1.25.1

Emergency Suspensions of License

Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the child care facility constitutes a substantial hazard to the health or safety of the children cared for by the child care facility.

Whenever a license is to be suspended, the operator or director shall be notified in writing that the license, upon service of the notice, is immediately suspended. The notice shall contain the reason for the emergency suspension, and shall set a date for a hearing, which shall be within 14 days

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of the service of notice. Source: Miss. Code Ann. §43-20-8. Rule 1.25.2 Denial, Revocation, or Suspension of License The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any child care facility upon one more of the following grounds: 1.

Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license.

Conviction of an operator of any crime, if the licensing agency finds that the acts of which the operator has been convicted could have a detrimental effect on the children cared for by the child care facility. 3.

Violation of any of the provisions of the act or of these rules and regulations.

Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child.

Failure by the child care facility to have all criminal records and child abuse central registry checks on file at the facility.

Information received by the licensing authority as a result of the criminal records check (fingerprinting) or the child abuse central registry check on an operator.

Source: Miss. Code Ann. §43-20-8. Rule 1.25.3

Notification

Rule 1.25.4

District Level Hearing for Monetary Penalties: 1.

If requested in writing within ten calendar days of receipt of notice of the imposition of a monetary penalty, a district level hearing shall be provided in which the operator or applicant may show cause why the monetary penalty should not be imposed. The District Health Officer or his/her designee will preside at said hearing.

Any hearing requested pursuant to Subchapter 1.25.4(1) shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period.

The district level hearing shall be informal. There will be no court reporter present and the Department will not be represented by counsel. However, the hearing officer will take notes of the proceedings and will provide the licensee with a written order outlining his decision within ten calendar days of conclusion of the district level hearing.

Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level.

Source: Miss. Code Ann. §43-20-8. Rule 1.25.5

State Level Hearing 2.

If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, restriction, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee.

Within 30 calendar days of the hearing, or such period as

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determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health Officer. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator. 4.

At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense.

Source: Miss. Code Ann. §43-20-8. Rule 1.25.6 Appeal: Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the child care facility is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. If a facility is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties. Source: Miss. Code Ann. §43-20-8. Rule 1.25.7 Injunction: Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a child care facility with or without a license under the act, or otherwise in violation of these regulations. Source: Miss. Code Ann. §43-20-8. Rule 1.25.8

Criminal

Penalties:

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Any

person

establishing,

conducting, managing, or operating a child care facility without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense. Source: Miss. Code Ann. §43-20-8. Rule 1.25.9 Violations and Penalties 1. In the event of an emergency occurring at a child care facility which makes it difficult or impossible to comply with any of these Rules, the facility shall not be considered to be in violation of these specific Rules. For purposes of this Rule 1.25.9, the term “emergency” shall include only the following: a. Inclement weather; b. Damage to the facility and/or structure which might require moving, transferring or consolidation or children; c. Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises; d. During any declaration of emergency by local or state officials; e. An injury or illness of a child at the facility requiring the immediate attention of one or more caregivers, resulting in non-compliance with childto-staff ratio or room capacity; and f. During a period when Department inspectors or other government official require facility staff to temporarily not be able to perform their normal supervisory duties. 2. Any Class I violation of these regulations is the discretion of the licensing agency and is punishable by a monetary penalty of five hundred dollars ($500.00) for a first occurrence and a monetary penalty of one thousand dollars ($1000.00) for each subsequent occurrence of the same violation. Each violation is considered a separate offense. The following are Class I violations: a. Failure to prevent the death, burns, dismemberment, or permanent disability of a child. b. Allowing a child to be unattended at a licensed . 89

child care facility before or after operating hours. This also includes a child being left alone during operating hours when no staff is present at the facility. Further, a child left unattended outside of a child care facility is also considered to be a Class I violation. c. Allowing a child to be unattended when not at the licensed facility but under the care of the licensed facility. 3. Should a facility be cited for Class I violations on two separate occasions, it may be cause for suspension or revocation of the facility license for habitual noncompliance with the Regulations Governing Licensure of Child Care Facilities. 4. Any Class II violation of these regulations is the discretion of the licensing agency and is punishable by a monetary penalty of fifty dollars ($50.00) for the first occurrence and a monetary penalty of one hundred dollars ($100.00) for each subsequent occurrence within the same licensure term. Each violation is considered a separate offense. The following are Class II violations: a. Failure to comply with Personnel Requirements and Records. b. Failure to comply with Emergency Preparedness and Evacuation Planning. c. Failure to comply with Staff to Child Ratio, Group Size, and Supervision. d. Failure to comply with Discipline and Guidance. e. Exceeding the maximum capacity for a facility or room. f. Allowing a child to leave the child care facility with an unauthorized individual. g. Violation of environmental health regulation. h. Failure to report a serious occurrence. i. Failure to report a communicable disease. j. Violation of transportation and safety policies, procedures, and regulations. k. Failure to have proper immunization documentation in each child's record and each employee's record. l. Failure to display license and/or complaint notice. m. Failure to meet conditions or restrictions placed on a license. The monetary penalty will be in addition . 90

to the immediate closure of the facility for failure to meet any conditions or restrictions as stated on the restricted license. n. Failure to comply with the nutrition standards. o. Failure to comply with the requirements of Smoking, Tobacco Products, and Prohibited Substances. p. Altering of any documents supporting suitability for employment in a child care facility. 5. Should a facility be cited for Class II violation on four separate inspection dates, it may be cause for suspension or revocation of the facility license for habitual noncompliance with the Regulations Governing Licensure of Child Care Facilities. 6. A Class III violation of these regulations, at the discretion of the licensing agency, is punishable by a monetary penalty of twenty-five dollars ($25.00) for each occurrence. A Class III violation is any violation of these regulations not listed as a Class I or Class II violation. 7. Unless they are appealed, all monetary penalties shall be payable within 30 business days of being levied. If monetary penalties are appealed, they shall be payable within 30 business days of final disposition. 8. An operator shall have the right to appeal a monetary penalty imposed pursuant to this section of the regulations, in accordance with the policy of the licensing agency. Any appeal of a monetary penalty must be filed with the licensing agency within ten business days of being levied. 9. An operator shall not be granted a license, nor shall a license be renewed for any operator with outstanding monetary penalties. 10. If a license expires during the appeal process, it shall be administratively extended, and documentation of the extension shall be provided to the licensee. A facility given an administrative extension during the appeal process, shall remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all . 91

required or requested documents, and payment of all applicable fees and/or monetary penalties. Source: Miss. Code Ann. §43-20-8. Subchapter 26:

RELEASE OF INFORMATION

Rule 1.26.1 Information in the possession of the licensing agency concerning the license of individual child care facilities may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a child care facility. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 43- 21-353(8) and Section 43-21-257 Mississippi Code of 1972, annotated. Source: Miss. Code Ann. §43-20-8. APPENDIX A § 43-21-353. Duty to inform state agencies and officials; duty to inform individual about whom report has been made of specific allegations. (1)

Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, public or private school employee or any other person having reasonable cause to suspect that a child is a neglected child or an abused child, shall cause an oral report to be made immediately by telephone or otherwise and followed as soon thereafter as possible by a report in writing to the Department of Human Services, and immediately a referral shall be made by the Department of Human Services to the youth court intake unit, which unit shall promptly comply with Section 43-21-357. In the course of an investigation, at the initial time of contact with the individual(s) about whom a report has been made under this Youth Court Act or with the individual(s) responsible for the health or welfare of a child about whom a report has been made under this chapter, the Department of Human Services shall inform the individual of the specific complaints or allegations made against the individual. Consistent with subsection (4), the identity of the person who reported his or her suspicion shall not be disclosed. Where appropriate, the Department of Human Services shall additionally make a referral to the youth court prosecutor.

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Upon receiving a report that a child has been sexually abused, or burned, tortured, mutilated or otherwise physically abused in such a manner as to cause serious bodily harm, or upon receiving any report of abuse that would be a felony under state or federal law, the Department of Human Services shall immediately notify the law enforcement agency in whose jurisdiction the abuse occurred and shall notify the appropriate prosecutor within forty-eight (48) hours, and the Department of Human Services shall have the duty to provide the law enforcement agency all the names and facts known at the time of the report; this duty shall be of a continuing nature. The law enforcement agency and the Department of Human Services shall investigate the reported abuse immediately and shall file a preliminary report with the appropriate prosecutor's office within twentyfour (24) hours and shall make additional reports as new or additional information or evidence becomes available. The Department of Human Services shall advise the clerk of the youth court and the youth court prosecutor of all cases of abuse reported to the department within seventytwo (72) hours and shall update such report as information becomes available. (2)

Any report to the Department of Human Services shall contain the names and addresses of the child and his parents or other persons responsible for his care, if known, the child's age, the nature and extent of the child's injuries, including any evidence of previous injuries and any other information that might be helpful in establishing the cause of the injury and the identity of the perpetrator.

(3)

The Department of Human Services shall maintain a statewide incoming wide-area telephone service or similar service for the purpose of receiving reports of suspected cases of child abuse; provided that any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer or public or private school employee who is required to report under subsection (1) of this section shall report in the manner required in subsection (1).

(4)

Reports of abuse and neglect made under this chapter and the identity of the reporter are confidential except when the court in which the investigation report is filed, in its discretion, determines the testimony of the person reporting to be material to a judicial proceeding or when the identity of the reporter is released to law enforcement agencies and the appropriate prosecutor pursuant to subsection (1). Reports made under this section to any law enforcement agency or prosecutorial officer are for the purpose of criminal investigation and prosecution only and no information

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from these reports may be released to the public except as provided by Section 43-21-261. Disclosure of any information by the prosecutor shall be according to the Mississippi Uniform Rules of Circuit and County Court Procedure. The identity of the reporting party shall not be disclosed to anyone other than law enforcement officers or prosecutors without an order from the appropriate youth court. Any person disclosing any reports made under this section in a manner not expressly provided for in this section or Section 43-21-261, shall be guilty of a misdemeanor and subject to the penalties prescribed by Section 43-21-267. (5)

All final dispositions of law enforcement investigations described in subsection (1) of this section shall be determined only by the appropriate prosecutor or court. All final dispositions of investigations by the Department of Human Services as described in subsection (1) of this section shall be determined only by the youth court. Reports made under subsection (1) of this section by the Department of Human Services to the law enforcement agency and to the district attorney's office shall include the following, if known to the department: (a) The name and address of the child; (b) The names and addresses of the parents; (c) The name and address of the suspected perpetrator; (d) The names and addresses of all witnesses, including the reporting party if a material witness to the abuse; (e) A brief statement of the facts indicating that the child has been abused and any other information from the agency files or known to the family protection worker or family protection specialist making the investigation, including medical records or other records, which may assist law enforcement or the district attorney in investigating and/or prosecuting the case; and (f) What, if any, action is being taken by the Department of Human Services.

(6)

(7)

In any investigation of a report made under this chapter of the abuse or neglect of a child as defined in Section 43-21-105(m), the Department of Human Services may request the appropriate law enforcement officer with jurisdiction to accompany the department in its investigation, and in such cases the law enforcement officer shall comply with such request. Anyone who willfully violates any provision of this section shall be,

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upon being found guilty, punished by a fine not to exceed Five Thousand Dollars ($5,000.00), or by imprisonment in jail not to exceed one (1) year, or both. (8)

If a report is made directly to the Department of Human Services that a child has been abused or neglected in an out-of-home setting, a referral shall be made immediately to the law enforcement agency in whose jurisdiction the abuse occurred and the department shall notify the district attorney's office within forty-eight (48) hours of such report. The Department of Human Services shall investigate the out-of-home setting report of abuse or neglect to determine whether the child who is the subject of the report, or other children in the same environment, comes within the jurisdiction of the youth court and shall report to the youth court the department's findings and recommendation as to whether the child who is the subject of the report or other children in the same environment require the protection of the youth court. The law enforcement agency shall investigate the reported abuse immediately and shall file a preliminary report with the district attorney's office within forty-eight (48) hours and shall make additional reports as new information or evidence becomes available. If the out-of-home setting is a licensed facility, an additional referral shall be made by the Department of Human Services to the licensing agency. The licensing agency shall investigate the report and shall provide the Department of Human Services, the law enforcement agency and the district attorney's office with their written findings from such investigation as well as that licensing agency's recommendations and actions taken. Sources: Laws, 1979, ch. 506, § 41; Laws, 1980, ch. 550, § 17; Laws, 1984, ch. 342; Laws, 1985, ch. 360; Laws, 1993, ch. 522, § 1; Laws, 1994, ch. 387, § 1; Laws, 1994, ch. 591, § 3; Laws, 1995, ch. 335, § 1; Laws, 1996, ch. 323, § 2; Laws, 1997, ch. 440, § 10; Laws, 1998, ch. 340, § 1; Laws, 1998, ch. 557, § 1; Laws, 2004, ch. 489, § 3; Laws, 2006, ch. 600, § 4; Laws, 2007, ch. 337, § 3, eff from and after July 1, 2007. § 43-21-355. Immunity for reporting information. Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, school attendance

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officer, public school district employee, nonpublic school employee, licensed professional counselor or any other person participating in the making of a required report pursuant to Section 43-21-353 or participating in the judicial proceeding resulting therefrom shall be presumed to be acting in good faith. Any person or institution reporting in good faith shall be immune from any liability, civil or criminal, that might otherwise be incurred or imposed. Sources: Laws, 1979, ch. 506, § 42; Laws, 1980, ch. 550, § 18; Laws, 1982, Ex Sess, ch. 17, § 22; Laws, 1993, ch. 522, § 2; Laws, 1994, ch. 591, § 4; Laws, 2004, ch. 489, § 4; Laws, 2006, ch. 430, § 1; Laws, 2006, ch. 600, § 5, eff from and after July 1, 2006.

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APPENDIX B DISHWASHING PROCEDURE The best way to wash, rinse, and disinfect dishes and eating utensils is to use a dishwasher with a sanitizing cycle. The final sanitizing rinse of a dishwasher must reach a temperature of 180 degrees. If a dishwasher is not available or cannot be installed, a three-compartment sink will be needed to wash, rinse, and disinfect dishes. A two-compartment or onecompartment sink can be used in child care facilities (located in an occupied residence) licensed for 12 or fewer children by adding one or two dishpans, as needed. In addition to three compartments or dishpans, you will need a dish rack with a drain board to allow dishes and utensils to air dry. To wash, rinse, and disinfect dishes by hand: • Fill one sink compartment or dishpan with hot tap water and a dishwashing detergent. • Fill the second compartment or dishpan with hot tap water. •

Fill the third compartment or dishpan with hot tap water and 1-1/2 tablespoons of

liquid chlorine bleach for each gallon of water. • Scrape dishes and utensils and dispose of excess food. •

Immerse scraped dish or utensil in first sink compartment or dishpan and wash

•

thoroughly.

•

Rinse dish or utensil in second dishpan of clear water.

•

Immerse dish or utensil in third dishpan of chlorinated water for at least 1 minute.

•

Place dish or utensil in a rack to air dry.

Note: Food preparation and dishwashing sinks should only be used for these activities and should never be used for routine hand washing or diaper changing activities. Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention. . 97

Source: Miss. Code Ann. §43-20-8.

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APPENDIX C See Public Playground Safety Handbook. As published by the United States Consumer Product Safety Commission – Saving Lives and Keeping Families SafeCHAPTER 2: REGULATIONS GOVERNING LICENSURE OF CHILD CARE FACILITIES FOR 12 OR FEWER CHILDREN IN THE OPERATOR’S HOME Subchapter 1.

GENERAL

Rule 2.1.1 Legal Authority; The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child care facilities defined under the law. Source: Miss. Code Ann. §43-20-8. Rule 2.1.2

Purpose

1. The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of child care facilities as defined herein to assure that certain minimum standards are maintained in such facilities. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing. This document and its appendices constitute the "Regulations Governing the Licensure of Child Care Facilities." 2. A child care facility may exceed the minimum quality standards required in these regulations, but may not operate without meeting the minimum standards set forth in these regulations. 3. The maximum capacity of a child care facility is determined by the indoor square footage, kitchen square footage, outdoor playground area, and the number of toilets, urinals, and hand washing lavatories, with the lowest capacity determination being controlling. The maximum capacity of each room that is utilized by the children in a child care facility is calculated individually and may not be exceeded except when provided in these regulations. 4. A child care facility is subject to inspection at anytime at the discretion of the licensing agency. 5. The Mississippi State Department of Health shall maintain a complaint hotline to accommodate reporting of complaints. The department shall investigate each complaint and maintain a log of such complaints. The identity of the reporting party . 99

shall not be disclosed to any other person than the Child Care Licensing Division staff unless upon order of a court of competent jurisdiction. Source: Miss. Code Ann. §43-20-8. Rule 2.1.3 Severability: If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable. Source: Miss. Code Ann. §43-20-8. Rule 2.1.4

Definitions

Act: The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972.

Agency Representative: An authorized representative of the Mississippi State Department of Health.

Caregiver: A person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation.

Child Care Facility (Facility): A place which provides shelter and personal care for six or more children who are not related within the third degree computed according to the civil law to the operator and who are under 13 years of age, for any part of the 24 hour day, whether such place be organized or operated for profit or not. The term “child care facility” includes day nurseries, day care centers, child care centers, preschool programs, and any other facility that fall within the scope of the definition set forth above. a. Exemptions: To the extent provided by law, including those facilities or programs which satisfy one or more of the requirements for exemption provided in Miss. Code Ann. § 43-20-5(a), an exemption from the provisions of the Act shall be recognized by the licensing agency. Facilities or programs claiming exemption shall be required, upon the written request of the licensing agency, to provide documentation of the facts claimed to support the basis for the exemption, which documentation shall be provided within 30 days of the request by the licensing agency and shall be sworn by affidavit to be true and accurate under the penalties of perjury. However, any entity exempt from the requirements to be licensed but voluntarily chooses to obtain a license is subject to all provisions of the licensing law and these regulations.

Children with Special Needs: A child needing adaptation in a particular child care facility to access programming and the physical environment

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Director Any individual, designated by the operator, who has met minimum state requirements and who has on-site responsibility for the operation of a child care facility. This person may or may not be the operator.

Director Designee: Any individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. A director designee shall, at a minimum, be at least 21 years of age, have a high school diploma or GED, and 2 years paid experience in a licensed child care facility. Director Designees shall not retain sole director authority in a facility for more than 24 total hours per calendar week. Exception: A facility may have a Director Designee serve for a maximum of 14 consecutive calendar days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc.

Group: The children assigned to a caregiver or team of caregivers, occupying an individual classroom, or well-defined physical space within a larger room.

Hazardous Condition: A situation or place that presents a possible source of injury or danger.

10.

Health: The condition of being sound in mind and body and encompassing an individual's physical, mental and emotional welfare.

11.

Infant: Any child under the age of 12 months.

12.

Licensing Agency: The Mississippi State Department of Health.

13.

Operator; Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a child care facility. The child care facility license shall be issued in the name of the operator, or if there is more than one operator, in the name of one of the operators. In the event that there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all operators of a facility, including, but not limited to, a spouse who jointly owns, operates, or maintains the child care facility regardless of which operator is named on the license.

14.

Parent: As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to which a court of competent jurisdiction has granted legal authority over the child.

15.

Person: Any person, firm, partnership, corporation or association.

16.

Personal Care: Assistance rendered by personnel of the child care facility in performing one or more of the activities of daily living, which includes but is not

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limited to the feeding, personal grooming, supervising, and dressing of children placed in the child care facility. 17.

Physical Confines: The space inside the walls of the child care facility.

18.

Safety

19.

School Age Child: A child five years of age or older and eligible to be enrolled in public school.

The condition of being protected from hurt, injury or loss.

Note: A child that is five (5) years old age must have turned five (5) on or before September 1 to be considered a school age child. 20.

Service Staff: A person who provides support services such as cooking, cleaning, or driving a vehicle, but is not a caregiver.

21.

Toddler: Any child the age of 12 months and under the age of 24 months.

22.

Usable Space: In measuring facilities for square footage per child, usable space shall mean space measured on the inside, wall-to-wall dimensions. These spaces are exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff rooms, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. Usable space shall be areas dedicated to children’s activities (play, learning, rest, and eating) and shall be utilized for those purposes on a daily basis. Furnishings shall be equipment that is both size and age appropriate for children receiving care. The space occupied by inappropriate or adult size equipment shall be deducted from the children’s usable space.

23.

Volunteer: Any person who is not an employee who is at the facility or assists with children. a. Individuals who volunteer for 120 or more hours in a given licensure year shall meet the requirements of (1) criminal record and child abuse central registry checks to include being fingerprinted, and (2) valid Immunization Compliance Form #121. The facility shall document the time that a volunteer is at the facility. b. Further, any individual who has not been fingerprinted and has not had a child abuse central registry check completed, and received the Letter of Suitability for Employment shall never be left alone with children.

Source: Miss. Code Ann. §43-20-8. Subchapter 2. Rule 2.2.1

LICENSURE Requirement for Licensure

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1. No person shall establish, own, operate, conduct, or maintain a child care facility in this state without a license issued pursuant to these regulations. 2. The licensing authority will require no entity exempt from the licensure requirement to apply for a license. However, should an exempt entity desire to obtain a license, it will be subject to these regulations. Source: Miss. Code Ann. §43-20-8. Rule 2.2.2

Types of Licenses

1. Temporary License: The licensing agency may issue a temporary license to any child care facility. This license will allow the child care facility to operate pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the facility is licensed. The license issue date is the actual date documentation is received and approval for initial temporary license is granted; the expiration date is the last day of the sixth month following the issue date; examples: January 01 through June 30 or January 15 through June 30. NOTE: Before a Temporary License is issued and the facility allowed to begin operation the following items must be submitted to and/or verified by the licensing authority, i.e., Mississippi State Department of Health: a.

License Application and $100.00 application fee.

License fee - the amount of fee is determined by the licensed capacity of the facility.

Documentation that the facility has a qualified director for the child care program that meets the standards set forth in Rule 2.5.3.

An MSDH Immunization Form #121 for every employee or volunteer that is to begin work when the facility starts operation and/or have documentation indicating that they comply with the immunization requirements of the Mississippi State Department of Health.

Valid MSDH Fire Inspection Form #333.

Verification of passing an American National Standards Institute – Conference for Food Protection (ANSI-CFP) Accredited food manager training. Currently

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the following providers are authorized by the MSDH to provide the required training: i. National Restaurant Association, Inc., i.e., ServSafe®, ii. Environmental Health Testing, Inc., i.e., National Registry of Food Safety Professionals, iii. Prometic, Inc., or iv. Mississippi State University Extension Service, i.e., TummySafe©. NOTE: For information on ServSafe® or TummySafe© contact the Mississippi State University Extension Service at www.msucares.com. In addition, the Mississippi Restaurant Association (MRA) also provides ServSafe® training. The MRA can be contacted at www.msra.org. For information on the National Registry of Food Safety Professionals or Prometric, contact the MSDH Office of Environmental Heath at 601-576-7690. h.

Wastewater disposal approval.

Potable water source approval - drinking water.

Zoning approval.

Lead Testing approval: i.

Building - if constructed before 1965

ii.

Playground

l. Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the facility during all hours of operation. m. Approved Menu if applicable. n. Floor Plan. o. MSDH Maximum Capacity Worksheet (Form #28). p. MSDH Child Care Facility Inspection Report (Form #281). q. MSDH Child Care Facility Data Sheet (Form #286). r. MSDH Food Service Inspection (Form #301-302) - if applicable. s. Daily Schedule of Activities - developed by provider. t. Arrival and Departure Procedures - developed by provider. . 104

u. Emergency Policy – developed by provider. v. Verification of Two Emergency Relocation Sites – developed by provider: i. One site must be a minimum of one mile distant from the facility. ii. One site must be a minimum of five miles distant from the facility. w. Transportation Policy – not required if facility does not transport children. NOTE: An emergency transportation policy is required even if the facility does not plan to transport children. An emergency transportation policy shall encompass such events as emergency evacuation of the facility and emergency transporting of a child to receive medical attention. x. Proof of Vehicle Insurance – not required if facility does not transport children. y. Verification, in writing, that the operator has or does not have accident/liability insurance covering the business. z. Verification, in writing, that the operator has or does not have accident/liability insurance covering the children enrolled at the facility. aa. Discipline Policy – developed by the provider. NOTE: The discipline policy developed by the provider shall not allow any of the prohibited behaviors listed in Subchapter 14 of these regulations. bb. Verification that the owner/operator and director have completed mandatory training on: i. Regulations Governing Licensure of Child Care Facilities. ii. New Directors Orientation. iii. Playground Safety. NOTE: Contact the Mississippi State Department of Health, Child Care Facilities Licensure Division at 601-364-2827 for more information on the availability and location of the above referenced training. Information on available training classes and approved training providers is listed on the MSDH website at www.HealthyMS.com. Training classes provided by the Child Care Licensing Division are listed under the heading “MSDH Child Care Provider Training Calendar.” Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH Approved Staff Development Trainers” and “Approved Child Care Staff Development Providers.” . 105

2. Regular License: The licensing agency may issue a regular license when all conditions and requirements for licensure have met compliance. The duration of a regular license shall not exceed one year. 3. Probational License: The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period of time for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months. 4. Restricted License: The licensing agency may issue any type of license with conditions/restrictions when, at its discretion, the health or safety of the children require such a conditional/restrictive statement on the license. Such conditions/restrictions shall include but not be limited to certain individuals to be barred from the premises or any other situations that may endanger children and that should be so recorded on the license. Any violation of any such condition/restriction shall result in immediate emergency suspension of the license. When such conditions/restrictions no longer pose a threat to the children, the conditional/restrictive statement may be removed. Source: Miss. Code Ann. §43-20-8. Rule 2.2.3 Application for License: An application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require. Source: Miss. Code Ann. §43-20-8. Rule 2.2.4 License Fee: All application fees, licensure fees, renewal fees, and administrative charges shall be paid by certified check or money order payable to the Mississippi State Department of Health, are nonrefundable. Checks returned for insufficient funds, closed account, etc., shall be assessed an additional $50 fee. 1.

Application Fee...............................................................................................$130.00

Initial Licensure Fee ......................................................................................$ 97.50

Renewal Fee ....................................................................................................$ 97.50

Reinstatement Fee ..........................................................................................$260.00

Returned Check Fee ......................................................................................$ 50.00

Late Fee ...........................................................................................................$ 25.00

Fingerprinting Fee (Per Fingerprint Card) .................................................$ 50.00

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NOTE: Except for the fingerprinting fee, no governmental entity or agency that operates a child care facility shall be required to pay the fees set forth in this section. Third party providers that contract with a state agency for the provision of child care services are subject to all fees, monetary penalties, etc. Further, should an entity exempt from licensure apply for a license it shall be subject to all fees listed in this section. Source: Miss. Code Ann. §43-20-8. Rule 2.2.5 Certificate of Inspection by Fire Department: A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection. Source: Miss. Code Ann. §43-20-8. Rule 2.2.6 Inspection: An agency representative(s) shall inspect each child care facility prior to issuing or renewing a license to assure compliance with these regulations. Source: Miss. Code Ann. §43-20-8. Rule 2.2.7 Record of Inspection : Whenever an inspection is made of a child care facility, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made. Source: Miss. Code Ann. §43-20-8. Rule 2.2.8

Renewal of License

1. The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall mail a renewal notice, at least 75 days prior to the expiration date of the license, to the address of the operator registered with the licensing agency. The operator shall: a. Complete the renewal form. b. Submit all certificates of inspection and approval required by the licensing agency. c. Enclose the renewal fee. d. File the above with the licensing agency at least 30 days prior to the expiration date on the license.

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NOTE: Renewal applications postmarked less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. 2. An operator who does not file the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. Said license may be reinstated by the licensing agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one month of the expiration date of the license. After the one month reinstatement period, it shall be required that an application for an initial license be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met. Source: Miss. Code Ann. §43-20-8. Rule 2.2.9 License Not Transferable or Assignable: Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child care facility or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included. Source: Miss. Code Ann. §43-20-8. Rule 2.2.10 Display of Licenses: The current license issued by the licensing agency to the named child care facility and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. Source: Miss. Code Ann. §43-20-8. Subchapter 3.

RIGHT OF ENTRY AND VIOLATIONS

Rule 2.3.5 Right of Entry: An agency representative may enter any child care facility for making inspections or investigations to determine compliance with these regulations. Source: Miss. Code Ann. §43-20-8. Rule 2.3.6 Violations: If violations noted on the inspection form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations. Source: Miss. Code Ann. §43-20-8. Subchapter 4.

FACILITY POLICY AND PROCEDURES

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Rule 2.4.5 Parental Information Before a child's enrollment, the parent shall be provided with the following: 1. Operating information: a. The child care facility's purpose, scope of service provided, philosophy, and any religious affiliation. b. Name(s), business phone number, business address, and home phone number of the operator, director or an individual in authority who can be reached after the facility’s normal hours of operation. c. The phone number of the child care facility. d. Organization chart or other description of established lines of authority of persons responsible for the child care facility's management within the organization. e. The program and services provided and the ages of children accepted. f. The hours and days of operation and holidays or other times closed. g. The procedures for admission and registration of children. h. Tuition, plans for payment, and policies regarding delinquent payments. i. Types of insurance coverage for children, or a statement that accident insurance is not provided or available. j. If a facility does not provide liability insurance there shall be a statement in the child’s record, signed by the parent indicating that the parent is aware that the facility does not carry liability insurance. k. Reasons/circumstances and procedures for removal of children from rolls when parents are requested by facility staff to remove a child. l. Procedures to include the amount of notice a parent is required to give the facility before removing a child. m. Policy governing the maximum hours per day or week that a child can be left at the child care facility. 2. Arrival and departure procedures for children: a. Procedure, approved by the licensing authority, for assuring a child's safe arrival and departure (All children shall be signed in and out of the facility by an authorized individual.). b. Procedures for protecting children from traffic and other hazards during arrival and departure and when crossing streets. . 109

c. Policy for release of children from the child care facility only to responsible persons for whom the child care facility has written authorization. d. Policy governing a parent picking up a child after closing hours and procedures if a child is not picked up. 3. Program and activities information: a. Policies and procedures about accepting and storing a child's personal belongings. b. Discipline policies including acceptable and unacceptable discipline measures. c. Transportation and safety policies and procedures. d. Policies prohibiting the photographing of a child without parental consent. e. Policies regarding a child's participation in extracurricular activities not sponsored by the child care facility, including but not limited to baseball, softball, soccer, ballet, or gymnastics. f. Policies regarding water activities and safety procedures. These policies shall include those water activities that take place away from the child care facility property, e.g., taking children to a public swimming pool. g. Policies encouraging sun safety practices and activities. 4. Health and emergency procedures: a. Procedures for storing and giving a child medication. b. Policy for reporting suspected child abuse. c. Provision for emergency medical care, treatment of illnesses and accidents, which include: i. A plan to handle a child in a medical crisis. ii. A plan to obtain prompt services of physician and hospitalization, if needed. iii. A plan for immediately notifying the parent of any illness, accident, or injury to the child. iv. A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds. d. Evacuation plan including procedures for notifying the parents of the relocation site.

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e. Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering facility with weapons, bomb threats, or conditions posing an immediate threat to children. 5. State regulations: a. A summary of the licensing regulations and any appendices thereto, provided by the licensing agency. b. Each child's record shall contain a statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency for such distribution. c. The name and phone number of the MSDH licensing official responsible for the inspection of the facility. d. The toll free 1-866-489-8734 Child Care Facility Complaint Hot Line phone number. Source: Miss. Code Ann. §43-20-8. Rule 2.4.6

Smoking, Tobacco Products, and Prohibited Substances

1. Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a child care facility. 2. The use of alcohol, illegal use of prescription drugs, or use of illegal drugs is prohibited within the physical confines or the campus of a child care facility. 3. Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. This definition includes volunteers and parents. Source: Miss. Code Ann. §43-20-8. Rule 2.4.7 Parental Access; Child care facilities shall assure the parent that they have welcome access to the child care facility at all times. Welcome access shall be defined as a parent having access to areas of the facility available to his child and non-disruptive to normal daily activities. Source: Miss. Code Ann. §43-20-8. Rule 2.4.8 Changes in Facility Operations: The operator shall immediately notify the licensing agency of any major changes affecting areas of the child care facility's

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operations. Such major changes include, but are not limited to, operator, director, location, physical plant, or number of children served. Source: Miss. Code Ann. §43-20-8. Rule 2.4.9 Notice of Legal Action; The licensing agency shall be notified within seven days, in writing, if notice is received of legal action against the child care facility. Source: Miss. Code Ann. §43-20-8. Rule 2.4.10 Posting of Information: The following items shall be posted conspicuously in the child care facility at all times: 1. Accessible to employees and parents: a. License. b. Daily activity schedule posted in each classroom. c. Inspection form, if applicable, or Menus and Food Service Permit, if applicable. d. Evacuation route. e. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. 2. In kitchens: a. Menus. b. Evacuation route. 3. The evacuation route in all rooms utilized by children. Source: Miss. Code Ann. §43-20-8. Rule 2.4.11 Weapons Prohibited : All firearms in the home shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under lock in a room not accessible to children. Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc. Source: Miss. Code Ann. §43-20-8. Subchapter 5. Rule 2.5.5

PERSONNEL REQUIREMENTS General Requirements For Personnel

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1. Each employee or potential employee of a child care facility, whether full time, part time, temporary, substitute, or volunteer, shall be of good moral character and shall meet the minimum qualifications for the respective job classification, as set forth in these regulations. 2. Any individual who, in the opinion of the licensing authority, appears to be unable to physically or mentally care for children on a daily basis and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing authority, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a. Physical ability to exit the children during a fire drill in under two minutes; b. Ability to read medication directions and properly dispense medication to children (required only if the facility dispenses medication) Source: Miss. Code Ann. §43-20-8. Rule 2.5.2 Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant (CCDBG) Act of 2014, and Federal Rules and Regulations .43 Criminal Background Checks all operators, employees, and prospective employees of a child care facility and any individual residing in a residence licensed as a child care facility shall have an FBI national criminal history records check (fingerprint), State criminal history records check (fingerprint), State child abuse registry check, National Crime Information Center (NCIC) National Sex Offender Registry (NSOR) sex offender registry check, and State sex offender registry check. Further, such checks must be completed at least every five years on the owner and staff of a child care facility. 1.

Before a prospective staff member may begin work in a child care facility a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. The child care facility shall submit the following for processing: a.

A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health (MSDH) for processing. A copy of the submitted fingerprint card, fees paid, and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Mississippi State Department of Health (Department) verifying the employee’s suitability for employment. If the facility is notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall reprint the individual and/or resubmit the necessary information within ten days of the dated letter on the notification.

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A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department of the employee’s suitability for employment.

Each licensed child care facility with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a Department maintained webpage: http://www.HealthyMS.com. (Licensed providers without electronic capabilities will receive hardcopy notification of an employee’s suitability status.)

Upon receipt of notification, either electronically or hardcopy, that the employee has been deemed suitable for employment in a child care facility, the facility shall provide the employee the original Letter of Suitability and shall maintain a copy of the suitability letter for the facility files. a.

Unless otherwise voided, the letter confirming an employee’s Suitability for Employment is valid for a period of five years from the date of the letter. However, if an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new criminal history records check must be submitted and approved before the individual may begin work in a child care facility regardless of the date of issuance on the letter.

The facility owner and each employee shall have criminal history records checks (fingerprint), child abuse registry checks, and sex offender registry checks completed at least every five years.

The Letter of Suitability is not transferable to another program licensed by the Child Care Licensure Bureau after the date of expiration as specified within the suitability letter.

If an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new criminal history records check must be submitted and approved before the individual may begin work in a child care facility.

Individuals under the age of 18 that are employed by a child care provider for compensation are required to complete a comprehensive background check that includes everything an adult criminal history records check requires.

Child care providers shall require each applicant that lives outside of Mississippi and/or has lived outside of Mississippi within the last 5 years to complete an interstate background check for the previous state(s) of residence, which includes at a minimum a state criminal history record check, state sex offender registry check,

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and state child abuse and neglect registry check. The interstate background check must be completed within 45 days of the submission of the prospective employee’s child care employment application. 6.

Volunteers a.

The facility shall maintain the following on any individual who volunteers in a child care facility for less than 120 hours per licensure year:

A provider will maintain a timesheet on all volunteers indicating the number of hours they worked each time they were at the facility. ii. Immunization Compliance Form 121.

ii. Immunization Compliance Form 121. Source: Miss. Code Ann. §43-20-8. Rule 2.5.6 Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, all operators, employees and prospective employees of a child care facility and any individual residing in a residence licensed as a child care facility shall have a criminal history records check (fingerprint), child abuse registry check and a sex offender registry check. 1. Within ten working days from the date of employment, the child care facility shall submit the following for processing: a. A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health for processing. A copy of the submitted fingerprint card, fees paid and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department (MSDH) verifying the employee’s suitability for employment. Should the facility be notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall reprint the . 115

individual and/or resubmit the necessary information within ten days of the dated letter on the notification. b. A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department (MSDH) of the employee’s suitability for employment. 2. Although an individual is allowed to begin employment prior to the receiving confirmation of the employee’s status for employment suitability, at no time shall the facility allow that individual to provide unsupervised care or be left alone with a child until the facility receives notification from the Department (MSDH) verifying that employee’s suitability for employment. Each licensed child care facility with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a MSDH maintained webpage: http://www.msdh.state.ms.us. (Licensed providers without electronic capabilities will receive hardcopy notification of an employee’s suitability status.) 3. Upon receipt of notification, either electronically or hardcopy, that the employee has been deemed suitable for employment in a child care facility, the facility shall provide the employee the original Letter of Suitability and shall maintain a copy of the suitability letter for the facility files. Unless otherwise voided, the letter confirming an employee’s Suitability for Employment is valid for a period of five years. However, if there is no break in service from the submitting licensed provider of origin and/or the same campus, as specified on the suitability letter, the Letter of Suitability will remain valid for as long as the individual remains employed at the licensed facility of origin. The Letter of Suitability is not transferable to another program licensed by the Child Care Licensure Division after the date of expiration as specified within the suitability letter. 4. Individuals under the age of 18 are not required to be fingerprinted. However, that individual must never be left alone with children. 5. The facility shall maintain the following on any individual who volunteers in a child care facility for 120 or more hours per licensure year: a. Letter of Suitability for Employment that reflects the completion of the criminal records check, child abuse registry check, and sex offender check. b. Immunization Compliance Form 121. Source: Miss. Code Ann. §43-20-8.

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Rule 2.5.7 Child Care Director Qualifications: A child care director shall be least 21 years of age and shall have at a minimum: 1. A bachelors degree in early childhood education, child development, elementary education, child care, special education, psychology (with emphasis on child psychology), or family and consumer sciences (with emphasis on child development), or equivalent degree from another child-related field or course of study. OR 2. two-year associate degree from an accredited community or junior college in child development technology which must include a minimum of 480 hours of practical training, supervised by college instructors, in a college operated child care learning laboratory. OR 3. A two-year associate degree from an accredited community or junior college in child development technology or child care and two years paid experience in a licensed child care facility. OR 4. Two years paid experience as a caregiver in a licensed child care facility, and either (1) a current Child Development Associate (CDA) credential from the Council for Early Childhood Professional Recognition (CECPR), or (2) a Mississippi Department of Human Services (MDHS) Division of Early Childhood Care and Development (DECCD) Child Care Director’s Credential or MDHS OCY Child Care Director’s Credential, or (3) 24 semester hours credit with a grade of “C” or better from an accredited college or university in courses specific to early childhood. OR 5. A verified certificate from the licensing agency certifying that the individual was qualified to be the director of a licensed child care facility prior to January 1, 2000 in the State of Mississippi. Source: Miss. Code Ann. §43-20-8. Rule 2.5.8 Caregivers: Caregivers shall be at least 18 years of age, and shall have at a minimum: 1. A high school diploma or equivalent (GED). OR 2. A current CECPR Child Development Associate (CDA) credential, a MDHS DECCD Child Care Director’s Credential, or MDHS OCY Director’s Child Care Credential. . 117

OR 3. Three years prior documented experience caring for children who are under 13 years of age and who are not related to the caregiver within the third degree computed according to civil law. Staff failing to meet the requirements of education and/or experience to act as a caregiver shall be designated as caregiver assistants. Source: Miss. Code Ann. §43-20-8. Rule 2.5.9 Caregiver Assistants: Caregiver assistants shall be at least 16 years of age. Caregiver assistants shall work under the direct on-site supervision of a director or caregiver at all times. They shall not have the direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children. Source: Miss. Code Ann. §43-20-8. Rule 2.5.10

Students

1. Students in a field study placement, a practicum, or vocational child care training program may assist in the care of the children when the following conditions have been met. 2. Students who are 18 years of age or older and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility which shall contain the following: a. Name, date of birth, address, and phone number. b. Name and phone number of a contact person from the school or university placing the student. c. Date placement began and daily record of hours the student is present. d. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. e. Documentation that the criminal records check (fingerprinting), and child abuse central registry check have been completed and no records found. f. Documentation of a minimum of one hour of orientation, within one week of placement, including but not limited to, the child abuse law and reporting procedures, emergency procedures, and facility discipline and transportation policies.

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Use of Director Designee

1. A director designee is an individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. 2. A A director designee shall, at a minimum have a high school diploma or GED and two years paid experience in a licensed child care facility or licensed/accredited kindergarten program. A director designee shall not retain sole director authority in a facility for more than 24 total hours per calendar week Exception: Facility may have a Director Designee serve for a maximum of 14 consecutive days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. In addition, if a Director has a medical condition (illness, recovery from surgery, accident, etc.) that requires more than 14 consecutive day’s recovery time, the time a Director Designee may be utilized may be extended. The facility is responsible to notify the Child Care Division of such circumstances and provide documentation supporting the need to extend the time the Director Designee needs to be utilized. Approval of this exception is at the discretion of the Child Care Licensure Division. 3. When the director designee is in charge of the facility, they shall have full access to all documents of the facility that are necessary for the licensing agency to conduct an inspection or complaint investigation. These documents shall include, but are not limited to, staff records, children’s records, safety inspections, and any other material or documents required by the inspecting official. Source: Miss. Code Ann. §43-20-8. Rule 2.5.12

Staff Development

1. Owners, Directors and Director Designees. Before a new license to operate is issued, owners, directors, and director designees of the child care facility shall each complete mandatory training on courses covering Child Care Regulations, Director Orientation, and Playground Safety. If a new director or director designee is appointed by the child care facility after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first six months of appointment. In the sole discretion of the licensing agency, mandatory training may be waived upon the submission of documentation of the individual’s prior completion of relevant training. . 119

2. All child care staff, directors, director designees, and caregivers shall be required to complete 15 contact hours of staff development, accrued during the licensure year, annually. The National Association for the Education of Young Children (NAEYC), a leading organization in child care and early childhood education recommends annual training based on the needs of the program and the pre-service qualification of the staff. Training should address the following: a. Health and safety. b. Child growth and development. c. Nutrition. d. Planning learning activities. e. Guidance and discipline techniques. f. Linkages with community services. g. Communications and relations with families. h. Detection of child abuse. i. Advocacy for early childhood programs. j. Professional issues. 3. Contact hours for staff development shall be approved by the licensing agency. 4. No more than five contact hours of approved in-service training provided by the child care facility may be counted toward the total number of hours required each year. More than five hours of in-service training may be provided by the child care facility but no more than five hours may be counted toward the required total of 15 hours. 5. All volunteers shall receive, at a minimum, one hour of orientation by the facility director. Such orientation, at a minimum, shall include a review of the child abuse law and reporting requirements, emergency exit procedures, and the facility transportation policy. Source: Miss. Code Ann. §43-20-8. Rule 2.5.13

Review by Licensing Agency

1. The satisfaction of the personnel requirements applicable to any individual shall be determined by the licensing agency acting pursuant to its authority under applicable statutes and regulations.

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2. The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual. Source: Miss. Code Ann. §43-20-8 Subchapter 6.

RECORDS

Rule 2.6.1 Records: Records listed in this section shall be kept within the physical confines of the child care facility and shall be made available to the licensing agency on request. Source: Miss. Code Ann. §43-20-8. Rule 2.6.2 Records Retention: 1.

All records, unless otherwise specified, shall be kept for a period of at least three years.

A child's records shall be retained for a period of one year after the child is no longer in attendance at the facility.

Source: Miss. Code Ann. §43-20-8. Rule 2.6.3

Facility Records:

Attendance records for children and employees.

A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth.

A current alphabetical roster of staff employed or volunteers in the child care facility.

Current license.

Records of monthly fire/disaster evacuation drills.

A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

Each facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the facility. The notebook shall contain separate current alphabetical rosters of both

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staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters. 9.

Each facility shall maintain a notebook containing a copy of the Letter of Suitability for Employment from the licensing agency on all employees and, when applicable, volunteers. The notebook shall contain an alphabetical roster of staff and volunteers. Along with the name, date-of-birth, the initial date of hire or volunteering must be given for cross-reference to individual personnel/volunteer files. The Letter of Suitability for Employment shall be filed in order matching the alphabetical roster. NOTE: Items required by 8 and 9 above may be placed within the same notebook.

10.

Current Monthly Rate (CMR)

Yearly Rate

Weekly Rate

Daily Rate Before Rounding

CMR X 12

Yearly Rate ÷ 52

Infant

$480.00

$5,760.00

110.7692308

22.15385

$22.16

Preschool

$440.00

$5,280.00

101.5384615

20.30769

$20.31

School Age

$320.00

$3,840.00

73.84615385

14.76923

$14.77

Weekly Rate ÷ 5

Daily Rate Rounded Up to the Next Cent

Source: Miss. Code Ann. §43-20-8. Rule 2.6.4 1.

Personnel Records:

Employee Records: Each employee's personnel record shall contain the following:

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Name, date of birth, address, and phone number.

Documentation of education, training, and experience necessary for employment.

Records of staff development accrued during each licensure year, beginning with the date employed.

Date of employment and date of separation.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted (Letter of Suitability for Employment); and the information shall be included in each employee's personnel file.

NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks. Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment.

Required Employee information to be entered into the Child Care Database – Licensure and Reporting System (LARS) The following information will be entered in the Child Care LARS Database for the Owner, Director, and all staff of the child care facility. The information will be entered during the Child Care Initial Application, Renewal Application, and Provider Portal “Manage Contacts” sections. a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address

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Contact Phone Number

The required information entered into the LARS Child Care Database under this rule is confidential and not viewable by the general public. The information will be used to authenticate the required contact hours taken by staff each licensure year. This information will also provide the ability for the child care operator to retrieve information regarding whether an employee is up-to-date or deficient regarding the required staff development hours (15 hours required) each licensure year. Further, this information will allow an individual employee or a supervisor of an employee, i.e., Owner and/or Director to register an employee for courses to maintain the continuing education hours required for the continued licensing of the child care facility. Source: Miss. Code Ann. §43-20-8. Rule 2.6.5 Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1.

Name, date of birth, address, and phone number.

Documentation of education, training, and experience that may help them in their role as a volunteer.

Date individual began volunteering and last date individual volunteered at the facility.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility.

A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

Source: Miss. Code Ann. §43-20-8. . 124

Rule 2.6.6 Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 1.

A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility.

A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

Source: Miss. Code Ann. §43-20-8. Rule 2.6.7

Facility Records

1. Attendance records for children and employees. 2. A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth. 3. A current alphabetical roster of staff employed or volunteers in the child care facility. 4. Current license. 5. Records of monthly fire/disaster evacuation drills. 6. A record shall be maintained of any medication administered by the director or caregiver showing date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication. 7. A record shall be maintained on each volunteer to document date and number of hours of volunteer service. 8. Each facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the facility. The notebook shall contain separate current alphabetical rosters of both staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters.

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9. Each facility shall maintain a notebook containing a copy of the Letter of Suitability for Employment from the licensing agency on all employees and, when applicable, volunteers. The notebook shall contain an alphabetical roster of staff and volunteers. Along with name, date-of-birth, the initial date of hire or volunteering must be given for cross-reference to individual personnel/volunteer files. The Letter of Suitability for Employment shall be filed in order matching the alphabetical roster. 10. Items required by items 8 and 9 above may be placed within the same notebook. Source: Miss. Code Ann. §43-20-8. Rule 2.6.8

Personnel Records

1. Employee Records: Each employee's personnel record shall contain the following: a. Name, date of birth, address, and phone number. b. Documentation of education, training, and experience necessary for employment. c. Records of staff development accrued during each licensure year, beginning with date employed. d. Date of employment and date of separation. e. Mississippi State Department of Health Certificate of Immunization Compliance Form #121. f. Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted; and the information shall be included in each employee's personnel file. NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks. g. Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. h. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment. Source: Miss. Code Ann. §43-20-8.

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Rule 2.6.9 Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1. Name, date of birth, address, and phone number. 2. Documentation of education, training, and experience that may help them in their role as a volunteer. 3. Date individual began volunteering and last date individual volunteered at facility. 4. Mississippi State Department of Health Certificate of Immunization Compliance Form #121. 5. Documentation that the criminal records check (fingerprinting), child abuse central registry check, and sex offender registry check have been conducted, and the information included in each volunteer’s file. 6. Documentation of a minimum of one hour of volunteer orientation, within one week of volunteering including but not limited to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy. 7. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 8. A record shall be maintained on each volunteer to document date and number of hours of volunteer service. Source: Miss. Code Ann. §43-20-8. Rule 2.6.10 Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 1. Documentation of a minimum of one hour of volunteer orientation within one week of volunteering, including but not limited, to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy and special needs of children. 2. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 3. A record shall be maintained on each volunteer to document date and number of hours of volunteer service. Source: Miss. Code Ann. §43-20-8.

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Rule 2.6.11 Child Records: The facility shall maintain an individual file for each child under its current care, and for any withdrawn child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: 1. Identification and Contact Information a. The name of the child and names of parents/guardians. b. Home address and home phone number. c. The parent’s business name, address and phone number. d. The child’s date of birth. e. Date of acceptance at facility and date of withdrawal, if any, with the parents’ stated reason for withdrawal. f. Other contact information required to be maintained in accordance with facility’s policy manual. 2. Parental Instructions a. If the parent provides written instructions to the facility, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and updated as provided from time to time. b. Written identification of an authorized, responsible person(s) for pick up of the child. c. Documentation of any limitation of parental rights of the other parent or stepparent. d. Documentation of any limitation or restriction, if any, on activities of child, or other participation by the child in certain events such as holiday celebrations or being photographed or other parental concerns. 3. Authorizations a. Signed written authorization to obtain emergency medical treatment and to administer medication. b. Election by parent either (a) to provide written authorization consenting to any and all field trips, excursions, or series of events outside the child care facility, or (b) to provide written consent only for those specific field trips, excursions, or series of events for which a date, time and location are specifically approved.

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c. Signed acknowledgment by parent that the written policies and procedures described in Rule 2.4.1 has been received by the parent. d. Signed acknowledgment by parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent. 4. Documents Required by Policy Manual or Contract a. If agreed by the facility in its policy manual or caregiver contracts, method in which facility will inform the parent or contact person if a child does not arrive at the facility within a reasonable time after a scheduled drop-off. b. Any other documents or identification records agreed to be maintained by the facility. 5. Confidentiality of Records and Information a. Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent. b. Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee. Source: Miss. Code Ann. §43-20-8. Subchapter 7.

REPORTS

Rule 2.7.7 Serious Occurrences Involving Children: The child care facility shall enter into the child’s record and immediately report, orally to the child’s parent and either orally or in writing, via email or fax, to the licensing agency, any serious occurrences involving children. If the child care facility is unable to contact the parent and the licensing official immediately, it shall document this fact, in writing, in the child’s record. Oral reports and/or emailed/faxed reports shall be confirmed in writing and mailed within two days of the occurrence. Serious occurrences include accidents or injuries requiring extensive medical care, e.g., child is taken to the doctor or hospital or hospitalizations, alleged abuse and neglect, fire or other emergencies. Source: Miss. Code Ann. §43-20-8. Rule 2.7.8 Child Abuse: Any operator or employee of a child care facility who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Human Services in accordance with the state's Youth Court Act. (Appendix "A") Source: Miss. Code Ann. §43-20-8.

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Rule 2.7.9 Communicable Disease: The child care facility shall promptly report any known or suspected case or carrier of any reportable disease to the Mississippi State Department of Health, as published in the "List of Reportable Diseases.” (Appendix "B") Source: Miss. Code Ann. §43-20-8. Rule 2.7.10 Infants and Toddlers: For infants and toddlers, the child care facility shall provide, to the child's parent, daily written reports that include liquid intake, child’s disposition, bowel movements, and eating and sleep patterns. Source: Miss. Code Ann. §43-20-8. Subchapter 8. Rule 2.8.7

STAFFING General

The staff-to-child ratio shall be maintained at all times, to include when children are arriving and departing the facility.

Children shall not be left unattended at any time. Video monitors cannot be used as a substitute for the physical presence of a caregiver in a room.

During all hours of operation, including arrival and departure of children, a child care facility employee shall be present to whom administrative and supervisory responsibilities have been assigned. This child care facility employee shall meet the minimum qualifications of a director or director designee. Note: Operators of child care facilities shall provide to the local licensing official a list of all individuals who meet the qualifications of a director or director designee and may be assigned administrative and supervisory responsibility for the facility when the director is absent. Documentation that an individual meets the qualifications of a director shall be submitted to and approved by the local licensing official. Director designee qualifications shall be maintained on site and available to the licensing official during site visits.

During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present who holds a valid CPR certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing authority.

During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present, at any location where the children are present, who holds a valid first aid certificate. Said certificate shall be issued by an agent recognized by the licensing authority. Note: When initially acquiring or renewing the CPR and First Aid certifications required in items 4 and 5 above, online (internet, etc.) training is not acceptable. Training must be face-to-face and hands on.

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Source: Miss. Code Ann. §43-20-8. Rule 2.8.8

Ratio

1. The minimum ratio of caregiver staff-to-children present at all times shall be as follows: Age of Children

Number of Children to Caregiver Staff

Less than 1 year

1 year

2 years

3 years

4 years

5 through 9 years

10 through 12 years

2. Staff-to-child ratios shall be met at all times, including during opening/closing, field trips and swimming or water activities whether at the child care premises or off-site. 3. In mixed age groups, the age of the youngest child in the group determines the staffto-child ratio. Preschool children shall not be grouped with school age children in any single area during normal classroom and playground or water activities. 4. With the exception of children under two years of age, children may be under the direct supervision (staff in the same room) of 50 percent of the staff required by this section during rest period times, provided the required staff-to-child ratio is maintained on the premises. 5. At no time will a single individual be responsible for the supervision of children located in more than one classroom at any given time. Source: Miss. Code Ann. §43-20-8. Subchapter 9. Rule 2.9.7

PROGRAM OF ACTIVITIES General

1. The child care facility shall provide a basic program of activities geared to the age levels and developmental needs of the children served. 2. The child care facility shall provide for the reading of age-appropriate materials to children. . 131

3. The child care facility shall incorporate programs to encourage sun safety practices (skin cancer prevention), into activities for all age levels. Source: Miss. Code Ann. §43-20-8. Rule 2.9.8 Daily Routines: All daily routines, such as eating and rest periods, shall be scheduled for the same time each day. Source: Miss. Code Ann. §43-20-8. Rule 2.9.9 Eating: Meal periods are breakfast, lunch, dinner, and snacks. A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period. Source: Miss. Code Ann. §43-20-8. Rule 2.9.10

Rest Periods

1. For preschool children, rest periods shall be scheduled for a minimum period of one hour, and shall not exceed two and one-half (2½) hours. Infant and toddler nap times shall be individualized to meet each child’s needs as sleeping patterns can vary greatly. Half-day programs must provide for rest periods as is appropriate when the children/child indicates or is observed to require some rest time. 2. Physical force shall not be used in requiring children to lie down or go to sleep during rest periods. 3. Rest periods are not required for children in attendance for less than six hours. 4. Rest periods are not required for school age children. 5. A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: a. An infant shall be placed on his/her back for sleeping unless written physician orders to the contrary are in the child's record. Sleeping infants shall be within the view of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. b. Infants shall be dressed in clothing appropriate for sleeping that is designed to keep the infant warm without the possible hazard of head covering or entrapment. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. c. Facilities shall use a firm mattress covered by a fitted sheet. . 132

d. Items such as but not limited to pillows, blanket, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib. Source: Miss. Code Ann. §43-20-8. Rule 2.9.11

Outdoor Activities

1. Each infant shall have a minimum of 30 minutes of outdoor activities per day, weather permitting. 2. Toddler, preschool, and school age children shall have a minimum of two hours of outdoor activities per day, weather permitting. Children who are in attendance at a facility for seven hours per day or less shall have a minimum of 30 minutes of outdoor activity per day, weather permitting. 3. Sun safe practices shall be used during outdoor activities scheduled between 10 A.M. and 2 P.M. during the period April 1 to September 15. 4. Sun safe practices shall be evident in the planning of all outdoor events. 5. Outdoor activities shall be held in areas providing shade or covered spaces Source: Miss. Code Ann. §43-20-8. Rule 2.9.12

Infant and Toddler Activities

1. Infants and toddlers shall be free to creep, crawl, toddle, and walk as they are physically able. a. Cribs, car seats, and high chairs are to be used only for their primary purpose, i.e., cribs for sleeping, car seats for vehicle travel, and high chairs for eating. b. Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they are awake. c. Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time. d. Providers should use strollers for toddlers and preschoolers only when necessary. 2. Infants and toddlers shall be taken outdoors every day, weather permitting. 3. For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about.

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4. Television viewing, including video tapes and/or electronic media, is not allowed for children under the age of two or for staff in the infant and toddler area. The playing of soothing music in the infant and toddler area is acceptable. 5. Television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to one hour per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 6. In half-day programs, television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to 30 minutes per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 7. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described in items 5 and 6 above. Source: Miss. Code Ann. §43-20-8. Rule 2.9.7 Indoor or Outdoor Physical Activity: Child care providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. 1.

Toddlers and preschool children will be provided the opportunity for light physical activity for at least 15 minutes per hour when children are not involved in their scheduled rest period.

Toddlers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day.

Preschoolers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day.

Caregivers should join in and lead the structured moderate to vigorous physical activities in which the children participate.

Structured physical activity should involve the performance of large muscle activities.

Half-day programs are only required to provide for physical activity for one-half (½) the time as stated above. NOTE: Examples of “light physical activity” may be found in the Child Care Licensure section of the MSDH website at www.HealthyMS.com. Examples of “moderate physical activity” are aerobic dancing, light calisthenics, getting up and down from the floor, dancing, playing on school ground equipment, singing while

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actively moving about, etc. Examples of “vigorous physical activity” are running, jumping rope, performing jumping jacks, playing soccer, skipping, etc. Regardless of the activity, it should be age appropriate and within the physical ability limits of the child. Please, understand the above requirement does not mean 60 minutes vigorous activity at one time. The 60 minutes of vigorous physical activity can and should be spread out in short time intervals, (e.g., 5-15 minute intervals) throughout the day. Source: Miss. Code Ann. §43-20-8. Subchapter 10. Rule 2.10.7

EQUIPMENT, TOYS, AND MATERIALS General

1. Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served. 2. Developmentally age-appropriate toys shall be available and accessible for infants, and shall include but not be limited to the following: a. Simple, lightweight, open-ended, easily washable toys such as containers, balls, large pop-beads, nesting cups. b. Rattles, squeak toys, action/reaction toys. c. Cuddly toys. d. Toys to mouth such as teethers and rings. e. Pictures of real objects. f. A crawling area with sturdy, stable furniture for pulling up self. 3. Developmentally age-appropriate toys shall be available and accessible for toddlers, and shall include but not be limited to the following: a. Push and pull toys. b. Stacking toys, large wooden spools/beads/cubes. c. Sturdy picture books, music. d. Pounding bench, simple puzzles. e. Play phone, dolls, and toys to appeal to child’s imagination. f. Large paper, crayons. g. Sturdy furniture to hold on to while walking. . 135

h. Sand and water toys. 4. Developmentally age-appropriate toys shall be available and accessible for preschoolers, and shall include but not be limited to the following: a. Active play equipment for climbing and balancing. b. Unit blocks and accessories. c. Puzzles, manipulative toys. d. Picture books and records, musical instruments. e. Art materials such as finger and tempera paints, clay, play dough, crayons, collage materials, markers, scissors, and paste. f. Dramatic play materials such as dolls, dress-up clothes and props, child-sized furniture, puppets. g. Sand and water toys. 5. Children's original work shall be displayed in the child care facility. 6. Books shall be on shelves and tables for children to look at and read. Every child shall have age-appropriate materials (including picture books) read to and discussed with him or her every day. Where appropriate, the materials should cover topics with which the children are involved. 7. Television viewing by preschool children shall be limited to one hour per day and shall be educational programming only. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described herein. 8. The daily activity schedule shall demonstrate that preschoolers are given opportunities to do a variety of activities, including both quiet and active, such as block play, art activities, puzzles, books, and learning games, and that stories are read to and discussed with each child every day. Source: Miss. Code Ann. §43-20-8. Rule 2.10.8

Playground Equipment

1. All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations. 2. Playground equipment shall be of safe design and in good repair. Outdoor playground climbing equipment and swings shall be set in concrete footings located at least six inches below ground surface. Indoor playground equipment shall be installed according to the manufacturer's specifications. Swings shall have soft . 136

and/or flexible seats. Access to playground equipment shall be limited to age groups for which the equipment is developmentally appropriate. 3. Equipment designed for outdoor use by infants and toddlers shall be accessible to shaded areas to ensure sun safe practices. Source: Miss. Code Ann. §43-20-8. Rule 2.10.9 Paint: Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous. Source: Miss. Code Ann. §43-20-8. Rule 2.10.10 Chairs and Tables: Chairs and tables shall be of a size appropriate to the size and age of the children. There shall be an adequate number of chairs and tables to accommodate the children present at the facility. Source: Miss. Code Ann. §43-20-8. Rule 2.10.11 Hooks and Compartments: Individual hooks or compartments shall be provided for each child for hanging or storing outer and/or extra clothing as well as for personal possessions. Hooks shall be spaced well apart so that clothes and belongings do not touch those of another child. Hooks shall also be placed at a height suitable to prevent an injury to a child. Source: Miss. Code Ann. §43-20-8. Rule 2.10.12

Sand Boxes

Cribs:

1. The facility shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. 2. The use of stackable cribs is prohibited. Source: Miss. Code Ann. §43-20-8. . 137

Rule 2.10.14 High Chairs: High chairs, if used, shall have a wide base and a T-shaped safety strap. They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs). Source: Miss. Code Ann. §43-20-8.

Rule 2.10.15

Rest Period Equipment

1. Individual beds, cots, mattresses, pads, or other acceptable equipment shall be used for rest periods, and children shall not be placed directly on the floor for rest periods. Bed linens, such as blankets or sheets, cannot be used in place of a bed, cot, mattress, or pad. These shall be kept in a sanitary condition. Once a sheet or blanket has been used by a child, it shall not be used by another child until it has been laundered. 2. Rest period equipment shall be clean and covered with a waterproof cover. 3. Nap pads/cots are designed for use by one child only at a time. 4. Nap pads utilized by more than one child shall be sanitized after each child’s use. Nap pads utilized by only one child shall be sanitized immediately when soiled or at least weekly. 5. Nap pads and nap cots without mattresses are not acceptable for use in 24-hour programs. Beds, cribs, or rollaway cots are the only acceptable bedding for 24-hour centers. 6. All infants shall have a crib. The use of “Pack and Plays” for infant sleeping is not allowed. Cribs, cots, and mats are to be a minimum of 24” apart or separated by a solid barrier. A minimum of 36 inches is recommended. 7. Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately to a sanitary individual sleeping place. Source: Miss. Code Ann. §43-20-8. Rule 2.10.16

Play Equipment

1. Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. Play equipment, toys, and materials shall be found to be appropriate to the development needs, individual interests, and ages of the children as identified as age-appropriate by a label provided by the manufacturer on the product package. . 138

2. Projectile toys, i.e., dart guns, toy guns, etc., are prohibited. 3. Water play tables, if used, shall be cleaned and sanitized daily. 4. Tricycles and other riding toys used by the children shall be spokeless, steerable, and of a size appropriate for the child, and shall have low centers of gravity. All such toys shall be in good condition and free of sharp edges or protrusions that may injure the children. When not in use, such toys shall be stored in a location where they will not present a physical obstacle to the children and employees. Riding toys shall be inspected at least monthly for protrusions and rough edges that could lead to injury. Source: Miss. Code Ann. §43-20-8. Rule 2.10.17

School Age Programs

1. The foregoing provisions in Subchapter 10 shall not be applied to any facility licensed solely for School age children unless specifically required in Rule 2.10.11. 2. All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations. 3. Projectile toys are prohibited. Projectile toys are toys which, when projected, have the ability to penetrate body or eye tissue. Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. 4. Possessions, belongings, and extra clothing for each school age child must be stored in such a manner as to not touch those of another child. Source: Miss. Code Ann. §43-20-8. Subchapter 11. Rule 2.11.7

BUILDINGS AND GROUNDS Building

1. A child care facility shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the child care facility for the purpose of entering the building or exiting the building, or passing through the child care facility for the purpose of gaining access to another part of the building. 2. All child care facility buildings shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances. 3. No house trailers, relocatable classrooms, or portable buildings shall be used to house a child care facility unless such structure was originally designed specifically for educational purposes and meets the Mississippi State Department of Education’s . 139

current standards for a relocatable classroom. Further, such portable structure shall meet all applicable fire safety codes. Current licensees operating facilities housed in such structures are exempted from this provision. Any change of ownership, need for major renovation, or other significant change in the facility’s status shall revoke such exemption. 4. Plans and specifications shall be submitted to the licensing agency for review and approval on all proposed construction and/or major renovations. 5. A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent. Space shall be located in an area that is supervised at all times by an employee. 6. Separate space for infants and toddlers shall be provided away from older children except in facilities licensed for 12 or fewer children. 7. Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately to a sanitary individual sleeping place. 8. All parts of the child care facility used by children shall be lead-safe, well lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as but not limited to, open stairs and unprotected low windows. a. All buildings intended for use as a child care facility constructed before 1965 shall be tested for lead. It is the responsibility of the facility applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be lead-safe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. b. All buildings intended for use as a child care facility, constructed prior to 1978, shall utilize MDEQ Lead Safe Certified individuals or companies for all renovation, repair and maintenance activities which disturb painted surfaces unless the paint to be disturbed has been documented to be lead-free by an individual or company that is MDEQ Lead Safe Certified as a risk assessor or inspector. NOTE: It is recommended that child care facility operators contact the Mississippi Department of Environmental Quality at 601-961-5630 regarding any questions they may have about compliance with the laws and regulations related to lead and lead based paint. 9. All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safetygrade glass or polymer (e.g., Lexan®) are not required to have a protective barrier. . 140

Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be so certified by the installer and the statement kept on file at the child care facility. 10. Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork. 11. All ceiling lighting shall be shielded completely and encased in shatterproof materials. 12. A child care facility shall have a working phone available to all staff at all times. Phones shall also be available for incoming calls and shall not be unplugged or disconnected during business hours. 13. All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician. 14. Unused electrical outlets shall be protected by a safety plug cover. 15. No extension cords shall be used in areas accessible to children. 16. Every child care facility which uses nonelectric heating and/or cooling systems, cooking stoves, and/or hot water heaters or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the child care facility. 17. All child care facilities are to be kept clean and in good repair. Source: Miss. Code Ann. §43-20-8. Rule 2.11.8

Indoor Square Footage

1. Every license shall set forth the licensed facility’s maximum licensed capacity, which shall be based upon a minimum of thirty-five (35) square feet of usable indoor space per child. Likewise, the capacity for each room where children are kept shall have a minimum of thirty five (35) square feet of usable space per child, measured on the inside, wall-to-wall dimensions, subject to the following exceptions: a. During group activity periods such as film viewing, parties, dining, and sleeping, provided child-to-staff ratio is maintained; b. During periods when child pick-up or delivery is normally done, provided child-to staff ratio is maintained; c. In infant and toddler rooms as required in subsections 2-7 below. The usable space in determining the facility’s maximum licensed capacity is measured exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff room, corridors, hallways, stairways, closets, lockers, laundries, . 141

furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. 2. Rooms in which infants both play and sleep shall have a minimum of 40 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. 3. Rooms where infants play but do not sleep shall have a minimum of 15 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than infant play. 4. Rooms where infants sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least two feet between each crib. Cribs with solid ends may be placed end-to-end. 5. Rooms in which toddlers both play and sleep shall have a minimum of 45 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. However, if stackable cots, mats, or other storable sleeping equipment is utilized for sleeping the room shall be measured using the standard of 35 square feet per child. Should it be determined that the sleeping equipment is not properly stored when not in use the capacity of the room will be determined using 45 square feet per child 6. Rooms where toddlers play but do not sleep shall have a minimum of 25 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than toddler play. 7. Rooms where toddlers sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. 8. The licensing agency will re-measure the square footage of licensed operating child care facilities for purposes of determining licensed facility or classroom capacity only under the following circumstances: a. Major renovations; b. Significant change in layout and use of space; c. A change of ownership of an existing facility should the layout or use of space change. 9. “Grandfather Provision” for regulatory changes regarding maximum facility capacity or room capacity. Whenever the Mississippi State Board of Health amends these rules regarding square footage and/or licensed maximum capacity of child care facilities, and such change would result in a reduction in the number of children to be served in a licensed and operating facility or any of its classrooms, any such facility . 142

in operation at the time of final adoption of said rule change, and in compliance with all other child care regulations, shall be “grandfathered” in and exempt from application of the new regulation regarding capacity. This exemption shall continue for said facility through changes of ownership so long as the building is used continuously as a licensed child care facility and so long as there is no change in the layout or use of the space, as set out in subsection 8 above. Any break in use of the building as a licensed child care facility shall moot the grandfather exemption, and thereafter, any child facility opened and operated in said building shall be required to comply with the square footage/capacity regulation in affect at the time of the new license. Source: Miss. Code Ann. §43-20-8. Rule 2.11.9

Openings

1. Each window, exterior door, and basement or cellar hatchway shall be weather tight and watertight. 2. All windows above ground level in areas used by children under five years of age shall be constructed, adapted, or adjusted to limit the exit opening accessible to children to less than six inches, or be otherwise protected with guards that do not block outdoor light. 3. Openable windows shall be of a safety type (not fully openable) that are child proofed and screened when open. When there are no openable windows, or when windows are not kept open, rooms shall be adequately ventilated. 4. All openings used for ventilation shall be screened. 5. The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities. 6. Exit doors shall open outward. Boiler room doors shall swing inward. 7. Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room. 8. The hand contact and splash areas of doors and walls shall be covered with an easily cleanable finish, at least as cleanable as an epoxy finish or enamel paint. Source: Miss. Code Ann. §43-20-8. Rule 2.11.10 Kitchens 1. Children are not allowed in the kitchen area. In School Age/After School programs, children may be allowed in the kitchen but not during times when food is being cooked. Supervision in the kitchen when children are present must meet the staffing requirements as referenced in Subchapter 8 of the regulations. . 143

2. Barriers, approved by the local fire authority, shall be erected and doors shall be closed at all times. 3. Kitchens shall have a minimum area of 90 square feet, measured wall to wall. 4. For a child care facility with 12 or fewer children, located in an occupied dwelling, the following regulations shall replace the Mississippi State Department of Health's 10.0 Regulation Food Code: a. No game or home canned foods shall be served. b. Other than fresh or frozen vegetables and fruit, all foods shall be from commercial sources. c. Food shall be cooked or reheated to a temperature of 165 degrees Fahrenheit. Hot food shall be held at a minimum temperature of 140 degrees Fahrenheit. d. Cold food shall be stored at a temperature of 41 degrees Fahrenheit or below. e. All food shall be covered while in the refrigerator or freezer. f. Any prepared foods not properly refrigerated at a temperature of 41 degrees Fahrenheit or less, or frozen, shall be discarded. g. If manual washing is utilized, a sanitizer shall be used. Rinsing in a chlorine solution using one and one-half tablespoons of household bleach per gallon of water is sufficient. (Appendix "E"). If a dishwasher is utilized, the nozzle ports shall be free of obstructions, and the interior of the machine shall be clean. Dishwashers shall have a sanitizing cycle that shall reach a temperature 165 degrees at the incoming water valve. h. Hot water, under pressure, shall be available. i. Insecticides, poisons, cleaning agents, and medications, shall be stored away from food, separately from each other, and out of the reach of children. j. Children shall not be exposed to insecticides or pesticides, or other toxic agents. k. Hands shall be washed frequently, when switching between working with raw and ready-to-eat foods, and after all non-food preparation activities. l. Clean clothing shall be worn. m. Gloves shall be worn if there are any cuts or abrasions on the hands. 5.

All kitchens and/or food/snack preparation areas in a child care facility shall be inspected as part of the child care inspection program.

Source: Miss. Code Ann. §43-20-8. . 144

Rule 2.11.11 Toilets and Hand Washing Lavatories 1. Toilets and hand washing lavatories shall be located within the physical confines of child care facility and shall be convenient to outside playground areas. 2. The following ratios shall apply: Toilets, urinals, and hand washing lavatories shall be apportioned at a ratio of 1:15. Urinals shall not exceed 33 percent of the total required toilet fixtures. When the number of children in the ratio is exceeded by one, an additional fixture shall be required. 3. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity. Diaper changing sinks shall not be used for any other purpose such as, but not limited to, rinsing or washing baby bottles, pacifiers, teething rings, or for food preparation. 4. All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit. 5. Toilets, urinals, hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper. Source: Miss. Code Ann. §43-20-8. Rule 2.11.12 Water The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1. Fountain; or 2. Disposable paper cups; or 3. Labeled cup for each child that shall be washed and sanitized daily. Source: Miss. Code Ann. §43-20-8. Rule 2.11.13 Exits 1. At least two separate exit doors shall be provided from every floor level. 2. Exit doors shall be remote from each other. 3. Dead end corridors shall not exceed 20 feet in length. 4. Exit doors necessitating passage through a kitchen shall not be counted as one of the two remote exits.

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5. Exit doors shall be a minimum of 32 inches wide and open outward. No single leaf in an exit door shall be less than 28 inches wide or more than 48 inches wide. 6. Any latch or other fastening device on an exit door shall be provided with a knob, handle, panic bar, or other simple type of releasing device. Dual action door fasteners are not permitted. 7. The force required to open fully exit doors shall not exceed 50 pounds applied to the latch stile (panic bar). 8. An exit door shall not reduce the effective width of a landing. Source: Miss. Code Ann. §43-20-8. Rule 2.11.14 Heating, Cooling, and Ventilation 1. A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained. 2. All rooms used by children shall be heated, cooled, and adequately ventilated to maintain the required temperatures, and air exchange, and to avoid the accumulation of objectionable odors and harmful fumes. 3. Ventilation may be in the form of openable windows as specified in these regulations. 4. Areas where art and craft activities are conducted shall be well ventilated. In areas where substances are used that create toxic fumes, exhaust hood systems or other devices shall be installed. 5. Electric fans, if used, shall be mounted high on the wall or ceiling or shall be guarded to limit the size of the opening in the blade guard to less than one-half inch. 6. When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children. 7. Filters on recirculation systems shall be checked and cleaned or replaced monthly. 8. Window draft deflectors shall be provided if necessary. 9. Thermometers that do not present a hazard to children shall be placed on interior walls in every activity area at children's height. 10. Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating. 11. Electric space heaters shall be UL-approved; inaccessible to children; and stable; shall have protective covering; and shall be placed at least three feet from curtains, papers, and furniture. . 146

12. Fireplaces and fireplace inserts shall be screened securely or equipped with protective guards while in use. They shall be properly drafted. The child care facility shall provide evidence of cleaning the chimney at least once a year, or as frequently as necessary to prevent excessive buildup of combustibles in the chimney. Records of chimney cleaning shall be retained in the center files. 13. Heating units that utilize gas shall be installed and maintained in accordance with the manufacturer’s instructions, are vented properly to the outside, and be supplied with sufficient combustion air as required by the International Fuel Gas Code. If the area of the state where the facility is located does not utilize the International Fuel Gas Code, the installation and maintenance of any heating units that utilize gas shall be in accordance with the manufacturer’s instructions and any local ordinances that apply. It is the responsibility of the licensee to provide to the licensing authority documentation that the heating units meet the above stated standards. 14. Heating units, including water pipes and baseboard heaters hotter than 110 degrees Fahrenheit, shall be made inaccessible to children by barriers such as guards or other devices. Source: Miss. Code Ann. §43-20-8. Rule 2.11.15 Outdoor Playground Area All playgrounds and playground equipment intended for use by children 2-12 years of age shall meet the standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission or its successor as shown in Appendix “D.” 1. The child care facility shall be equipped with an outdoor playground area that directly adjoins the indoor facilities or that can be reached by a route free of hazards and is no farther than 1/8 mile (660 feet) from the child care facility. The outdoor playground area shall comprise a minimum of 75 square feet for each child using the outdoor playground area at any one time. 2. The total outdoor playground area shall accommodate at least 33 percent of the licensed capacity at one time. 3. A rooftop used as an outdoor playground area shall be enclosed with a fence not less than six feet high and designed to prevent children from climbing it. An approved fire escape shall lead from the roof to an open space at the ground level that meets safety standards for outdoor playground areas. 4. The outdoor playground area shall be well arranged so that all areas are visible to staff at all times. 5. The outdoor playground area shall be free of hazards and not less than 30 feet (measured horizontally parallel to the ground) from electrical transformers, high. 147

voltage power lines, electrical substations, railroad tracks, or sources of toxic fumes or gases. Hazards, including but not limited to air conditioner units and utility mains, meters, tanks, and/or cabling shall be inaccessible to children. Fencing at least four feet high shall be provided around the outdoor playground area. Fencing higher than four feet but not to exceed eight feet may be required if the licensing authority determines that a hazard exists. Fencing twist wires and bolts shall face away from the playground. As an alternative, exposed bolt ends may be cut to no more than two exposed threads. Then the bolt ends shall be ground/sanded smooth or capped. 6. Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, quarries, canals, excavations, fishponds, or other bodies of water. 7. Sunlit areas and shaded areas shall be provided by means of open space and tree plantings or other cover in outdoor spaces. Outdoor spaces shall be laid out to ensure ample shaded space for each child. 8. The outdoor playground area shall be enclosed with a fence. The fence shall be at least four feet in height and the bottom edge shall be no more than three and one-half inches off the ground. There shall be at least two exits from such areas, with at least one remote from the buildings. The gate latch or securing device shall be high enough or of such a type that it cannot be opened by small children. The openings in the fence shall be no greater than three and one-half inches, e.g., between the building and the fence. The fence shall be constructed to discourage climbing. 9. The soil in outdoor playground areas shall not contain hazardous levels of any toxic chemical or substances. The child care facility shall have soil samples and analyses performed where there is good reason to believe a problem may exist. 10. The soil in outdoor playground areas shall be analyzed for lead content initially. It shall be analyzed at least once every two years where the exteriors of adjacent buildings and structures are painted with lead-containing paint. Lead in soil shall not exceed 400 ppm. Testing and analyses shall be in accordance with procedures specified by the licensing agency. Source: Miss. Code Ann. §43-20-8. Rule 2.11.16 Grounds 1. The grounds, including the outdoor playground area, shall be free of hazardous or potentially hazardous objects. 2. In-ground swimming pools are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum five feet from the pool edge. Above ground pools, including decking and pool structures, are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum ten feet from the pool/deck edge. . 148

3. All paved surfaces shall be well drained to avoid water accumulation and ice formation. 4. All walking surfaces, such as walkways, ramps, and decks, shall have a non-slip finish, and shall be free of holes and sudden irregularities in the surface. Source: Miss. Code Ann. §43-20-8 Rule 2.11.17 Garbage Removal: Garbage and trash shall be removed from the child care facility daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children, and in insect and rodent resistant containers. Source: Miss. Code Ann. §43-20-8. Rule 2.11.18 Environmental Health: The child care facility shall comply with all regulations promulgated by the Division of Sanitation of the Mississippi State Department of Health for: 1. Food Service 2. On-site Wastewater Systems 3. Vector (pest) Control Source: Miss. Code Ann. §43-20-8. Rule 2.11.19 Pest Control All child care facilities are to use a contractor licensed by the State of Mississippi to control pests, e.g., rats, mice, insects, etc. Before a pest control contractor is used, it is the responsibility of the operator to ensure that the pest control contractor is properly licensed. Use of agricultural chemicals for pest control is strictly prohibited. Source: Miss. Code Ann. §43-20-8. Subchapter 12. Rule 2.12.7

HEALTH, HYGIENE, AND SAFETY

Employee Health

1. Employees manifesting symptoms or otherwise suspected of having upper respiratory, gastrointestinal, skin, or other serious contagious conditions shall be excluded from work until either free from symptoms or certified by a physician to be no longer infectious. 2. Staff shall use universal precautions when changing diapers or being exposed to blood, fecal material, or urine. Refer to Appendix “F” for instructions on how to properly wash hands. 3. Staff shall wash their hands upon: . 149

a. Immediately before handling food, preparing bottles, or feeding children. b. After using the toilet, assisting a child in using the toilet, or changing diapers. c. After contacting a child’s body fluids, including wet or soiled diapers, runny noses, spit, vomit, etc. d. After handling pets, pet cages, or other pet objects. e. Whenever hands are visibly dirty or after cleaning up a child, the room, bathroom items, or toys. f. After removing gloves used for any purpose. g. Before giving or applying medication or ointment to a child or self. Refer to Appendix “F” for instructions on how to properly wash hands. Source: Miss. Code Ann. §43-20-8. Rule 2.12.8

Child Health

1. A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible. 2. A child having a serious contagious condition shall not be allowed to return to the child care facility until they have been certified by a physician to be no longer contagious. 3. Parents of all children shall be notified of a contagious illness in the child care facility as soon as possible. 4. A child with a physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority. A child with a serious physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority and transported to a hospital or medical facility as soon as appropriate. Source: Miss. Code Ann. §43-20-8. Rule 2.12.9

Child Hygiene

1. A child's wet or soiled clothing shall be changed immediately. 2. A child's hands shall be washed: a. Immediately before and after eating. b. After using the toilet or having their diapers changed. . 150

c. After playing on the playground. d. After handling pets, pet cages, or other pet objects. e. Whenever hands are visibly dirty. f. Before going home. 3. A child shall have a shower, tub, or sponge bath to ensure bodily cleanliness when necessary. 4. Individual toilet articles (e.g., combs, brushes, toothbrushes, towels, and wash cloths) used by children shall be provided by the parent or child care facility and plainly marked and stored individually in a sanitary manner in areas which promote drying. Single use and disposable articles are acceptable. Grooming accessories, including but not limited to brushes, combs, barrettes, or picks, shall not be used jointly by children or on children. Source: Miss. Code Ann. §43-20-8. Rule 2.12.10 Toys and Equipment: Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution. Refer to (Appendix – “H” for instructions on cleaning and disinfection procedures. A recommended resource regarding sanitation of equipment and toys can be found in the National Health and Safety Performance Standards: Guidelines for out of home Child Care, Second Edition (Standard 3.030) website: www.nrc.uchsc.edu Source: Miss. Code Ann. §43-20-8. Rule 2.12.11

First Aid Supply

1. A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children. 2. A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children. 3. Medicine shall be kept out of the reach of the children. 4. All vehicles used by the facility in transporting children shall be equipped with a first aid kit. 5. It is recommended that first aid kits contain the following items, according to American Red Cross guidelines: a. 20 Antiseptic Toweletts b. 50 Plastic Strips (Band Aids) . 151

c. 5 Fingertip Bandages d. 5 Knuckle Bandages e. 5 Butterfly Closures f. 5 Non Adherent Pads 2" x 3" g. 2 Sterile Eye Pads h. 1 pressure Bandage 4" i. 1 Bandage Scissors j. 1 Triangular Bandage k. 1 Instant Cold Compress l. 2 Tongue Depressors/Finger Splints m. 1 Elastic Bandage 2: x 5 yards n. 5 3" x 3" Gauze Pads o. 1 Trauma Pad 5" x 9" p. 5 Insect Sting Relief Pads q. 10 First Aid Ointment 1 gr. r. 5 Non Adherent Pads 3: x 4" s. 5 Pair of Examination Gloves t. 2 Conforming Bandage 2" x 5 yards u. 1 Tweezers v. 2 Poison Ivy Relief Treatment w. 1 Booklet “Till Help Arrives” x. 1 Emergency Rescue Blanket y. 1 Adhesive Tape ½" x 5 yards 6. Some items in this kit may have expiration dates. All first aid kits should be periodically inspected for contents. Depleted and out of date materials should be replaced. . 152

7. Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs. 8. For additional information on supplies for first aid kits contact your local office of the American Red Cross. Source: Miss. Code Ann. §43-20-8. Rule 2.12.12 Animals and Pets 1. Any pet or animal present at a child care facility, indoors or outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children. 2. Dogs or cats, where allowed, shall be immunized for any disease that can be transmitted to humans, and shall be maintained on a flea, tick, and worm control program. 3. All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the child care facility, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the child care facility where the pet is kept. 4. A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when in close proximity to these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space with the children. 5. Each child’s hands shall be properly washed after being exposed to animals. Source: Miss. Code Ann. §43-20-8. Rule 2.12.13 Fire/Disaster Evacuation Drills 1. Monthly fire/disaster (e.g., tornados, severe weather, floods, earthquakes, hurricanes, etc.) evacuation drills are required and a record of each drill shall be maintained in the facility records; to include date, time, number of children and staff present, and amount of time required to totally exit the building. 2. During fire/disaster evacuation drills, all staff and children present shall be required to exit the building. Source: Miss. Code Ann. §43-20-8. Subchapter 13.

NUTRITION AND MEALS

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Rule 2.13.7

General

1. A child care facility shall provide adequate and nutritious meals prepared in a safe and sanitary manner. 2. Meal periods are breakfast, lunch, dinner, and snacks. A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period. 3. Meals shall be served at tables where each child may be seated. 4. Meals shall be served by employees only. 5. Employees shall wash hands prior to preparing or serving food. 6. Children shall not share food. Source: Miss. Code Ann. §43-20-8. Rule 2.13.8 Nutritional Standards: Meals shall meet the nutritional standards as prescribed in Appendix “C” Minimum Standards for Nutritional Care in Child Care Facilities. Source: Miss. Code Ann. §43-20-8. Rule 2.13.9

Refreshments

1. Refreshments may be provided by parents only on a child's birthday or other special celebration such as Valentine's Day, Easter, Christmas, Graduation, etc. Food provided to children, including vending machines at the facility, must meet nutritional guidelines as set forth in Appendix “C.” 2. It is recommended that foods for the event that are brought to the facility by parents should be “store bought” and not “home cooked.” 3. Food items for the event may include cake, ice cream, fresh fruit, cheese and crackers, etc. Other items, i.e., party favors such as stickers, books, toothbrushes, and crayons, etc., are encouraged. Source: Miss. Code Ann. §43-20-8. Rule 2.13.10 Sack Lunches : Sack lunches prepared by parents may be permitted as included on approved menu plans but shall not exceed one day per month per child. Exceptions may be made for specific activities such as field trips outside the child care facility. Measures to assure proper storage and refrigeration of sack lunches are required of the child care facility. Source: Miss. Code Ann. §43-20-8.

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Rule 2.13.11 Snacks: All snacks shall meet acceptable nutritional standards, as prescribed in Appendix “C” Minimum Standards for Nutritional Care in Child Care Facilities. Source: Miss. Code Ann. §43-20-8. Rule 2.12.6

Food Safety and Food Manager

All kitchens and/or food/snack preparation areas in a child care facility must be inspected as part of the child care inspection process.

Each child care facility must have a Certified Food Manager meeting the standards set forth in Rule 1.2.2 (1)(g). The only exception would be if two facilities had COMPLETELY different operating hours. If this situation exists then one Certified Food Manager could serve more than one facility. Should such occur, documentation to that affect must be in the each facility’s file.

A Certified Manager does NOT have to be present at all times. However, a person in charge of food preparation does have to be present at all times

Source: Miss. Code Ann. §43-20-8. Subchapter 14.

DISCIPLINE AND GUIDANCE

Rule 2.14.7 Prohibited Behavior The following behaviors are prohibited by anyone (i.e., parent, caregiver, or child) in all child care settings: 1. Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain. 2. Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities. 3. Abusive or profane language to include but not limited to yelling at, and/or using harsh tones toward the children or in close proximity (hearing distance) to children. 4. Any form of public or private humiliation, including threats of physical punishment. 5. Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating (out of view of a caregiver), or corrupting a child. 6. Use of any food product or medication in any manner or for any purpose other than that for which it was intended. 7. Inappropriate disciplinary behavior includes, but is not limited to, putting soap or pepper in a child's mouth. 8. Any acceptable disciplinary action that is not age-appropriate for the child or is excessive in time or duration. Source: Miss. Code Ann. §43-20-8. . 155

Rule 2.14.8 Restraint of a Child: Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs. Source: Miss. Code Ann. §43-20-8. Rule 2.14.9 Time Out : "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, taking into account the child's developmental stage and the usefulness of "time out" for the particular child. “Time out” means that the child is given time away from an activity which involved inappropriate behavior. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than three years of age. Source: Miss. Code Ann. §43-20-8. Rule 2.14.10 Children Shall Not Discipline Other Children Children shall neither be allowed nor be instructed to discipline other children. Source: Miss. Code Ann. §43-20-8. Subchapter 15.

TRANSPORTATION

Rule 2.15.7 General: Regardless of transportation provisions, the child care facility is responsible for the safety of the children. Source: Miss. Code Ann. §43-20-8. Rule 2.15.8

Requirements: It is required that:

1. All drivers are appropriately licensed. 2. All vehicles have current safety inspection stickers, licenses, and registrations. 3. Insurance adequately covers the transportation of children. 4. Children board or leave the vehicle from the curbside of the street and/or are safely accompanied to their destinations. 5. A parent is present if the child is delivered home. 6. Seat restraints are used. Source: Miss. Code Ann. §43-20-8. Rule 2.15.9

Occupant Restraints

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1. All children will be properly restrained whenever they are being transported in a motor vehicle. a. Every person transporting a child under the age of four (4) years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, e.g., child safety seat. b. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five (65) pounds. c. Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above. 2. No vehicle shall be occupied by more individuals than its rated capacity. 3. No children shall be transported in the front seat of vehicles equipped with passengerside air bags. 4. All vehicles under 10,000 lbs. GVWR (Gross Vehicle Weight Rated) shall be equipped with occupant restraints appropriate for the age and/or weight of the children being transported. A child under the age of four shall be transported only if the child is securely fastened in a child safety seat that meets Federal Motor Vehicle Safety Standards (FMVSS, 49 CFR 571.213), which shall be indicated on the child safety seat. The child safety seat shall be appropriate to the child's weight and be installed and used according to the manufacturer's instructions. 5. Vehicles (e.g., school buses) with a GVWR 10,000 lbs. or more, at a minimum, shall meet the current Federal Motor Vehicle Safety Standards (FMVSS) for buses of that size. It is the responsibility of the child care facility operator to have documentation verifying that a bus meets the current FMVSS. NOTE: Federal Motor Vehicle Safety Standards (FMVSS) means the National Highway and Traffic Safety Administration's standards for motor vehicles and motor vehicle equipment established under Section 103 of the Motor Vehicle Safety Act of 1966 (49 CFR Part 571) as they apply to school buses. 6. An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed. Source: Miss. Code Ann. §43-20-8.

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Rule 2.15.10 Staff-to-Child Ratio: The staff to child ratio shall be maintained at all times. The driver of the vehicle shall not be counted as a caregiver while transporting the children. Source: Miss. Code Ann. §43-20-8. Subchapter 16.

DIAPERING AND TOILETING

Rule 2.16.7 Diaper Changing Area: Each room in which diaper-wearing children play shall contain a diapering area. A diapering area shall contain a hand washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plastic-lined, covered garbage receptacle, and sanitizing solution. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity nor shall they be used for any other purpose. Example: The diaper-changing sink may not be used for washing/rinsing cups, baby bottles, food, dishes, utensils, pacifiers, etc. In addition, the diaper changing area is not to be used as a storage area for anything other than those items used when changing diapers, such as but not limited to, gloves, towels, soap, etc. For proper diaper changing procedure, see Appendix G - PROCEDURE FOR DIAPERING A CHILD. Source: Miss. Code Ann. §43-20-8. Rule 2.16.8 Non-Disposable Diapers and Training Pants: The fecal contents of nondisposable diapers or training pants shall be disposed of into a toilet. The soiled nondisposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container. Source: Miss. Code Ann. §43-20-8. Rule 2.16.9 Disposable Diapers: Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle. Source: Miss. Code Ann. §43-20-8. Rule 2.16.10 Potty Chairs: Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use. Source: Miss. Code Ann. §43-20-8. Rule 2.16.11 Hand Washing: Employees shall wash their hands with soap and running water before and after each diaper change. Individual or disposable towels shall be used for drying. Hand washing sinks at diaper changing stations shall not be used for any other purpose. Example: The diaper-changing sink may not be used for washing cups, baby bottles, food, dishes, utensils, etc. Source: Miss. Code Ann. §43-20-8. . 158

Rule 2.16.12 Parental Consultation: A parent-caregiver consultation is required prior to toilet training. Source: Miss. Code Ann. §43-20-8. Subchapter 17.

REST PERIODS

Rule 2.17.7 Equipment: Each child shall be placed on a separate bed, crib, cot, or mat. Cribs shall be labeled so that the child's name is visible. Source: Miss. Code Ann. §43-20-8. Rule 2.17.8 Cleaning of Linens and Bed Coverings: Linens and bed coverings shall be changed immediately when soiled. All linens and bed coverings shall be changed, at a minimum, two times per week. Source: Miss. Code Ann. §43-20-8. Rule 2.17.9 Cleaning of Rest Period Equipment: All rest period equipment shall be wiped clean immediately when soiled. All rest period equipment shall be cleaned twice a week with a germicidal solution. Additional cleaning may be required by the licensing authority if there is an outbreak of a communicable disease, including but not limited to, rotavirus, giardiasis, etc., or a noninfectious condition such as, but not limited to, an infestation of head lice. Source: Miss. Code Ann. §43-20-8. Rule 2.17.10 Sharing of Rest Period Equipment: At no time will two or more children be allowed to share the same bed, crib, cot, or mat during their time of enrollment, unless it is cleaned with a germicidal solution between each child's use. Source: Miss. Code Ann. §43-20-8. Subchapter 18.

FEEDING OF INFANTS AND TODDLERS

Rule 2.18.7 Hand Washing: Employees shall wash their hands with soap and water, and dry their hands with individual or disposable towels, before and after each feeding. The infant and toddler's hands shall be washed with soap and water, and dried with individual or disposable towels, before and after each feeding. Source: Miss. Code Ann. §43-20-8. Rule 2.18.8 Bottle Feeding: Infants shall be held while being bottle-fed. Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep. Source: Miss. Code Ann. §43-20-8. . 159

Rule 2.18.9 Formula Storage: Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival. Source: Miss. Code Ann. §43-20-8. Rule 2.18.10 Baby Food: Foods stored or prepared in jars shall be served from a separate dish for each infant or toddler. Any leftovers from the serving dish shall be discarded. Leftovers in the jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or discarded. Source: Miss. Code Ann. §43-20-8. Rule 2.18.11 Refrigerator: A refrigerator shall be available and easily accessible to the infant or toddler's room(s). Source: Miss. Code Ann. §43-20-8. Rule 2.18.12 Heating Unit and Microwave Use 1.

A heating unit for warming bottles and food shall be accessible only to adults.

Microwave ovens shall not be used for warming bottles or baby/infant food.

Source: Miss. Code Ann. §43-20-8. Rule 2.18.13 Breast-Feeding Accommodations and Staff Training: This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1.

Breast-feeding mothers, including employees, shall be provided a sanitary place that is not a toilet stall to breast-feed their child or to express milk. This area shall provide an electrical outlet, comfortable chair, and nearby access to running water.

Child care staff shall be trained in the safe and proper storage and handling of human milk. Although other training materials may be utilized, training materials will be available through MSDH.

Guidelines for Milk Storage and Use for All Infants Maximum Amount of Time For Storage Method and Temperature Storage Room (25 C or 77 F) 4 hours . 160

Refrigerator (4 C or 39 F)

48 hours

Previously thawed – Refrigerated milk

24 hours

Freezer (-20 C or 0 F)

3 months

From the ACOG/AAP publication: Breastfeeding Handbook for Physicians Source: Miss. Code Ann. §43-20-8. Subchapter 19.

SWIMMING AND WATER ACTIVITIES

Rule 2.19.7 General: This section shall apply to any child care facility that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on site or at any other location during the time staff has responsibility for children enrolled. Source: Miss. Code Ann. §43-20-8. Rule 2.19.8

Lifeguard Supervision

1. Swimming pools, lakes, etc. a. A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities. b. One lifeguard is required for every 25 children or any portion thereof (i.e., two lifeguards are required for groups of 26 - 50, three for 51 - 75, etc.). This required ratio also includes activities that occur near water such as fishing or beach activities. c. Lifeguards are not counted in the staff-to-child ratio. d. The staff-to-child ratio shall be maintained at all times. e. It is the child care facility operator’s responsibility to provide adequate certified lifeguards if the pool or lake operator does not. f. Each child will be tested by a certified lifeguard prior to participating in swimming lessons or any pool activities. Children will be assigned to swim groups according to the results of the test. g. Staff, as well as lifeguards, shall be responsible for enforcing general safety rules. h. Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can understand what is expected. . 161

2. Wading pools For activities taking place in wading pools with a water depth of one foot or less the following is required: a. There shall be a person(s) with a valid CPR certificate and a valid first aid certificate present at all times. b. The staff-to-child ratio shall be maintained at all times. c. Wading pools shall be cleaned after each use. Source: Miss. Code Ann. §43-20-8. Rule 2.19.9

Health and Safety

1. All piers, floats, and platforms shall be in good repair, and where applicable, the water depth shall be indicated by printed numerals on the deck or planking. 2. There shall be a minimum water depth of ten feet for a one-meter diving board and 13 feet for a three-meter board or diving tower. 3. For outdoor swimming areas in natural bodies of water, the bottom shall be cleared of stumps, rocks, and other obstacles. 4. Diving boards shall be mounted on a firm foundation and never on an insecure base, such as a float that can be affected by shifting weight loads and wave action. The entire length of the top surface of diving boards shall be covered with nonskid material. The diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines for the board by professional swimming pool installers who shall certify in writing to the facility that the diving board is adequately installed in accordance with manufacturer’s guidelines for the board, in a commercially reasonable manner, located so as to allow a child to safely enter the water from the diving board, and that the diving board is safe for its intended use. Facilities with existing pools equipped with diving boards that are unable to obtain the required certification within 60 days of the adoption of this regulation shall have the diving boards removed. 5. Swimming pools, when in use, shall be continuously disinfected by a chemical that imparts an easily measured free available residual effect. When chlorine is used, a free chlorine residual of at least 0.4 ppm shall be maintained throughout the pool whenever it is open or in use. If other halogens are used, residuals of equivalent disinfecting strength shall be maintained. 6. A testing kit for measuring the concentration of the disinfectant, accurate within 0.1 ppm, shall be provided at each swimming pool. 7. Swimming pool water shall be maintained in an alkaline condition as indicated by a pH of not less than 7.2 and not over 8.2. A pH testing kit accurate to the nearest 0.2 pH unit shall be provided at each swimming pool. The alkalinity of the water shall be . 162

at least 50 ppm, as measured by the methyl-orange test. The following chart may be used for reference: pH

Minimum Free Available Residual Chlorine-mg/L (not stabilized with cyanuric acid)

7.2.............................................0.40 7.3.............................................0.40 7.4.............................................0.40 7.5.............................................0.40 7.6.............................................0.50 7.7.............................................0.60 7.8.............................................0.70 7.9.............................................0.80 8.0.............................................1.00 8. If cyanuric acid is used to stabilize the free available residual chlorine, or if one of the chlorinated isocyanurate compounds is used as the disinfecting chemical in a swimming pool, the concentration of cyanuric acid in the water shall be at least 30 mg/L but shall not exceed 100 mg/L. The free available residual chlorine, of at least the following concentrations, depending upon the pH of the water, shall be maintained: pH

Minimum Free Available Residual Chlorine-mg/L (cyanuric acid is at least equal to 30 mg/L, but not greater than 100 mg/L)

7.2............................................1.00 7.3............................................1.00 7.4............................................1.00 7.5............................................1.00 7.6............................................1.25 7.7............................................1.50 7.8............................................1.75 7.9............................................2.00 8.0............................................2.50 9. The water in a swimming pool shall have sufficient clarity at all times so that a black disk, six inches in diameter, is readily visible when placed on a white field at the deepest point of the pool. The pool shall be closed immediately if this requirement cannot be met. . 163

10. For natural bodies of water (e.g., lakes, rivers, streams, etc.), sewage treatment plants or other discharge lines shall not be within 750 feet of swimming areas. Source: Miss. Code Ann. §43-20-8. Subchapter 20. Rule 2.20.7

CHILDREN WITH SPECIAL NEEDS

Facility Adaptation

1. The child care facility areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate. 2. A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures. Source: Miss. Code Ann. §43-20-8. Rule 2.20.8 Activity Plan: A child with special needs shall have an individual activity plan. The individual activity plan shall have been developed by a person with a bachelors or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months. Source: Miss. Code Ann. §43-20-8. Rule 2.20.9 Caregiver Staff Development: Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served. Source: Miss. Code Ann. §43-20-8. Rule 2.20.10 Staffing: Caregiver staffing shall be appropriate and adequate to meet the specific physical and/or developmental needs of the special needs children served at the child care facility. Staff-to-child ratio shall be determined by the needs of the child rather than child’s chronological age as based upon the child’s individual plan (i.e., individual education plan, individual habilitation plan, individual family service plan, etc.). The facility is encouraged to be an active participant in the child’s individual plan development. Source: Miss. Code Ann. §43-20-8. Subchapter 21.

NIGHT CARE

Rule 2.21.7 General This section shall apply to any child care facility that is open past 11:30 p.m., as part of their regular hours of operation. Source: Miss. Code Ann. §43-20-8. Rule 2.21.8

Nutrition

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1. A child care facility that is open prior to 7:00 p.m. shall provide a dinner meal period. 2. A child care facility that remains open after 5:00 a.m., shall provide a breakfast meal period. 3. A snack period shall be provided to children in attendance for more than two and onehalf hours prior to bedtime. 4. Menu plans for lunch and dinner meals shall be varied. No single menu shall be repeated in a 24-hour period. Source: Miss. Code Ann. §43-20-8. Rule 2.21.9

Sleeping

1. Mats shall not be used for sleeping. 2. Bedtime schedules shall be established in consultation with the child's parent. 3. Provisions shall be made in sleeping areas for the use and storage of clothing and personal belongings and they shall be within easy reach of the child using them. 4. A child shall be provided with a bed or cot equipped with a comfortable mattress (a minimum of three inches thick), sheets, a pillow with a pillowcase, and a blanket. 5. The upper level of double-deck beds shall not be used for children under ten years of age. The upper level of double-deck beds are allowed for children ten years of age or older if a bed rail and safety ladder is provided. 6. Each child shall have clean and comfortable sleeping garments. Source: Miss. Code Ann. §43-20-8. Rule 2.21.10 Bathroom Facilities 1. There shall be a bathtub or shower available for children of toddler age or older. 2. Bathtubs and showers shall be equipped to prevent slipping. 3. If night care is provided for infants, there shall be age appropriate bathing facilities for these children. 4. Bathrooms shall be located near the sleeping areas. 5. No children under six years of age shall be left alone or with another child while in the bathtub or shower. 6. All children shall be bathed separately. . 165

7. All children shall be provided an individual washcloth, towel, and soap for bathing, with fresh water for each child. Source: Miss. Code Ann. §43-20-8. Subchapter 22. Rule 2.22.7

HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES

Emergency Suspensions of License

1. Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the child care facility constitutes a substantial hazard to the health or safety of the children cared for by the child care facility. 2. Whenever a license is to be suspended, the operator or director shall be notified in writing that the license, upon service of the notice, is immediately suspended. The notice shall contain the reason for the emergency suspension, and shall set a date for a hearing, which shall be within 14 days of the service of notice. Source: Miss. Code Ann. §43-20-8. Rule 2.22.8 Denial, Revocation, or Suspension of License The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any child care facility upon one or more of the following grounds: 1. Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license. 2. Conviction of an operator of any crime, if the licensing agency finds that the acts of which the operator has been convicted could have a detrimental effect on the children cared for by the child care facility. 3. Violation of any of the provisions of the act or of these rules and regulations. 4. Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child. 5. Failure by the child care facility to have all criminal records and child abuse central registry checks on file at the facility. 6. Information received by the licensing authority because of the criminal records check (fingerprinting) or the child abuse central registry check on an operator. Source: Miss. Code Ann. §43-20-8. Rule 2.22.9

Notification

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Prior to the denial, refusal to renew, suspension, revocation or restriction of a license, and at the time of the imposition of any monetary penalty, written notice of the contemplated action shall be given to the applicant or person named on the license of the child care facility, at the address on record with the licensing agency. Such notice shall specify the reasons for the proposed action and shall notify the operator of the right to a hearing on the matter. Source: Miss. Code Ann. §43-20-8. Rule 2.22.10 District Level Hearing 1. If requested in writing within ten calendar days of receipt of notice of the imposition of a monetary penalty, a district level hearing shall be provided in which the operator or applicant may show cause why the monetary penalty should not be imposed. The District Health Officer or his/her designee will preside at said hearing. 2. Any hearing requested pursuant to Subchapter 22, Rule 2.22.4(1) shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period. 3. The district level hearing shall be informal. There will be no court reporter present and the Department will not be represented by counsel. However, the hearing officer will take notes of the proceedings and will provide the licensee with a written order outlining his decision within ten calendar days of conclusion of the district level hearing. 4. Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level. Source: Miss. Code Ann. §43-20-8. Rule 2.22.11 State Level Hearing 1. If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee. 2. Within 30 calendar days of the hearing, or such period as determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health Officer. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator. . 167

3. At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense. 4. For the Rules and Procedures for State Level Administrative Hearings refer to APPENDIX J of these regulations. Source: Miss. Code Ann. §43-20-8. Rule 2.22.12 Appeal Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the child care facility is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. If a facility is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties. Source: Miss. Code Ann. §43-20-8. Rule 2.22.13 Injunction Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a child care facility with or without a license under the act, or otherwise in violation of these regulations. Source: Miss. Code Ann. §43-20-8. Rule 2.22.14 Criminal Penalties Any person establishing, conducting, managing, or operating a child care facility without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense. Source: Miss. Code Ann. §43-20-8. Rule 2.22.15 Violations and Penalties In the event of an emergency occurring at a child care facility which makes it difficult or impossible to comply with any of these Rules, the facility shall not be considered to be in violation of those specific Rules. For purposes of this Rule 2.22.9, the term “emergency” shall include only the following: . 168

a. b.

Inclement weather; Damage to the facility and/or structure which might require moving, transferring or consolidation of children; Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises; or During any declaration of emergency by local or state officials. An injury or illness of a child at the facility requiring the immediate attention of one or more caregivers, resulting in non-compliance of child-to-staff ratio or room ratio; and During a period when Department inspectors or other government officials requires facility staff to temporarily not be able to perform their normal supervisory duties.

c. d. e. f.

Source: Miss. Code Ann. §43-20-8. Subchapter 23.

RELEASE OF INFORMATION

Rule 2.23.1 Information in the possession of the licensing agency concerning the license of individual child care facilities may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a child care facility. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 4321-353(8) and Section 43-21-257 Mississippi Code of 1972, annotated. Source: Miss. Code Ann. §43-20-8. CHAPTER 3: REGULATIONS GOVERNING REGISTRATION OF CHILD RESIDENTIAL HOMES Subchapter 1: Rule 3.1.1

GENERAL

Legal Authority The Child Residential Home Notification Act, §43-16-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child residential homes defined under the law. The Mississippi State Department of Health shall be the notification agency for all child residential homes, and the department shall discharge the provisions the Child Residential Home Notification Act, §43-16-1 et. seq. of the Mississippi Code of 1972.

Source: Miss. Code Ann. § 43-16-5. Rule 3.1.2 1.

Purpose The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the registration of child residential homes as defined herein to assure that certain minimum standards are maintained in such

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facilities. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of registration. This document and its appendices constitute the Regulations Governing the Registration of Child Residential Homes. 2.

A child residential home may exceed the minimum quality standards required in these regulations, but may not operate without meeting the minimum standards set forth in these regulations.

Source: Miss. Code Ann. § 43-16-5. Rule 3.1.3 Severability If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations which can be given effect without the invalid provision or application, and to this end the provisions of these regulations are declared to be severable. Source: Miss. Code Ann. § 43-16-5. Rule 3.1.4

Definitions

1. Act: The Child Residential Home Notification Act, §43-16-1 et. seq. of the Mississippi Code of 1972. 2. Agency Representative: An authorized representative of the Mississippi State Department of Health. 3. Child: A person who has not reached the age of 18 years or who has not otherwise been legally emancipated. 4. Child Residential Home: Any place, facility or home operated by any person which receives children who are not related to the operators and whose parents or guardians are not residents of the same facility for supervision, care, lodging and maintenance for 24 hours a day, with or without transfer of custody. The term “A Child Residential Home” shall not include: a.

residential homes which are licensed by the Mississippi Department of Human Services under the provisions of §43-15-5, Mississippi Code of 1972 (such facility shall hereafter be known as a Residential Child-Caring Agency);

any public school;

any such home operated by a state agency;

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child care facilities as defined in §43-20-5, Mississippi Code of 1972;

youth camps as defined in §75-74-3, Mississippi Code of 1972; or

health care facilities licensed by the Department of Health.

5. Department: The Mississippi State Department of Health (MSDH). 6. Person: An individual, partnership, organization, association, or corporation. 7. Director: An individual, designated by the operator, who has met minimum state requirements and who has on-site responsibility for the operation of a child care facility. This person may or may not be the operator. 8. Health: The condition of being sound in mind and body and encompassing an individual's physical, mental, and emotional welfare. 9. Operator: Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct, or maintain a child residential home. The child residential home registration shall be issued in the name of the operator, or, if there is more than one (1) operator, in the name of one (1) of the operators. In the event that there is more than one (1) operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all operators of a facility, including, but not limited to, a spouse who jointly owns, operates or maintains the child residential home regardless of which operator is named on the license. 10. Parent: As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to whom a court of competent jurisdiction has granted legal authority over the child. 11. Personal Care: Assistance rendered by personnel of the child care facility in performing one or more of the activities of daily living, which includes but is not limited to the feeding, personal grooming, supervising and dressing of children placed in the child care facility. 12. Safety: The condition of being protected from hurt, injury or loss. 13. Service Staff : A person who provides support services such as cooking, cleaning, or driving a vehicle, but is not a caregiver. Source: Miss. Code Ann. § 43-16-5. Subchapter 2: Rule 3.2.1

REGISTRATION

Requirement for Registration

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1. No person shall establish, own, operate, conduct, or maintain a child residential home in this state without being registered pursuant to these regulations. 2. The operator of any child residential home shall provide notification/registration in accordance with these regulations within 60 days of beginning operation. The registering authority will require no entity exempt from the licensure requirement to apply for a license. However, should an exempt entity desire to obtain a license, it will be subject to these regulations. Source: Miss. Code Ann. § 43-16-5. Rule 3.2.2 Eligibility for Registration Any Child Residential Home not meeting the following criteria is required by §43-15-101 through §43-15-125 to be licensed by the Mississippi Department of Human Services. It is the responsibility of operator of the home claiming exemption from licensure to provide the required documentation to both the Mississippi State Department of Health (MSDH) and the Mississippi Department of Human Services (MDHS). To be exempt from MDHS licensure and eligible to register with the MSDH, a Child Residential Home shall: 1. Operate under the auspices of a religious institution. a.

Such religious institution must have a tax exempt status as a nonprofit religious institution in accordance with §501(c) of the Internal Revenue Code of 1954, as amended, or

The real property owned and exclusively occupied by the religious institution must be exempt from location taxation.

2. The agency or institution must be in compliance with the requirements of the Child Residential Notification Act, §43-16-1 et seq., Mississippi Code of 1972 and these regulations. 3. The agency or institution must not be in violation of §43-16-21(c) regarding the abuse and/or neglect of any child served by such home who has been adjudicated by the youth court as an abused and/or neglected child. Source: Miss. Code Ann. § 43-16-5. Rule 3.2.3 Application for Registration An application for registration under these regulations shall be made to the registering agency upon forms provided by it and shall contain such information as the registering agency may reasonably require. Source: Miss. Code Ann. § 43-16-5.

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Rule 3.2.4 Registration Fee All registration fees, registration renewal fees, and administrative charges shall be paid by certified check or money order payable to the Mississippi State Department of Health, and are non-refundable. Checks returned for insufficient funds, closed account, etc., shall be assessed an additional $50 fee. 1.

Initial Registration Fee……………………………………………...$100.00

Registration Renewal Fee…………………………………………..$100.00

Reinstatement Fee…………………………………………………..$200.00

Returned Check Fee…………………………………………………$ 50.00

Late Fee……………………………………………………………..$ 25.00

Fingerprinting Fee (Per Fingerprint Card)………………………….$ 50.00

Certificate of Inspection by Fire Department

A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child residential home is located shall be submitted to the licensing agency with the application and registration fee. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards

The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection

Source: Miss. Code Ann. § 43-16-5. Rule 3.2.6 Inspection: An agency representative(s) shall inspect each child care facility prior to issuing or renewing a registration to assure compliance with these regulations. Source: Miss. Code Ann. § 43-16-5. Rule 3.2.7 Record of Inspection: Whenever an inspection is made of a child residential home, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made.

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Source: Miss. Code Ann. § 43-16-5. Rule 3.2.8

Renewal of Registration

1. The registering agency shall issue licenses which may be renewed annually. The registering agency shall mail renewal notices, at least 75 days prior to the expiration date of the license to the address of the operator registered with the registering agency. The operator shall: a.

Complete the renewal form;

Submit any and all certificates of inspection and approval required by the registering agency;

Enclose the renewal fee; and

File the above with the registering agency at least 30 days prior to the expiration date on the registration.

NOTE:

Renewal applications postmarked less than 30 days prior to the expiration date of the registration shall be assessed a $25.00 late fee.

2. An operator who does not file the renewal application prior to the date that the registration expires will be deemed to have allowed the registration to lapse. Said registration may be reinstated by the registering agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one (1) month of the expiration date of the registration. After the one month reinstatement period, it shall be required that an application for an initial registration be submitted. All registration requirements in effect at the time the new initial application is filed shall be met. In addition all delinquent fees shall be paid. Source: Miss. Code Ann. § 43-16-5. Rule 3.2.9 Registration Not Transferable or Assignable Each registration shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivos gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child residential home. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included. Source: Miss. Code Ann. § 43-16-5. Rule 3.2.10 Display of Registration The current registration issued by the registering agency to the named child residential home and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the

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MSDH that informs the public of where and how they may report a complaint against the facility. Source: Miss. Code Ann. § 43-16-5. Subchapter 3:

RIGHT OF ENTRY AND VIOLATIONS

Rule 3.3.1 Right of Entry An agency representative may enter any child residential home for the purpose of making inspections or investigations to determine compliance with these regulations. Source: Miss. Code Ann. § 43-16-5. Rule 3.3.2 Violations: If violations noted on the inspection form are not corrected within the period of time specified by the registering agency, a registration may be denied, suspended, or revoked in accordance with these regulations. Source: Miss. Code Ann. § 43-16-5. Subchapter 4: Rule 3.4.1

INITIAL NOTIFICATION REQUIREMENTS

When making the initial notification that a Child Residential Home is operating or intending to operate, the executive director of the Child Residential Home shall provide the following information to the department on forms provided by the department:

Documentation that the agency is exempt from the licensure requirements of the MDHS.

Name, street address, mailing address and phone number of the home.

Name of the executive director and all staff members of the home.

Name and description of the agency or organization operating the home, which shall 1include a statement as to whether or not the agency or organization is incorporated. Name and address of the sponsoring organization of the home, if applicable.

Source: Miss. Code Ann. § 43-16-5. Rule 3.4.2 The names of all children living at the home which shall include the following personal data: 1.

Full name and a copy of the child’s birth certificate;

Name and address of parent(s) or guardian(s); and

Name and address of other nearest relative.

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School(s) attended by the children served by such home.

Fire department or State Fire Marshal inspection certificate.

Local health department inspection certificate.

Source: Miss. Code Ann. § 43-16-5. Rule 3.4.3 Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant (CCDBG) Act of 2014, and Federal Rules and Regulations .43 Criminal Background Checks all operators, employees, and prospective employees of a child residential home and any individual residing in a residence licensed as a child residential home shall have an FBI national criminal history records check (fingerprint), State criminal history records check (fingerprint), State child abuse registry check, National Crime Information Center (NCIC) National Sex Offender Registry (NSOR) sex offender registry check, and State sex offender registry check. Further, such checks must be completed at least every five years on the owner and staff of a child residential home. 1. Before a prospective staff member may begin work in a child residential home a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. The child residential home shall submit the following for processing: A. A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health (MSDH) for processing. A copy of the submitted fingerprint card, fees paid, and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Mississippi State Department of Health (Department) verifying the employee’s suitability for employment. If the facility is notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall resubmit the necessary information within ten days of the dated letter on the notification. B. A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department of the employee’s suitability for employment. 2. Each licensed child residential home with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a department-maintained webpage: http://www.HealthyMS.com. 3. Upon receipt of notification, that the employee has been deemed suitable for

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employment in a child residential home, the facility shall provide the employee the original Letter of Suitability and shall maintain a copy of the suitability letter for the facility files. A. Unless otherwise voided, the letter confirming an employee’s Suitability for Employment is valid for a period of five years from the date of the letter. However, if an individual has been separated from employment (break in service) in a child residential home for more than 180 consecutive days a new criminal history records check must be submitted and approved before the individual may begin work in a child residential home regardless of the date of issuance on the letter. B. The facility owner and each employee shall have criminal history records checks (fingerprint), child abuse registry checks, and sex offender registry checks completed at least every five years. C. The Letter of Suitability is not transferable to another program licensed by the Child Care Licensure Bureau after the date of expiration as specified within the suitability letter. 4. Individuals under the age of 18 that are employed by a child provider for compensation are required to complete a comprehensive background check that includes everything an adult criminal history records check requires. 5. Child residential home providers shall require each applicant that lives outside of Mississippi and/or has lived outside of Mississippi within the last 5 years to complete an interstate background check for the previous state(s) of residence, which includes at a minimum a state criminal history record check, state sex offender registry check, and state child abuse and neglect registry check. The interstate background check must be completed within 45 days of the submission of the prospective employee’s child residential home employment application. 6. Volunteers. A. The facility shall maintain the following on any individual who volunteers in a child residential home for less than 120 hours per licensure year: i. A timesheet on all volunteers indicating the number of hours they worked each time they were at the facility; and ii. Immunization Compliance Form 121. B. The facility shall maintain the following on any individual who volunteers in a child residential home for 120 or more hours per licensure year: i. Letter of Suitability that reflects the completion of a full criminal records

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check, child abuse registry check, and sex offender check. Also, if required an out-of-state criminal records check, child abuse registry check, and sex offender check; and ii. Immunization Compliance Form 121. Source: Miss. Code Ann. § 43-16-5 Rule 3.4.3 Proof, to be shown by sworn affidavit of the executive director of the home, that medical records are maintained for each child. Source: Miss. Code Ann. § 43-16-5. Subchapter 5: ACKNOWLEDGMENT OF NOTIFICATION AND CERTIFICATE OF REGISTRATION Rule 3.5.1

Upon the submission of a properly completed notification form accompanied by

1. A certificate of inspection and approval by the fire department of the municipally or other political subdivision in which the home is located, and 2. a certificate of inspection and approval by the health department of the county in which the home is located, the department will acknowledge that the home has properly notified the department regarding its operation and issue a “Certificate of Registration.” Source: Miss. Code Ann. § 43-16-5. Rule 3.5.2 Upon issuing the acknowledgment of notification and certificate of registration the MSDH shall provide copies of the notification form to the chancery court or the youth court, as appropriate, of the county in which the home is located. Source: Miss. Code Ann. § 43-16-5. Subchapter 6: Rule 3.6.1

MONTHLY REPORTS

Each child residential home shall file monthly reports with the department, on forms provided by the department. Said monthly report shall indicate any changes in the notification information originally provided in accordance with Subchapter 4 of these regulations which have occurred, if any.

Source: Miss. Code Ann. § 43-16-5. Subchapter 7:

ANNUAL INSPECTION OF HOMES

Rule 3.7.1 The department, once a year, shall make or cause to be made inspections limited to health, nutrition, cleanliness, sanitation, written medical records for children, discipline

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policy, family communication policy, and required criminal checks of all child residential homes. Source: Miss. Code Ann. § 43-16-5. Rule 3.7.2 Reasonable additional inspections may be made as often a may be deemed necessary by the department, but shall not be scheduled so as to disrupt the normal activities of the home. Source: Miss. Code Ann. § 43-16-5. Rule 3.7.3

Annual fire inspections are required and shall be made of the home.

Source: Miss. Code Ann. § 43-16-5. Rule 3.7.4 Any violation of state law on the premises of a child residential home shall immediately be reported by such inspection personnel to the appropriate law enforcement official. Source: Miss. Code Ann. § 43-16-5. Subchapter 8: Rule 3.8.1

REQUIRED WRITTEN POLICIES

Every child residential home shall have a written discipline policy and written family communication policy which shall be approved in writing, if possible, by the parent(s) or guardian(s) of the children residing at such home, and shall be made available to authorized inspection personnel upon request.

Source: Miss. Code Ann. § 43-16-5. Subchapter 9: ENFORCEMENT OF NOTIFICATION/REGISTRATION REQUIREMENTS Rule 3.9.1

Whenever the department is advised or has reason to believe that any child residential home is operating without proper notification in accordance with this chapter, it shall request a meeting with the governing board and executive director of such home to ascertain the fact. If the department finds that such home is providing supervision, care, lodging or maintenance for any children without such notification, it shall give the executive director of the home written notice by certified mail that such person shall file notification in accordance with this chapter within 60 days after receipt of such notice or the department may request a court injunction as provided in §43-16-21.

Source: Miss. Code Ann. § 43-16-5. Subchapter 10: COURT ACTION FOR INJUNCTION OR RESTRAINING ORDER AGAINST HOME: GROUNDS

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Rule 3.10.1 Notwithstanding the existence of any other remedy, the department may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the department in the proceedings, maintain an action in the name of the state for an injunction or restraining order to cease the operation of the home, and to provide for the appropriate removal of the children from the home and placement in the custody of the parents or legal guardians, the Department of Human Services, or any other appropriate entity in the discretion of the court. Such action shall be brought in the chancery court or the youth court, as appropriate, of the county in which such child residential home is located, and shall only be initiated for the following violations: 1.

Providing supervision, care, lodging, or maintenance for any children in such home without filing notification in accordance with this chapter.

Failure to satisfactorily comply with local health department or State Fire Marshal inspections made pursuant to §43-16-15, regarding the health, nutrition, cleanliness, safety, sanitation, written records and discipline policy of such home.

Suspected abuse and/or neglect of the children served by such home, as defined in §43-21-105, Mississippi Code of 1972.

Source: Miss. Code Ann. § 43-16-5. Subchapter 11:

REGULATION OF PROGRAM CONTENT

Rule 3.11.1 No governmental agency shall have jurisdiction or authority to regulate or attempt to regulate, control or influence the form, manner or content of the religious curriculum, program or ministry of a school or of a facility sponsored by a church or religious organization. Source: Miss. Code Ann. § 43-16-5. CHAPTER 4: REGULATIONS GOVERNING LICENSURE OF YOUTH CAMPS Subchapter 1:

DEFINITIONS

Rule 4.1.1 The following words and terms, when used in these regulations, shall have the following meanings unless the context indicates otherwise. 1.

Adult means a person 18 years of age or older.

Board means the State Board of Health(s governing board consisting of 13 members.

Camper means any child six (6) to eighteen (18) years of age who is attending a youth camp.

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Camping means a sustained experience which provides a creative, recreational, and educational opportunity in-group living in the out-of-doors.

Camp Director means the individual who has the primary responsibility for health matters, food, and supportive services, such as business and transportation, at a youth camp. This person may or may not be classified as the Program Manager also.

Assistant Camp Director means an individual appointed by the director and who must be present and responsible in his absence.

Youth Camp Operator shall mean any person who owns, operates, controls, or supervises, whether or not for profit, a youth camp. The license is issued to the Youth Camp Operator, and has the ultimate responsibility for the operation of the youth camp.

Program Manager is the individual responsible for the staff supervision and program administration and shall meet the requirements of CAMP DIRECTOR.

Program Manager Permit is the permit to operate a camping program of four or more consecutive days in a site rental situation.

10.

Counselor means an individual who has a supervisory role with campers. This individual shall be at least a high school graduate or 18 years of age.

11.

Health Officer means the State Health Officer, Mississippi State Board of Health.

12.

Person means any individual, partnership, corporation, association, or organization.

13.

Swimming and Diving Areas mean and include those aquatic facilities and operations generally known as swimming pools, wading pools, diving tanks, beaches, rivers, lakes, or other natural bodies of water, and similar areas and facilities.

14.

Tent means any shelter of which 25 percent or more of the walls or roof or both are constructed of, or covered, or protected by canvas or any other fabric material.

15.

Youth Camp means any camp operating on a permanent campsite for four (4) or more consecutive periods of twenty-four (24) hours and accommodating twenty (20) or more children six (6) to eighteen (18) years of age: provided, however, athletic camps and hunting and fishing camps shall not be included in this definition.

16.

Special Needs Campers mean those campers who have (1) physical disabilities affecting sense organs, muscles or skeletal structure, (2) mental impairments altering their intellectual performance, reasoning, or judgment, or (3) special medical problems which place restrictions upon their movement or render them

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unable to function in a normal setting without assistance or special supervisory attention. 17.

Department means the Mississippi State Department of Health.

Source: Miss. Code Ann. § 75-74-9. Subchapter 2: Rule 4.2.1

LICENSING, APPLICATIONS, and PLANS General Requirements

No person shall establish, promote, conduct, advertise, or maintain a youth camp without a license or permit issued by the Department.

A youth camp, as defined in these regulations, shall advertise and operate only as the type of camp for which it has been licensed.

Services for campers with special needs shall not be advertised unless the camp has suitable facilities and staff members qualified to offer such specific services.

The Department may at any time evaluate the conditions of a youth camp. Duly authorized representatives of the Department shall have the right of entry and access to any such camps at any reasonable time. Said representative shall notify the person in charge immediately upon arrival and present proper credentials.

Each license shall specify the name of the camp, the age, and maximum capacity that may be served, the name of the camp operator and owner and the specific base site(s) where the camp may operate.

The license shall be posted in a conspicuous place in the camp.

All camps shall report immediately in writing to the Department when the following changes or events occur:

Change of owner or operator

Proposed increase in enrollment over number authorized in the license

Proposed capital improvements or additions to facilities

Cancellation of camp for the season

In camps where the camp director is unable to be present during the hours of operation or is unable to assume full responsibility for the operation and staff of the camp, there shall be an assistant director on the premises who shall be responsible for insuring that all requirements are met during all hours of operation under his jurisdiction.

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The camp operator (licensee) is responsible for notifying the licensing agency when camps will be conducted by a permitted program manager and the name of said manager.

10.

All licensed camps shall apply for renewal of license and inspection on an annual basis to the Department. The licensing year shall be June 1 through May 31.

Source: Miss. Code Ann. § 75-74-9.

Rule 4.2.2

Submission of Plans

Sanitary Facilities for New Camps and Modification of Existing Camps In accordance with applicable state and local laws, ordinances and regulations, plans and specifications for the construction, reconstruction or extensive alteration of any plumbing system, water supply, sewage system, garbage or refuse disposal system, kitchen, food service or dining facilities, swimming and/or diving area at any residential camp shall be submitted to the Department for review at least 60 days prior to the initiation of construction, to be returned by the Department within 30 days. This review is to determine that the facility meets all rules and regulations as stipulated for Youth Camp Licensure. Camps on New Site a.

In accordance with applicable State and local laws, ordinances and regulations, plans and specifications for the construction and operation of a residential camp on a new site should be submitted to the Department for review at least 60 days prior to the initiation of construction and shall contain at least the following information: i.

Name and address of owner or operator of camp

ii.

Location, boundaries and dimensions of campsite and lots

iii.

Entrance and exit roads, access roads and trails

iv.

Location, use and floor plans of all proposed and existing buildings; detailed plans and specifications of swimming pools and other swimming areas

Location of all proposed or existing water supplies and sewage systems

vi.

Source and method of protecting water supply

vii. Documentation of an approved sewage disposal method

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viii. Method of storm water drainage ix.

Method of storage, collection, and disposal of solid wastes

Location and number of sanitary conveniences including toilets, water closets, privies, urinals, showers, bathtubs, and hand washing facilities

xi.

Plumbing in plan and elevation of all proposed buildings and sanitary facilities

xii. A topographical map showing the relief of the land surface, location of all lakes, ponds, swamps, sink holes, abandoned wells, rivers, streams, abandoned quarries and forests xiii. Method of ventilation of sleeping quarters and food service facilities. b.

The Department may declare campsites unsatisfactory for camping purposes if, after review of the plans and a visit to the site, conditions are found to exist which are in violation of these regulations.

The camp operator shall notify the Department upon completion of construction of a camp on a new site for a final inspection.

Source: Miss. Code Ann. § 75-74-9. Subchapter 3:

GENERAL SUPERVISION

Rule 4.3.1 Ratio of Counselors to Campers Residential and Groups Camps shall have one counselor to 10 campers. Individuals who are at least 16 years of age may be used as adjuncts to the counselor staff. However, these individuals shall not be included in meeting the specified counselor to camper ratio requirements. Camps including special needs campers shall have counselors to the special needs campers at a ratio of 1 to 5. Source: Miss. Code Ann. § 75-74-9. Rule 4.3.2 1.

Camp Director/Program Manager Each Residential Camp shall have a camp director or permitted program manager on the premises who shall: a.

Be at least 25 years of age and

Have successfully completed a documented course in camping administration such as those offered by professional camping associations, national agencies or their equivalent as determined by the Youth Camp Safety Advisory Council

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or c. 2.

Have had at least two years previous documented experience as part of the administrative staff of a youth camp.

In addition to the above, the camp director for special needs campers shall have educational background or experience appropriate to the groups being served.

Source: Miss. Code Ann. § 75-74-9. Rule 4.3.3 Supervision of Specialized Activities When campers participate in specialized activities such as, but not limited to, horseback riding, hiking, scuba diving, rock climbing, firearms, canoeing, aquatic events, and ropes challenge courses, the counselors supervising the activity shall possess evidence of appropriate training and experience in their program specialties. When applicable, camp operators shall assure any special training necessary for camp personnel to protect the health and safety of special needs campers. 1.

Aquatics Activities including those events associated with swimming, boating, canoeing, water craft and water skiing shall be directed by individuals currently certified as having passed American National Red Cross Lifeguard Training, Boy Scouts of America Lifeguard Training, Y.M.C.A. Lifeguard Training or the equivalent, as determined by the Advisory Council on Youth Camp Safety. The aquatics director shall be at least 18 years of age.

Swimming Activity Supervision

There shall be a minimum ratio of one counselor with at least a current Lifeguard Certificate as issued by the American National Red Cross, Boy Scouts of America, Y.M.C.A. or its equivalent* per 25 campers in the water. There shall be a minimum of one to 10 total staff to camper ratio maintained at all times.

A system shall be devised and on file for checking participants in and out during swimming and boating activities.

Water Craft Activities A Coast Guard approved personal flotation device (PFD) must be worn by all campers and counselors when in water craft regardless of swimming ability. All Mississippi Boating Safety Act regulations must be followed in water craft activities. (Refer to current Mississippi regulations, available through Coast Guard and Coast Guard Auxiliaries) a.

There shall be a minimum ratio of one counselor with at least a current Lifeguard Certificate as issued by the American Red Cross, Boy Scouts of America, YMCA, or equivalent, as determined by the Youth Camp Advisory Council, per 25 campers on the water. All water craft activities shall be supervised by a minimum of one staff on the water to each 10

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campers in water craft. Said staff shall have participated in at least 6 hours of the activity for which he is responsible. b.

For Waterskiing, in addition to the above: i.

The skier must wear a vest approved by the Coast Guard for that activity

ii.

The driver of the boat must have 6 hours of driving experience and another person on board as an observer.

For Salt Water Boating, in addition to the above part (a), the responsible supervisor shall: i.

Have had 6 weeks experience in the salt water activity for which he is responsible

ii.

Have had practical instruction in survival & water safety as taught by American Red Cross, Mississippi Boat & Water Safety Commission or the equivalent

iii.

Have in operation a motorized rescue vessel when sailboats are being used.

For White Water Activities, in addition to the above part (a), the responsible supervisor shall: i.

Have had practical instruction and experience in white water activity

ii.

Have had the aforementioned survival and water safety instruction

iii.

All white water activities in the state must be carried out on water determined to be no more difficult than Class III as defined by the International Scale of River Difficulty. No trips shall be taken on unclassified white water.

Campers participating in White Water Activity must be able to swim. Helmets must be worn by all participants in Class III White Water Activity.

Fishing and Shoreline Activities shall be supervised.

Scuba Diving Activities shall be supervised by individuals who are currently certified by a national or regional scuba training program acceptable to the Advisory Council on Youth Camp Safety.

Firearm Activities a.

Campers and staff may NOT bring their own firearms to a youth camp

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Supervisors of activities must have certification and/or documented training and experience in that type activity acceptable to the Advisory Council in Youth Camp Safety

A ratio of one staff to 10 campers must be maintained on the range at all times

Archery Activities shall be supervised by a counselor who: a. Possesses a working knowledge of rules covering archery safety b. In addition, a minimum ratio of one staff to 10 campers must be maintained on the range at all times.

Source: Miss. Code Ann. § 75-74-9. Rule 4.3.4 Personnel Records The camp shall keep on site a record of all employees and staff, which shall include at least: name, address, age, training, education, experience and other qualifications and the names and telephone numbers of persons to be notified in the event of an emergency. Source: Miss. Code Ann. § 75-74-9. Rule 4.3.5 All camps are to conduct an orientation period to acquaint all staff and personnel with health safety and welfare programs of the camp. This must be documented in personnel records. Source: Miss. Code Ann. § 75-74-9. Subchapter 4:

GENERAL HEALTH and SAFETY

Rule 4.4.1

General Health

Health Records a.

Campers records shall be readily available to health authorized personnel and shall include: i.

Camper's name and address

ii.

Name, address, and telephone number of parent, legal guardian and designated adult emergency contact

iii.

Authorization from the parent/guardian of all minors for emergency care.

Every camper and staff member entering camp shall furnish a health history which should emphasize those potential conditions for which camp personnel should be prepared.

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Every camper shall receive a health screening not later than 48 hours after arrival at camp.

All records shall be on file in camp for review by Department personnel.

Injury and Illness Reports a.

If an injury or illness is judged to be serious by the individual in charge of health supervision, the camp physician shall be consulted immediately. When the patient is a legally defined minor, the parents or guardian shall be notified as soon as possible.

A bound medical log listing date, name of patient, ailment and treatment prescribed shall be maintained at the camp.

A report form (provided by the Department) shall be completed in duplicate for each injury, illness or fatality which occurs at camp and which is attended by a health staff person and as a result of which the child or staff (1) is sent home, (2) is admitted to a hospital or (3) has either laboratory analysis or x-rays performed which result in a positive diagnosis. The original report form shall be maintained at the camp or sponsoring organization for at least 1 year for the purpose of these regulations. A copy shall be forwarded to the Department not later than one week after the event comes to the attention of camp authorities.

Reportable communicable diseases, fatalities and animal bites must be reported immediately.

Health Staff a.

There shall be an adult with the youth camp at all times who is charged with health supervision. Said adult may be a licensed physician, licensed physician's assistant, a registered nurse, licensed practical nurse, a camp health director who has been certified by a national professional camping association, national agency, or an individual who has completed at least the Standard First Aid and Personal Safety Course as prescribed by the American National Red Cross or its equivalent.

There shall be a current written agreement or exchange of letters with a nearby hospital regarding procedures for admitting campers and providing for financial arrangements.

Medication a.

Medications prescribed for campers or staff members shall be kept under lock and key by the health supervisor in the original containers bearing the pharmacy label which shows the prescription number, date filled, physician's name, direction for use and the patient's name. Medication shall

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be administered under the direction of health supervisor or adult supervision. When no longer needed, medications shall be returned to parents, staff member or destroyed. b. 5.

Administration of ANY medications must be documented in the Health Log.

First Aid Supplies a.

First aid supplies shall be available to staff in all youth camps at food service operations, program areas, in motor vehicles, office maintenance areas and on camp outings. i.

Supplies should be arranged so that the desired item can be found quickly without unwrapping the entire package.

ii.

Material should be wrapped so that unused portions do not become contaminated through handling.

Kits should include provisions for the area in which camping is being done.

Source: Miss. Code Ann. § 75-74-9. Rule 4.4.2 1.

General Safety Equipment and Facilities a.

All equipment and facilities used in youth camp programs, whether owned by the camp or not, shall be of good quality and not present undue risk.

Archery equipment, firearms, and ammunition shall be stored in a locked cabinet or building when not in use.

Power equipment shall not be stored, operated, or left unattended without proper safeguards in camper areas. All power tools shall be stored in a locked place not occupied by campers. Power tools and outboard motors shall be used by campers only under the direct supervision of counselors.

Equipment used for arts and crafts shall be in good repair, of safe design and properly installed.

Commercial playground equipment shall be securely anchored to imbedded concrete or other approved footing, acceptable to the Department.

All water craft shall be equipped with U.S. Coast Guard approved personal flotation devices of types I, II, or III as prescribed for the specific type of craft and number and age of occupants. Water skiers shall wear a vest as approved by the U.S. Coast Guard for that particular activity. Water craft towing a skier shall have an observer on board.

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All swimming and diving areas shall be provided with selected safety equipment which is in good useable condition. Appropriate staff shall be trained in the proper use of said equipment.

All piers, floats, platforms, and decks shall be in good repair and, where applicable, the water depth shall be indicated by printed numerals on the deck or planking.

Firearms and archery ranges shall be constructed and maintained in accordance with the standards of the appropriate national professional association.

Emergency Procedures - Residential Camps a.

When telephones are provided, camp operators shall maintain and post by each phone a current roster of telephone numbers of physicians, hospitals, police, ambulance, and fire departments in the immediate area.

The camp program shall include written contingency plans and related procedures dealing with circumstances such as natural disasters and other emergencies. i.

Fire drills shall be held within the first 24 hours at the beginning of each camp session and frequently enough thereafter to minimize danger of panic.

ii.

Each camp shall have at the campsite a written disaster plan. All staff shall be advised of the procedures contained in the plan. Arrangements for transporting individuals from the camp to emergency facilities shall be included in the plan.

iii.

Lost camper and lost swimmer plans shall be formulated and on file. Appropriate staff shall be trained in the procedures contained in these plans.

iv.

A plan for communicating with emergency medical facilities as well as the nearest fire station regarding responses to emergency situations shall be on file at the camp.

When tents are used for sleeping purposes, whether or not said tents are located on platforms, procedures shall be developed to ensure rapid evacuation in the event of an emergency.

vi.

A plan relating to the control of the movement of vehicular traffic through the camp shall be on file.

Injury Control - Residential Camps

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Premises shall be reasonably free of hazards such as: i.

Old refrigerators with doors, freestanding walls, open cisterns, open grease traps and unsafe fences in which children can be caught or strangled.

ii.

Substances which may be toxic if ingested, inhaled or handled, including, but not limited to drugs, medications, pool chemicals, pesticides and other toxic chemicals which shall be plainly marked and stored in locked cabinets or enclosures located in an area not accessible to campers.

Other Precautions i.

Gasoline and other petroleum products shall be stored in accordance with existing and applicable State and local laws, ordinances and regulations dealing with safety.

ii.

Radiators, registers, steam, and hot water pipes shall have protective covering or insulation for the protection of campers and staff.

iii.

Floor furnaces, open grate gas heaters, electric heaters or other heaters shall not be operated by campers. When fuel ignition type heaters are used, they shall be properly vented and installed with permanent connections and protectors and shall have sealed combustion chambers.

iv.

Glass doors and glass panels adjacent to doors shall be marked.

Stairways over four steps in height shall be equipped with hand rails.

vi.

Rooms shall not be equipped with open or unguarded stairwells, windows which present a hazard from falling, unsafely located, or constructed electrical outlets, any broken items which may cause injury and elevators or other vertical shafts.

Potentially Hazardous Areas i.

Campers shall be informed about potential natural hazards to their safety and, where feasible, "hazardous area" shall be posted. Such natural or potential hazards shall include but not be limited to:

ii.

Noxious plants, harmful reptiles, insects, and rodents

iii.

Steep drop-offs, cliffs or mine shafts in the area

iv.

Swimming or diving areas or streams that contain polluted waters or steep drop-offs or other unusual bottom conditions or currents.

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Fire Safety in Residential Camps Documentation of an annual FIRE SAFETY SURVEY FOR YOUTH CAMPS must be conducted before a license can be issued. (These forms are be available from the Mississippi State Department of Health.) a.

Building Standards The procurement, construction, and maintenance of resources, equipment, and buildings shall be in conformance with existing and applicable State and local laws, ordinances and regulations dealing with fire safety.

Means of Egress i.

The means of egress from all structures shall be maintained in an unobstructed, easily traveled condition at all times. Exposure to inherent hazards of the building such as heating plant, kitchen, flammable storage or other similar conditions is not permitted. Furniture, equipment, and utility materials shall not be stored or maintained in a location or position which may cause them to fall into, be pushed into or be obstructive in any way to the means of egress.

ii.

A building with an occupancy of more than 12 persons, including staff, shall be provided with at least two separate and independent means of egress located as far apart as practical and, in no case, less than 50 percent of the longest dimension of the building. Each door shall be hung in the direction of egress. Where a sliding door is the only means of egress, such door shall be kept open a minimum of three feet while the building is occupied.

iii.

An occupancy above the first floor shall be provided with two separate and independent means of egress and located so that all persons are situated between approved exit facilities. Said exits shall lead to an approved outside fire escape or to an interior stairway enclosed with an assembly of materials affording substantial protection from fire and leading directly to the outdoor at grade.

iv.

A required exit from a facility for an occupancy of more than 25 persons, or where an exit is not readily visible to the occupants, shall be designated by a luminescent exit sign. Directional exit signs shall be installed where needed.

Emergency lighting shall be provided for any stairway, corridor and fire escape that constitutes a means of egress. In new construction or remodeling of existing structures, where electric power is provided, the lighting required by this rule shall be installed on separate circuits from and fused ahead of the main switch or disconnected. In the event electricity is not available, a battery system shall be provided.

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vi.

In an assemblage area such as a recreation room, dining hall or chapel, each door from a room occupied by campers shall enter a corridor between exits or there shall be direct egress to the outside from each room.

vii. In newly constructed buildings, an exit door shall not be less than 36 inches wide. viii. A door forming part of a means of egress where door hardware is used shall be of a type that is non-locking against egress and operable with a single motion not to exceed 35 pounds of pressure. The use of bolts, bars and similar devices is prohibited on any door provided for exit purposes or designed as an exit. c.

Fire Warning Equipment i.

All multi-story buildings and all areas of occupancy which are deemed to have high-risk fire hazards shall be protected throughout with a battery operated automatic fire detection system.

ii.

Fire extinguishers of an approved type with a current inspection date so tagged shall be properly located and easily visible in buildings having fire hazards.

Heating Heating devices, their installation, operation, and maintenance shall be in compliance with existing and applicable State and local laws, ordinances and regulations.

Tents i.

All tents shall be of the fiber impregnated flame retardant variety.

ii.

All tents shall be posted with permanent warning "No open flame in or near this tent.” This warning may be on a sign or stenciled directly on the tent.

iii.

Campfires and open flames of any type shall be prohibited within 10 feet of any tent.

iv.

Plastic tents of any type shall not be allowed.

Source: Miss. Code Ann. § 75-74-9. Subchapter 5: Rule 4.5.1 1.

CAMP CONSTRUCTION

Building and Living Shelters General Construction

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Camp structures and facilities shall comply with applicable State and local building and zoning codes with Southern Building Code being the final authority.

Every building, structure, tent, cabin, and premises shall be kept in good repair and shall be maintained in a safe and sanitary condition.

When electrical systems are installed in camps, they shall be approved, installed, and maintained in accordance with the provisions of the National Electrical Code.

Where floors are provided in buildings, tents or other structures used for sleeping quarters, they shall be easily cleanable and in good repair; shall be constructed and maintained in a safe condition; shall afford adequate protection against inclement weather; and shall be located and maintained so as to provide easy, unobstructed exit in case of fire or other emergency.

Shelters for Residential Camps a.

In all buildings or tents, sleeping space shall be so arranged to provide a minimum of 25 square feet of floor area per person.

Each camper shall be provided with an individual sleeping space.

All buildings used as permanent sleeping quarters shall have a minimum ceiling height of 7 feet over at least 50% of the floor area.

Source: Miss. Code Ann. § 75-74-9. Subchapter 6: Rule 4.6.1

SWIMMING AND DIVING AREAS Management of Swimming and Diving Areas

All swimming and diving areas shall be operated and maintained in accordance with recommended State and local sanitation and safety standards.

A youth camp operator intending to use any swimming or diving area shall first determine that such facilities meet the standards indicated.

Boating shall not be allowed in designated swimming areas.

Source: Miss. Code Ann. § 75-74-9. Rule 4.6.2 1.

Safety and Rescue Equipment Safety equipment provided for swimming and diving areas shall be in good, usable condition.

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All piers, floats, platforms, and decks shall be in good repair and, where applicable, the water depth shall be indicated by painted numerals on the deck or planking.

There shall be a minimum water depth of 10 feet for a 1 meter diving board. Pools constructed after January 1, 1997 shall have a minimum depth of 12 feet under the board which continues out at least 15.5 feet from the end of the board before starting to angle upward at an angle of not more than 30 degrees

For outdoor diving areas, the bottom shall be cleared of stumps, rocks and other obstacles.

Diving boards shall be mounted on a firm foundation and never on an insecure base such as a float that can be affected by weight loads and wave action. The entire length of the top surface of diving boards shall be covered with a non-skid surface. Clearance from the sides of and the distance between diving boards shall be at least 8 feet.

Each swimming pool shall be fenced to discourage entry of unauthorized persons.

Natural bodies of water shall have marked swimming areas and be free of stumps, debris, etc.

Source: Miss. Code Ann. § 75-74-9. Rule 4.6.3

Plumbing Fixtures

Cross-connections shall not be permitted.

A cross-connection shall be considered broken where a minimum air gap of at least twice the diameter of the water pipe is provided, where potable water enters the pool and where pool water or water from the recirculation system is discharged to a sewer system.

Back flow shall not be permitted. A potable water distributing pipe shall be considered as protected against back flow from any plumbing fixture or other piece of equipment or from any appliance capable of affecting the quality of the water in the potable water supply where as air gap of at least twice the diameter of the water supply pipe has been provided. Where it is not practicable to provide such minimum air gap, the connection of the fixture, equipment or appliance shall be equipped with a back flow preventer assembly of a type and at a location provided by the Board.

The Board may require that a back flow preventer assembly of an approved type be installed at any fixed potable water outlet to which a hose may be connected and used in contact with liquids and other substances.

The Southern Plumbing Code shall be final authority.

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Source: Miss. Code Ann. § 75-74-9. Rule 4.6.4

Electrical Safety

The electrical installation at all newly constructed swimming and diving areas shall comply with and be maintained in accordance with requirements of the latest edition of the National Electrical Code.

Existing installations shall, upon application, be inspected and granted a variance if a hazard does not exist.

All swimming pools, regardless of construction date, shall comply with the latest edition of the National Electrical Code requirements pertaining to underwater lights.

Defects in the electrical installation of underwater lights shall be repaired, removed, or disconnected immediately.

All electrical wiring where exposed and accessible to bathers shall be in rigid conduit or electrical metallic tubing and all boxes, fittings, and accessories used in damp or wet locations shall be installed and equipped to prevent the entrance of water.

Distribution centers where fused switches or circuit breakers are grouped shall be enclosed in inaccessible to all except authorized individuals.

The crossing of outdoor swimming and diving areas by open overhead electrical conductors shall be prohibited.

Overhead electrical conductors crossing playgrounds contiguous to outdoor swimming and diving areas shall comply with the requirements of the latest edition of the National Electrical Code.

All metal fences or railings on which a broken electrical conductor might fall shall be effectively grounded.

10.

All water and other piping to and from the swimming and diving areas, including inlet and outlet pipes, shall be metallically bonded together and adequately connected to the same grouping electrode used to ground the neutral conductor of the electrical system. This shall be in addition to the grounding requirements for electrical equipment and circuits as required by the latest edition of the National Electrical Code.

11.

Pumps, filters and other mechanical and electrical equipment shall be enclosed in such a manner as to be accessible only to authorized individuals.

12.

Construction and drainage shall be such as to avoid the entrance of accumulation of water in the vicinity of electrical equipment.

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13.

Electrical installations at all swimming and diving areas and any future additions or modifications to, such installations, prior to being placed in service and every 3 years thereafter, shall be inspected and approved in accordance with these regulations.

Source: Miss. Code Ann. § 75-74-9. Subchapter 7:

Water Supply

Rule 4.7.1 All youth camps shall have a water supply which is potable, adequate and from a source approved by the State Board of Health annually. Source: Miss. Code Ann. § 75-74-9. Rule 4.7.2 Only potable water shall be used for drinking, brushing teeth, cooking or reconstituting dehydrated or concentrated products. Source: Miss. Code Ann. § 75-74-9. Rule 4.7.3 Supplies shall be constructed, protected, operated, and maintained in conformance with applicable State and local laws, ordinances and regulations. Source: Miss. Code Ann. § 75-74-9. Rule 4.7.4

The supply servicing a youth camp may consist of:

A public water supply system

An on-site individual water supply system

Water which has been transported to the camp for dispensing to campers

Water which has been purified before use in accordance with approved procedures of the board, or

A combination of the above sources acceptable to the Board.

Source: Miss. Code Ann. § 75-74-9. Subchapter 8:

Waste Disposal and Sanitary Facilities

Rule 4.8.1 Solid Wastes All refuse and other solid wastes shall be stored, collected and disposed of in a manner approved by the Board. Source: Miss. Code Ann. § 75-74-9. Rule 4.8.2 Sewage and Liquid Waste Disposal The sewage and waste water from all youth camps shall be disposed of in a manner approved by the Board. This shall consist of:

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Connection to an approved public sewer system or

Connection to an individual on-site sewage treatment system or

The use of subsurface disposal system or

The use of chemical toilets, privies or similar facilities acceptable to the Board

The use of slit-trench latrine or other method acceptable to the Board, or

A combination of the above methods acceptable to the Board.

Source: Miss. Code Ann. § 75-74-9. Rule 4.8.3 1.

Sanitary Facilities Toilet Facilities a.

Toilet facilities shall be provided in youth camps. The minimum number of toilet facilities shall be provided in a ratio of 1 to 12. In residential camps, flush urinals may be substituted for not more than one-half the required number of toilet facilities.

Covered trash receptacles shall be provided in all permanent toilets.

Pit privies and latrines shall be located at least 100 feet from any well, stream, or lake and not less than 50 feet from any sleeping area.

Pit privies and latrines shall be located at least 200 feet from a kitchen or food service area.

Installation, Operation, and Maintenance Requirements for Toilet Facilities and Urinals a.

Water-flushed toilets, chemical toilets, pit privies or latrines (slit-trench, deep pit, mound or bored hole latrines) and urinals shall be provided and maintained in a clean and sanitary condition.

The underground water level and soil conditions shall be considered when determining the appropriate type of toilets and urinals to be provided as shall applicable State and local laws, ordinances and regulations.

Hand-washing and Bathing Facilities a.

Camps shall provide hand-washing facilities at a ratio of 1 to 12 and bathing facilities shall meet the ratio of 1 to 15.

Primitive or Outpost Camps shall not be required to adhere to the handwashing or bathing facility requirements outlined above.

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Hand-washing facilities shall be supplied with running water and shall be maintained in a clean and sanitary condition.

Hand-washing facilities, when provided, shall be adjacent to toilet facilities.

Showers or bathtubs, when provided, shall be in the living areas or in a centrally located structure.

Shower stalls, bathtub areas and dressing compartments shall be maintained in a clean and sanitary condition.

Drinking Facilities a.

At least one drinking facility shall be provided and centrally located for each 80 campers.

No common drinking utensils shall be provided or used.

Source: Miss. Code Ann. § 75-74-9. Subchapter 9:

Insect, Rodent, and Weed Control (Vector Control)

Rule 4.9.1 General Statement Adequate measures for the control of insects and rodents which the Board seems of public health significance shall be taken. Source: Miss. Code Ann. § 75-74-9. Rule 4.9.2

Rodent and Insect Control

Buildings and structures shall be maintained free of insect and rodent harborages and infestation.

Extermination methods or other measures to control rodents and insects shall conform to the requirements of the Board.

Source: Miss. Code Ann. § 75-74-9. Rule 4.9.3

Weed Control

The growth of brush, weeds, grass, and plants shall be controlled in central camp areas to prevent harborage of ticks, chiggers and other insects of public health importance.

The central camp area shall be maintained to retard growth of ragweed, poison ivy, poison oak, sumac and other noxious plants considered detrimental to health.

Source: Miss. Code Ann. § 75-74-9.

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Subchapter 10: Rule 4.10.1

Farm and Domestic Animals

Pets and Other Small Animals

The camp premises shall be free of unvaccinated (rabies) dogs or other mammals which may cause injury or disease to campers.

Horses, dogs or other domestic animals or pets shall not be permitted at swimming, diving, or food service areas.

The camp operator shall promptly report to the Board animal bits inflicted upon any individual in the camp area.

Source: Miss. Code Ann. § 75-74-9. Rule 4.10.2

Stable Sanitation

Horses or other farm animals shall not be permanently quartered within 500 feet of living quarters, kitchens, or mess halls.

A temporary shelter, corral, tie-rail, or hitching post shall not be located within 200 feet of dining hall, kitchen, or other place where food is prepared, cooked, or served.

Manure shall not be allowed to remain for more than 24 hours at such locations as temporary shelter, corrals, tie-rails, or hitching posts.

Manure from permanent and shelter quarters shall be removed at least weekly. Interim storage shall be in fly-tight enclosures or an area isolated from camp activity.

Adequate measures shall be taken at all times to keep fly, mosquito and rodent populations to a minimum.

Source: Miss. Code Ann. § 75-74-9. Subchapter 11:

Food Service

Rule 4.11.1 Food handling establishments which are located on the premises of licensed camps shall meet the Regulations Governing Food Service Sanitation of the Mississippi State Department of Health. Source: Miss. Code Ann. § 75-74-9. Rule 4.11.2 Since meals in camp are considered a part of the program, all camps that are serving in a manner known as "family style" should be allowed to continue this means as long as existing guidelines governing food preparation and protection are followed. Source: Miss. Code Ann. § 75-74-9.

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Subchapter 12: Rule 4.12.1

Transportation

Responsibility for Children Being Transported

When a camp provides transportation for a camper, it shall provide adult supervision between the pickup site, camp and delivery site.

A maximum of 10 hours travel time in any 24-hour period shall be permitted.

Source: Miss. Code Ann. § 75-74-9. Rule 4.12.2

Responsibilities in Transit

When two or more vehicles are traveling to the same distant point, there shall be a prearranged method of communication with each other.

Only that number of children or adults for whom there is seating space shall be transported in a vehicle. Adequate space for luggage and other equipment shall also be provided.

The gross weight of vehicles (GVW) when loaded with passengers, gear and trailer-tongue weight should not exceed the manufacturer's GVW regardless of whether or not the number of passengers is within the specified number of seats.

Standing while in transit and projection of head or limbs outside the vehicle is prohibited.

In addition to the driver, there shall be at all times at least one adult or counselor in a vehicle on a public thoroughfare when 9 or more campers are being transported where the driver and the campers are not physically separated. When physically separated, an adult or counselor must ride in the compartment with the campers.

Speed limits shall be posted on the campgrounds and observed by all vehicle operators.

In all vehicles used, seats or benches must be securely fastened to the floor. Open-body or stake-bed vehicles shall not be permitted for transportation of passengers outside the confines of the campgrounds.

Persons shall not be permitted to sit in the front seat unless each such individual is secured with a seat belt.

For specialized trips from camp, each camper shall have evidence of previous experience and ability with each method of transportation to be used such as horseback riding, backpacking and canoeing.

Source: Miss. Code Ann. § 75-74-9.

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Rule 4.12.3

Responsibility for Drivers and Vehicles

All drivers and vehicles shall be in compliance with applicable regulations of the Mississippi Highway Safety Patrol and ordinances of the municipality in which the vehicle is operated. Drivers operating vehicles designed for 16 or more persons must have a commercial license in accordance with Sections 63-173 through 63-190 of the Mississippi Code, 1972, revised 1989.

The driver of a camp vehicle shall be at least 18, shall have at least 1 year's experience as a licensed driver, and shall possess the required license.

All camp vehicles shall be maintained in safe operating condition and be equipped with a first-aid kit.

A current state inspection sticker shall be exhibited on vehicles transporting campers.

All vehicles transporting campers off site shall be equipped with a first-aid kit, fire extinguisher, flares, and reflectors and must meet current seat belt requirements.

Campers shall not be allowed to repair, or assist in the repair, of any vehicles where dangers are involved either by the process of repair or from the environment in which the repair is to be conducted.

Trailers whose loaded weight when added to the GVW of the towing vehicle exceed the normal braking ability of that vehicle, shall be equipped with auxiliary brakes.

Trailers shall be designed and equipped to prevent sway or other influence(s) that significantly affect the control of the towing vehicle.

The GVW of towed trailers shall exceed by at least 10 percent the load being carried.

10.

Annual inspection schedules for trailer under-pinnings, brakes and hitches shall be documented and maintained.

Source: Miss. Code Ann. § 75-74-9. Subchapter 13: Rule 4.13.1 1.

Penalties and Legal Action

Emergency Suspension of License Any license issued pursuant to this regulation may be suspended prior to a hearing if the licensing agency has reasonable cause to suspect that the continued operation of the licensed youth camp facility constitutes a substantial hazard to the health and safety of the children entrusted to or cared for by such facility.

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Whenever a license is suspended, pursuant to this section, the holder of the license or person in charge shall be notified in writing that the license is, upon service of the notice, immediately suspended and that an opportunity for hearing will be provided if requested in writing within ten (10) days of the receipt of the notice of suspension. If no written request for hearing is filed within ten days, the suspension is sustained.

The licensing agency may reverse the suspension at any time if the reasons for the suspension no longer exist.

Source: Miss. Code Ann. § 75-74-9. Rule 4.13.2 1.

Denial, Revocation, or Suspension of License The licensing agency may refuse to issue or renew, or may suspend or revoke the license of any facility upon one (1) or more of the following grounds: a.

Fraud or misrepresentation by the owner or operator in securing the issuance or renewal of a license.

Conviction of a youth camp operator of a crime, if the acts for which he or she is convicted are found by the licensing agency to have a direct and detrimental effect on the children entrusted to or cared for by such licensee.

Violation of any of the provisions of the Mississippi Youth Camp Safety and Health law or of the rules and regulations adopted pursuant to that act.

Any conduct or failure to act, which threatens the health or safety of the children at the facility.

Source: Miss. Code Ann. § 75-74-9. Rule 4.13.3 Notification Prior to the denial, revocation or suspension of a license, written notice of the contemplated action shall be given to the owner of the facility. Such notice shall specify the reasons for the proposed action and shall notify the applicant of the right to a hearing on the matter. Source: Miss. Code Ann. § 75-74-9. Rule 4.13.4 1.

Hearings If requested in writing ten (10) days of receipt of said notice, a hearing shall be provided in which the operator may show cause why the license should not be denied, suspended or revoked. Any such hearing shall be conducted by a hearing officer designated by the State Health Officer.

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Within twenty (20) working days of the hearing, or such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. Copies of the same shall be provided to the owner or applicant. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within the twenty-day period. Written notice shall be provided to the owner or applicant.

Source: Miss. Code Ann. § 75-74-9. Rule 4.13.5 Appeal Any licensee who disagrees with or is aggrieved by a decision of the licensing agency in regard to the suspension or revocation of such license, may appeal, in accordance with the applicable law. Source: Miss. Code Ann. § 75-74-9.

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APPENDIX A § 43-21-353. Duty to inform state agencies and officials; duty to inform individual about whom report has been made of specific allegations. (1) Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, public or private school employee or any other person having reasonable cause to suspect that a child is a neglected child or an abused child, shall cause an oral report to be made immediately by telephone or otherwise and followed as soon thereafter as possible by a report in writing to the Department of Human Services, and immediately a referral shall be made by the Department of Human Services to the youth court intake unit, which unit shall promptly comply with Section 43-21-357. In the course of an investigation, at the initial time of contact with the individual(s) about whom a report has been made under this Youth Court Act or with the individual(s) responsible for the health or welfare of a child about whom a report has been made under this chapter, the Department of Human Services shall inform the individual of the specific complaints or allegations made against the individual. Consistent with subsection (4), the identity of the person who reported his or her suspicion shall not be disclosed. Where appropriate, the Department of Human Services shall additionally make a referral to the youth court prosecutor. Upon receiving a report that a child has been sexually abused, or burned, tortured, mutilated or otherwise physically abused in such a manner as to cause serious bodily harm, or upon receiving any report of abuse that would be a felony under state or federal law, the Department of Human Services shall immediately notify the law enforcement agency in whose jurisdiction the abuse occurred and shall notify the appropriate prosecutor within forty-eight (48) hours, and the Department of Human Services shall have the duty to provide the law enforcement agency all the names and facts known at the time of the report; this duty shall be of a continuing nature. The law enforcement agency and the Department of Human Services shall investigate the reported abuse immediately and shall file a preliminary report with the appropriate prosecutor's office within twenty-four (24) hours and shall make additional reports as new or additional information or evidence becomes available. The Department of Human Services shall advise the clerk of the youth court and the youth court prosecutor of all cases of abuse reported to the department within seventy-two (72) hours and shall update such report as information becomes available. (2) Any report to the Department of Human Services shall contain the names and addresses of the child and his parents or other persons responsible for his care, if known, the child's age, the nature and extent of the child's injuries, including any evidence of previous injuries and any other information that might be helpful in establishing the cause of the injury and the identity of the perpetrator. (3) The Department of Human Services shall maintain a statewide incoming wide-area telephone service or similar service for the purpose of receiving reports of suspected cases of child abuse; provided that any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer or public or private school employee who is required to report under subsection (1) of this section shall report in the manner required in subsection (1).

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(4) Reports of abuse and neglect made under this chapter and the identity of the reporter are confidential except when the court in which the investigation report is filed, in its discretion, determines the testimony of the person reporting to be material to a judicial proceeding or when the identity of the reporter is released to law enforcement agencies and the appropriate prosecutor pursuant to subsection (1). Reports made under this section to any law enforcement agency or prosecutorial officer are for the purpose of criminal investigation and prosecution only and no information from these reports may be released to the public except as provided by Section 43-21-261. Disclosure of any information by the prosecutor shall be according to the Mississippi Uniform Rules of Circuit and County Court Procedure. The identity of the reporting party shall not be disclosed to anyone other than law enforcement officers or prosecutors without an order from the appropriate youth court. Any person disclosing any reports made under this section in a manner not expressly provided for in this section or Section 43-21-261, shall be guilty of a misdemeanor and subject to the penalties prescribed by Section 43-21-267. (5) All final dispositions of law enforcement investigations described in subsection (1) of this section shall be determined only by the appropriate prosecutor or court. All final dispositions of investigations by the Department of Human Services as described in subsection (1) of this section shall be determined only by the youth court. Reports made under subsection (1) of this section by the Department of Human Services to the law enforcement agency and to the district attorney's office shall include the following, if known to the department: (a) The name and address of the child; (b) The names and addresses of the parents; (c) The name and address of the suspected perpetrator; (d) The names and addresses of all witnesses, including the reporting party if a material witness to the abuse; (e) A brief statement of the facts indicating that the child has been abused and any other information from the agency files or known to the family protection worker or family protection specialist making the investigation, including medical records or other records, which may assist law enforcement or the district attorney in investigating and/or prosecuting the case; and (f) What, if any, action is being taken by the Department of Human Services. (6) In any investigation of a report made under this chapter of the abuse or neglect of a child as defined in Section 43-21-105(m), the Department of Human Services may request the appropriate law enforcement officer with jurisdiction to accompany the department in its investigation, and in such cases the law enforcement officer shall comply with such request. (7) Anyone who willfully violates any provision of this section shall be, upon being found guilty, punished by a fine not to exceed Five Thousand Dollars ($5,000.00), or by imprisonment in jail not to exceed one (1) year, or both. (8) If a report is made directly to the Department of Human Services that a child has been abused or neglected in an out-of-home setting, a referral shall be made immediately to the law enforcement agency in whose jurisdiction the abuse occurred and the department shall notify the district attorney's office within forty-eight (48) hours of such report. The Department of Human Services shall investigate the out-of-home setting report of abuse or neglect to determine whether the child who is the subject of the report, or other children in the same environment, comes

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within the jurisdiction of the youth court and shall report to the youth court the department's findings and recommendation as to whether the child who is the subject of the report or other children in the same environment require the protection of the youth court. The law enforcement agency shall investigate the reported abuse immediately and shall file a preliminary report with the district attorney's office within forty-eight (48) hours and shall make additional reports as new information or evidence becomes available. If the out-of-home setting is a licensed facility, an additional referral shall be made by the Department of Human Services to the licensing agency. The licensing agency shall investigate the report and shall provide the Department of Human Services, the law enforcement agency and the district attorney's office with their written findings from such investigation as well as that licensing agency's recommendations and actions taken. Sources: Laws, 1979, ch. 506, § 41; Laws, 1980, ch. 550, § 17; Laws, 1984, ch. 342; Laws, 1985, ch. 360; Laws, 1993, ch. 522, § 1; Laws, 1994, ch. 387, § 1; Laws, 1994, ch. 591, § 3; Laws, 1995, ch. 335, § 1; Laws, 1996, ch. 323, § 2; Laws, 1997, ch. 440, § 10; Laws, 1998, ch. 340, § 1; Laws, 1998, ch. 557, § 1; Laws, 2004, ch. 489, § 3; Laws, 2006, ch. 600, § 4; Laws, 2007, ch. 337, § 3, eff from and after July 1, 2007. § 43-21-355. Immunity for reporting information. Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, school attendance officer, public school district employee, nonpublic school employee, licensed professional counselor or any other person participating in the making of a required report pursuant to Section 43-21-353 or participating in the judicial proceeding resulting therefrom shall be presumed to be acting in good faith. Any person or institution reporting in good faith shall be immune from any liability, civil or criminal, that might otherwise be incurred or imposed. Sources: Laws, 1979, ch. 506, § 42; Laws, 1980, ch. 550, § 18; Laws, 1982, Ex Sess, ch. 17, § 22; Laws, 1993, ch. 522, § 2; Laws, 1994, ch. 591, § 4; Laws, 2004, ch. 489, § 4; Laws, 2006, ch. 430, § 1; Laws, 2006, ch. 600, § 5, eff from and after July 1, 2006.

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APPENDIX B Mississippi State Department of Health List of Reportable Diseases and Conditions Reporting Hotline: 1-800-556-0003 Monday - Friday, 8:00 am - 5:00 pm To report inside Jackson telephone area or for consultative services Monday - Friday, 8:00 am - 5:00 pm: (601) 576-7725 Phone Fax Epidemiology (601) 576-7725 (601) 576-7497 STD/HIV (601) 576-7723 (601) 576-7909 TB (601) 576-7700 (601) 576-7520 Class 1 Conditions may be reported nights, weekends and holidays by calling: (601) 5767400 Class 1: Diseases of major public health importance which shall be reported directly to the Mississippi State Department of Health (MSDH) by telephone within 24 hours of first knowledge or suspicion. Class 1 diseases and conditions are dictated by requiring an immediate public health response. Laboratory directors have an obligation to report laboratory findings for selected diseases (refer to Appendix B of the Rules and Regulations Governing Reportable Diseases and Conditions). Any Suspected Outbreak (including foodborne and waterborne outbreaks) (Possible biological weapon agents appear in bold italics) Anthrax Arboviral infections including but not limited to those due to: California encephalitis virus Eastern equine encephalitis virus LaCrosse virus Western equine encephalitis virus St. Louis encephalitis virus West Nile virus Botulism (including foodborne, infant or wound) Brucellosis

Encephalitis (human) Glanders Haemophilus influenzae Invasive Disease†‡ Hemolytic uremic syndrome (HUS), post-diarrheal Hepatitis A HIV infection, including AIDS Influenza-associated pediatric mortality (<18 years of age) Measles Melioidosis Neisseria meningitidis Invasive Disease†‡ Pertussis

Ricin intoxication (castor beans) Smallpox Staphylococcus aureus, vancomycin resistant (VRSA) or vancomycin intermediate (VISA) Syphilis (including congenital) Tuberculosis Tularemia Typhoid fever Typhus fever Varicella infection,

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Chancroid Cholera

Plague Poliomyelitis

Creutzfeldt-Jakob disease, including new variant Diphtheria Escherichia coli O157:H7 and any shiga toxin-producing E. coli (STEC)

Psittacosis Q fever Rabies (human or animal)

primary, in patients >15 years of age Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo]) Yellow fever

Any unusual disease or manifestation of illness, including but not limited to the appearance of a novel or previously controlled or eradicated infectious agent, or biological or chemical toxin. Class 2: Diseases or conditions of public health importance of which individual cases shall be reported by mail, telephone, fax or electronically, within 1 week of diagnosis. In outbreaks or other unusual circumstances they shall be reported the same as Class 1. Class 2 diseases and conditions are those for which an immediate public health response is not needed for individual cases. Chlamydia trachomatis, genital infection Dengue Ehrlichiosis Enterococcus, invasive infection‡, vancomycin resistant Gonorrhea Hepatitis (acute, viral only) Note - Hepatitis A requires Class 1 Report Legionellosis Listeriosis

Lyme disease Malaria Meningitis other than meningococcal or H. influenzae

Rubella (including congenital) Salmonellosis Shigellosis

Mumps

Spinal cord injuries

M. tuberculosis infection (positive TST or positive IGRA***) in children < 15 years of age Noncholera vibrio disease Poisonings* (including elevated blood lead levels**) Rocky Mountain spotted fever

Streptococcus pneumoniae, invasive infection‡ Tetanus Trichinosis Viral encephalitis in horses and ratites

†

Usually presents as meningitis or septicemia, or less commonly as cellulitis, epiglottitis, osteomyelitis, pericarditis or septic arthritis. ‡ Specimen obtained from a normally sterile site. *Reports for poisonings shall be made to Mississippi Poison Control Center, UMMC 1-800-2221222. **Elevated blood lead levels (as designated below) should be reported to the MSDH Lead Program at (601) 576-7447. For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 209

Blood lead levels (venous) of >10 µg/dL in children less than 16 years of age Blood lead levels (venous) of >25 µg/dL in those 16 years or older ***TST- tuberculin skin test; IGRA- Interferon-Gamma Release Assay Except for rabies, equine, and ratite encephalitis, diseases occurring in animals are not required to be reported to the MSDH. Class 3: Laboratory based surveillance. To be reported by laboratories only. Diseases or conditions of public health importance of which individual laboratory findings shall be reported by mail, telephone, fax or electronically within one week of completion of laboratory tests (refer to Appendix B of the Rules and Regulations Governing Reportable Diseases and Conditions). All blood lead test results Blastomycosis Campylobacteriosis

Chagas Disease (American Trypanosomiasis) Cryptosporidiosis Hansen disease (Leprosy)

Hepatitis C infection Histoplasmosis Nontuberculous mycobacterial disease

Class 4: Diseases of public health importance for which immediate reporting is not necessary for surveillance or control efforts. Diseases and conditions in this category shall be reported to the Mississippi Cancer Registry within six months of the date of first contact for the reportable condition. The National Program of Cancer Registries at the Centers for Disease Control and Prevention requires the collection of certain diseases and conditions. A comprehensive reportable list including ICD9CM codes is available on the Mississippi Cancer Registry website, http://mcr.umc.edu/documents/ReportableCases10-09andlater.pdf. Each record shall provide a minimum set of data items which meets the uniform standards required by the National Program of Cancer Registries and documented in the North American Association of Central Cancer Registries (NAACCR).

For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 210

Laboratory Results that must be Reported to the Mississippi State Department of Health Laboratories shall report these findings to the MSDH at least WEEKLY. Diseases in bold type shall be reported immediately by telephone. Isolates of organisms marked with a dagger (†) should be sent to the MSDH Public Health Laboratory (PHL). All referring laboratories should call the PHL at (601) 576-7582 prior to shipping any isolate. Confirmatory tests for some of these results may be obtained by special arrangement through the Epidemiology Program at (601) 576-7725. Positive Bacterial Cultures or Direct Examinations Result Reportable Disease Any bacterial agent in CSF Bacterial meningitis † Bacillus anthracis Anthrax Bordetella pertussis Pertussis † Borrelia burgdorferi Lyme disease Brucella species † Brucellosis † Burkholderia mallei Glanders Burkholderia pseudomallei † Melioidosis Campylobacter species Campylobacteriosis Chlamydia psittaci Psittacosis Chlamydia trachomatis Chlamydia trachomatis genital infection † Clostridium botulinum ** Botulism Clostridium tetani Tetanus † Corynebacterium diphtheriae Diphtheria Coxiella burnetii † Q fever Enterococcus species,* vancomycin resistant Enterococcus infection, invasive vancomycin resistant Escherichia coli O157:H7 and any shiga Escherichia coli O157:H7 and any shiga toxintoxin-producing E. coli (STEC) † producing E. coli (STEC) Francisella tularensis † Tularemia Haemophilus ducreyi Chancroid Haemophilus influenzae †* H. influenzae infection, invasive Legionella species Legionellosis Listeria monocytogenes † Listeriosis Mycobacterium species Nontuberculous mycobacterial disease Mycobacterium tuberculosis † Tuberculosis Neisseria gonorrhea Gonorrhea Neisseria meningitidis †* Meningococcal infection, invasive Rickettsia prowazekii Typhus Fever Rickettsia rickettsii Rocky Mountain Spotted Fever Salmonella species, not S. typhi Salmonellosis † Salmonella typhi Typhoid fever Shigella species Shigellosis Staphylococcus aureus, vancomycin Staphylococcus aureus vancomycin resistant resistant or vancomycin intermediate (VRSA) or vancomycin intermediate For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 211

(VISA) Streptococcus pneumoniae* Streptococcus pneumoniae, invasive infection Vibrio cholerae 01† Cholera Vibrio species † Vibrio infection † Yersinia pestis Plague † Isolates of organism should be sent to the MSDH PHL. All referring laboratories should call the PHL at (601) 576-7582 prior to shipping any isolate. * Specimen obtained from a normally sterile site (usually blood or cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid). Do not report throat or sputum isolates. **Contact the MSDH Epidemiology Program at (601) 576-7725 or the PHL at (601) 576-7582 for appropriate tests when considering a diagnosis of botulism.

For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 212

Positive Serologic Tests For: Arboviral agents including but not limited to those due to: California encephalitis virus Eastern equine encephalitis virus LaCrosse virus St. Louis encephalitis virus Western equine encephalitis virus West Nile virus

Dengue

M. tuberculosis infection

Ehrlichiosis Hepatitis A (anti-HAV IgM) Hepatitis B (anti-HBc IgM) Hepatitis C

Plague Poliomyelitis

HIV infection (refer to Section 113) Legionellosis§

Brucellosis Chagas Disease (American Trypanosomiasis) Cholera

Lyme disease Malaria

Chlamydia trachomatis genital infection

Mumps

Measles

Psittacosis Rocky Mountain Spotted Fever Rubella Syphilis (refer to Section 116) Smallpox Trichinosis Varicella infection, primary in patients >15 years of age

Yellow fever Serologic confirmation of an acute case of legionellosis cannot be based on a single titer. There must be a four-fold rise in titer to >1:128 between acute and convalescent specimens.

Positive Parasitic Cultures or Direct Examinations Result Reportable Disease Any parasite in CSF

Parasitic meningitis

Blood Chemistries ALL blood lead test results are reportable to the MSDH Lead Program at (601) 576-7447.

Cryptosporidium parvum Cryptosporidiosis Plasmodium species ‡ Malaria ‡ Indicates the positive specimens may be submitted to the MSDH PHL for confirmation. Positive Fungal Cultures or Direct Examinations Result Reportable Disease Any fungus in CSF Blastomyces dermatitidis Histoplasma capsulatum

Positive Toxin Identification Ricin toxin from Ricinus communis (castor beans)

Fungal meningitis Blastomycosis Histoplasmosis

For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 213

Positive Viral Cultures or Direct Examinations Result Reportable Disease Any virus in CSF Arboviral agents including but not limited to those due to: California encephalitis virus Eastern equine encephalitis virus LaCrosse virus St. Louis encephalitis virus Western equine encephalitis virus West Nile virus Arenaviruses Dengue virus, serotype 1, 2, 3 or 4 Filoviruses Poliovirus, type 1, 2 or 3 Varicella virus Variola virus Yellow fever virus

Viral meningitis

California encephalitis Eastern equine encephalitis (EEE) LaCrosse encephalitis St. Louis encephalitis (SLE) Western equine encephalitis (WEE) West Nile encephalitis (WNV) Viral hemorrhagic fevers Dengue

Surgical Pathology results Creutzfeldt-Jakob Disease, including new variant Hansen disease (Mycobacterium leprae) Human rabies Malignant neoplasms Mycobacterial disease including Tuberculosis Trichinosis

Viral hemorrhagic fevers Poliomyelitis Varicella in patients >15 years of age Smallpox Yellow fever

For further information, please refer to the Mississippi State Department of Health’s website at www.msdh.state.ms.us. Revision: November 19, 2010 214

APPENDIX C Nutritional Standards Introduction Meals shall meet the nutritional standards as prescribed in this section. A child care facility shall provide adequate and nutritious meals prepared in a safe and sanitary manner. Healthy diets help children grow, develop, and perform well in learning environments. Healthy diets contain the amounts of essential nutrients and calories needed to prevent nutritional deficiencies while preventing an excess amount of discretionary calories. Planned meals and snacks provide the right balance of carbohydrate, fat, and protein to reduce risks of chronic diseases, and are part of a full and productive lifestyle. Such diets are obtained from a variety of foods. Nutrition and feeding practices for children strongly affect the development and long-term health of the child. Proper nutritional care during the early years is essential for intellectual, social, emotional, and physical growth. It is also necessary that an environment be provided which encourages the development of good food habits. Meals and vending services shall meet the standards from the Offices of Healthy Schools and Child Nutrition for the Mississippi State Department of Education as well as USDA Food and Nutrition Service guidelines. THE GOALS OF A CHILD CARE FACILITY IN RELATION TO NUTRITION SHALL BE: 1. 2. 3. 4. 5. 6. 7.

Menus shall be nutritionally adequate and consistent with the Dietary Guidelines for Americans. Foods shall be provided in quantities and meal patterns that balance energy and nutrients with children’s ages, appetites, activity levels, special needs, and cultural and ethnic differences in food habits. Parents shall be involved in the nutrition component of their child-care facility. A variety of fruits, vegetables, and whole-grain products shall be offered to children for meals and snacks. Mealtime should be used as an opportunity to teach nutrition and/or food concepts. The addition of fat, sugar, and sources of sodium shall be minimal in food preparation and service. Food preparation and service shall be consistent with best practices for food safety and sanitation. Furniture and eating utensils shall be age-appropriate and developmentally suitable to encourage children to accept and enjoy mealtime. 215

Child-care personnel shall encourage positive experiences with food and eating.

Caregivers shall receive appropriate training in nutrition, food preparation, and food service. Child-care facilities shall obtain assistance as needed from the Child Care Licensure Division and the supportive staff. Nutrition education for children and for their parents shall be encouraged as a component of the child-care program. Child-care programs must comply with local and state regulations related to wholesomeness of food, food preparation facilities, food safety, and sanitation. Family style dining is encouraged.

10. 11. 12. 13.

Based upon the American Dietetic Association Benchmarks for Nutrition Programs in Child-Care Settings

FEEDING SCHEDULE FOR INFANTS AND CHILDREN ONE YEAR AND OLDER 1. Children's food needs are based on the amount of time spent in the child care facility. 2. Any child in a child care facility at the time of service of a meal or snack will be served that meal or snack 3. Child care facilities that are open 24 hours are required to serve three meals and three snacks. IF YOU ARE OPEN Nine hours or less Over nine hours 24 hours or during all meals I.

YOU MUST SERVE Two snacks and one meal OR One snack and two meals Two snacks and two meals OR Three snacks and one meal Three meal and three snacks: one snack should be a late night snack only served to children who are awake.

Meal Time

Meals and snacks shall be served at regularly scheduled times each day. The same meal or snack shall not be served more than one time in any 24-hour (one-day) period. No more than four and no less than a two and one-half hour period must elapse between the beginning of a meal and a snack. If breakfast is not served, then a mid-morning snack shall be provided.

216

Since not all children arrive at the facility at the same time, certain parental options regarding breakfast will be allowed as follows: 1. Parent can feed the child prior to arrival at the child care facility. 2. The parent may have the meal provided by the child care facility. Note:

Either option above must be documented and included in the child's record.

Outside foods shall not be brought into the facility, with the exception of special dietary needs. Exempt facilities are facilities that operate less than six hours and as noted in the regulations, otherwise noted in other sections of the standards. Any outside foods shall meet the Office of Healthy School and MSDH Nutrition Standard guidelines. II.

Meal Time Environment

Age appropriate utensils, plates, bowls, cups, and dining area shall be provided. Children shall not wait longer than fifteen minutes at the table for food to be served. Sufficient time shall be allowed for children to wash their hands and prepare for the meal. Mealtime shall be used for socialization, and shall be a relaxed, happy time for the children. No media, e.g., televisions, videos, or DVD’s may be viewed during meal and snack times. Family style dining is encouraged with serving platters, bowls, and pitchers on the table so that all present can serve him/her self. Children are encouraged to assist with table setting and bowling up fruits for dessert. All foods served must meet the serving guidelines, and be age appropriate. “Seconds” of foods can be served as indicated at the request of the child or by hunger cues. A caregiver shall sit and join the children while they are eating. When caregivers are allowed to eat with the children, which is encouraged, staff will eat items that meet nutrition standards. It is suggested that the staff eat the same food items that are served to the children. The staff will encourage social interaction, conversation, and use the mealtime for education purposes. Extra assistance and time shall be provided for slow eaters. Caregivers shall not eat foods outside of the foods served in the facility in front of the children. Food shall not be used as a reward or punishment. Children will not be encouraged to “clean your plate,” but encouraging children to try two bites of each food served is acceptable. 217

Additional servings shall be provided for the child who requests more food at a meal or snack. It is at the discretion of the facility and knowledge of the child’s eating pattern to allow seconds on food items. This time to teach children on portion control, monitoring extra intake, and better food selections is higher in nutritional value. Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation. Foods for a party or celebration shall meet the Office of Healthy School guidelines. Children will be permitted in meal preparation areas when under the direct supervision of a staff person, when there is no danger of injury from equipment, and for instruction/teaching purposes only. III.

Menus

A complete two-week cycle of menu plans shall be submitted annually to Child Care Licensure as part of the renewal process. Although a minimum complete, two-week cycle menu is required to be submitted annually, child care facilities at their discretion may submit a 4 to 8 week cycle of menu plans. Daily menus for all meals and snacks prepared and/or served in the child care facility shall be plainly posted. Any substitution shall be of comparable food value and shall be recorded on the menu and dated. Menus shall be written at least one week in advance. Menus can be completed on a rotating cycle for 4-12 weeks. Menus shall be posted in the food preparation area and in a conspicuous place in the child care facility at all times. Menus shall be planned to include food with variety in texture, color, and shape. Record of dated menus served, and any substitutions made, shall be kept on file for a minimum of one year. New food shall be introduced to help develop good food habits. Introduce only one new food per meal or snack. Foods used for activities/teaching can be included on the written record of foods served for the day. It is the facility’s responsibility to discuss recurring eating problems with the child's parent. IV. Child Requiring a Special Diet 218

A child requiring a special diet due to medical reasons, allergic reactions, or religious beliefs, shall be provided meals and snacks in accordance with the child's needs. If medical reasons exist for the special diet, a medical prescription from the child’s physician stating that the special diet is medically necessary is required. Information required for dietary modifications include: • Child’s full name and date of instructions, updated annually; • Any dietary restrictions based on the special needs; • Any special feeding or eating utensils; • Any foods to be omitted from the diet and any foods to be substituted; • Limitations of life activities; • Any other pertinent special needs information; • What, if anything, needs to be done if the child is exposed to restricted foods. Religious or ethnic requests should include the above information as needed, plus a certified statement of request based upon the religious or ethnic beliefs of the family. The facility shall not serve nutrient concentrates and supplements such as protein powders, liquid protein, vitamins, minerals, and other nonfood substances without written instructions from the child’s physician. The child’s parent shall meet with the facility staff and/or director to review the written instructions. Such instructions shall list any dietary restrictions/requirements and shall be signed and dated by the child's physician requesting the special diet. Parents of children with severe restrictions and dietary needs will be given a copy of the facility’s menu to pre-select foods to be served. The parents will be responsible for ensuring the accuracy of foods served based upon the preplanned menu. The child care facility may request the parent to supplement food served by the child care facility. When food is supplied by the parent, the child care facility shall be responsible for assuring that it is properly stored and served to the child in accordance with the diet instructions on file at the child care facility. Any food item that must cooked, shall be prepared by the facility, such as a soy patties. Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation. Records of food intake shall be maintained when indicated by the child's physician. Vegetarian/Vegan Dietary Requests Request for a vegetarian/vegan diet shall be accommodated with the same information completed as for dietary modifications. Specialty items may be supplied by the parent to meet nutritional needs. Contact with the nutritionist with MSDH is recommended. 219

To the extent authorized by Federal laws, the facility may determine that the special nutritional needs of a child cannot be met at the facility and the child may be excluded from admission into the facility. V.

Food Preparation

Recipes shall be used and a file of recipes used to prepare the food shall be maintained. Foods shall be prepared in a form that is easy for children to handle. Bite size pieces and finger foods are suitable. Bones shall be removed from any food served to any child in the child care setting. Foods shall be prepared as close to serving time as possible to preserve nutrients, flavor, and color. Food should not be highly seasoned. No extra salt or fats should be added to the foods in cooking. The use of salt free, low fat products is allowed. Children need to learn the flavors of food. Raw vegetables and foods that may cause choking in young children shall not be served to children less than two years of age. VI. Choking Prevention A caregiver shall join the children while they are eating. This is an opportunity to teach socialization skills, nutrition education, and is a safety measure to help prevent choking. Children should be encouraged to eat slowly, take small bites, and chew well before swallowing. FOODS THAT MAY CAUSE CHOKING Sausage shaped meats (hot dogs)* Hard Candy* Nuts Grapes Gum* Dried Fruits

Pop Corn Chips* Thick Pretzels Rods* Thin pretzel sticks and rounds would be allowed Chunks of peanut butter Marshmallows

*Not allowed to be served To Reduce Choking Hazards

220

Cook food until soft and cut into short strips, not round slices. Serve other foods in thin slices or small pieces. Remove bones from meat, chicken, and fish, and remove seeds and pits from fruit. With toddlers, cutting foods into “pea” size is recommended. VII.

Feeding of Infants

When a pregnant mother is visiting the facility to consider enrollment, breastfeeding should be encouraged. Breast milk is the recommended feeding for infants and should be encouraged and supported by child care facility staff. The mother may choose to come to the child care facility to nurse her infant, or may choose to supply bottles of expressed breast milk for the child care facility staff to feed the infant. To help a mother be successful with breastfeeding the faculty may: 1. Encourage the mother to come to the facility to breastfeed and provide a • Quiet, comfortable and private place to feed; • Place to wash the hands; • Pillow to support her infant if desired; • A comfortable chair, stool for feet while nursing; • The mother may opt to nurse while in the infants room; 2. Encourage the mother to provide a back-up supply of frozen breast milk that is labeled with the infant’s name and date of expression. The mother’s expressed milk shall be used for her infant only. Note: Excessive shaking of human milk may damage some components that are valuable to the infant. The Centers for Disease Control’s (CDC) guidelines for storage of frozen expressed breast milk are as follows: • • •

Freezer compartment of a refrigerator at a temperature of 5 F or -15 C the expressed breast milk can be safely stored for 2 weeks Freezer compartment of refrigerator with separate doors 0° F or -18° C the expressed breast milk can be safely stored for 3-6 months Freezer compartment of refrigerator with separate doors -4° F or -20° C the expressed breast milk can be safely stored for 6-12 months

Note: Store milk toward the back of the freezer, where temperature is most constant. Milk stored for longer durations in the ranges listed is safe, but some of the lipids in the milk undergo degradation resulting in lower quality. You can go to the CDC website at http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm for more information. 221

3. Note: for the breast fed infant, it is acceptable to introduce iron-fortified cereal earlier, at four months if desired, but preferably at 6 months. A written schedule for feeding the infant shall be provided by the parent and posted for reference by the child care facility staff. Feeding should be by hunger cues whenever possible. Hunger cues may include: • Sucking on his tongue, lips, hands, or fingers while asleep • Moving his arms and hands toward his mouth • Restless movements while asleep • Rapid eye movements under his eyelids • Opening his mouth when his lips are touched • “Rooting” or searching for your nipple • Making small sounds Late hunger cues include: • Crying • Fussiness Signals when an infant is full and feeding should stop: • “Falls off” your breast, releasing the nipple; • Falls asleep; or • Relaxes his body and opens his fists. Breast milk or formula shall be brought to the child care facility daily, ready to be warmed and fed. Each bottle shall be labeled with the infant's name and the date. No cereal, juice or other foods may be added to the infant’s breast milk/formula without a physician’s written request, as done for a child with special needs. Bottles should be warmed for five minutes in a pan of hot, not boiling water; never microwave. Before feeding, test the temperature by squirting a couple of drops on the back of your hand. At the end of each feeding, discard any milk left in the bottle. Staff will send all used bottles home with the parent for proper cleaning and sanitizing. Age-appropriate solid foods (complimentary foods) may be introduced no sooner than when the child has reached 4 months of age, but ideally at six months. The first food introduced usually is cereal mixed with breast milk or formula (not in a bottle). Adding juice to dry cereal is not allowed. Commercially prepared B baby foods shall be brought in unopened jars and labeled with the infant's name. Home prepared/blended and home canned infant foods shall not be 222

served. A facility may chose to mash and puree the foods served to older children for the infants 7 months to one year - no additional juice, sauces, or fats may be added to the pureed foods. Iron-fortified dry infant cereal shall be brought in sealed container premeasured for each feeding and labeled with the infant’s name. Juice shall not be served to infants (children less than 12 months of age). A small amount of water is encouraged at 8-12 months. Infants shall be held cradled in the arms during feeding. At no time shall an infant be fed by propping a bottle. Introduction of solid foods to an infant should be done in consultation with the parent and/or according to the schedule of the Mississippi State Department of Health Infant Feeding Guide. Solid foods must be spoon-fed. No solid foods shall be fed by bottle or infant feeder without written direction from a physician. Infants are fed when hungry by noting hunger cues, such as crying, being restless. Feeding is stopped when it is determined that the infant is satisfied. Signs of satiety include, refusing the nurse, turning away from the nipple, falling asleep. Infants are encouraged to start using a cup at six to nine months, based upon motor skills. When the cup is used, the breast milk or formula may be brought into the center in a clean closed container that is clearly labeled. By the age of one, all children should be off a bottle. Older infants are encouraged to hold and drink from cups, to use child appropriate eating and serving utensils. Self-feeding should be encouraged. All food should be served in a manner to prevent choking, such as mashing, cutting in small “pea” size portions. Breast or formula is served to at least 12 months. Cow's milk is not served until age one, unless provided with a written exception from the infant’s physician. Children ages one to two, shall be served whole cow’s milk, after age two, toddlers should be served fat free/skim milk. When there are children older than two in the classroom with younger children, all children shall be served the whole milk. Guidelines for Milk Storage and Use for All Infants Storage Method and Temperature Maximum Amount of Time For Storage Room (25 C or 77 F) 4 hours Refrigerator (4 C or 39 F) 48 hours 223

Previously thawed – Refrigerated milk 24 hours Freezer (-20 C or 0 F) 3 months From the ACOG/AAP publication: Breastfeeding Handbook for Physicians When centers are reimbursed for meals and must supply formula for their infants, only ready to use formula may be purchased for use. The center may require the parents to supply clean bottles daily. If the center supplies the bottles, there must be provisions in place for the proper cleaning, sanitizing, and drying of all bottles and supplies outside of the infant room. FEEDING SCHEDULE FOR INFANTS THROUGH ONE YEAR INFANT’S FOOD NEEDS ARE BASED ON THE AMOUNT OF TIME SPENT IN THE CHILD CARE FACILITY. ANY INFANT IN A CHILD CARE FACILITY AT THE TIME OF SERVICE OF A MEAL OR SNACK SHALL BE SERVED FOODS APPROPRIATE TO THE AGE.

MEAL/SNACK Breakfast

Lunch or Supper

BIRTH THROUGH 5 MONTHS 4-6 fl. oz. breast milk or formula

4-6 fl. oz. breast milk or formula

Supplement/Snack 4-6 fl. oz. breast milk or formula

6 THROUGH 12 MONTHS 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed) 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed) 1-4 Tbsp. infant meat 2-4 fl. oz. breast milk or formula 0-1/2 dry bread or 0-2 crackers (optional) 224

Infant cereal and formulas shall be iron fortified. Infant feeding is individualized after consultation with the parent and by hunger cues from the infant. MENU PLANNING Dietary Guidelines for Americans provide assistance in planning meals for ages two and older, which will promote health and prevent disease. The guidelines, applied to child care feeding are: 1. Offer a variety of foods. 2. Serve meals and snacks that help maintain a healthy weight. 3. Serve fresh, frozen, canned, or dried vegetables, fruits whenever possible, and whole grain products. 4. Avoid excessive fat, saturated fat, and cholesterol. No fried foods or foods with transfats shall be served. 5. Use and serve sugar only in meal preparation and then in moderation. No concentrated sweets, such as candy, syrup, sweetened drinks sodas, or flavored milks may be served. 6. Limit sodium products and the use of salt. 7. Promote an alcohol, tobacco and drug free lifestyle for children, parents, and caregivers. 8. Promote and encourage daily physical activity. PARTIES AND SPECIAL OCCASIONS Parties and special party type events should not be held more that once a month. Food for parties should be prepared at the facility when possible. It is recommended that if foods for the event are brought to the facility by parents it should be “store bought” and not “home cooked.” It is suggested that a plain “store bought” cake be served. Other items may include ice cream, fresh fruit, cheese and crackers, and party favors such as stickers, books, toothbrushes, crayons, etc., are encouraged. Meal Pattern Points to Remember

225

Keep in mind the following points when you plan menus to meet meal pattern requirements for each of the food groups. • Plan your meats first. Then select fruits and vegetables, making sure that you have a Vitamin C source daily and a Vitamin A source every other day, or three times a week. Refer to the vitamin tables. Limit starchy vegetables to once/day - these include lima beans, butterbeans, white/sweet potatoes, English peas, black-eye peas, field peas, Crowder peas, cream and whole kernel corn, any dried pea/bean(unless counted for a meat substitute). •

Two vegetables or two fruits may be served at the mealtime, but it is recommended to serve a vegetable and a fruit for variety. Including brightly colored fruits and vegetables, such as tomatoes, broccoli, carrots, greens, strawberries, melon, peaches, will help to meet the vitamin requirements.

•

The same meal may not be served more than once in a day (i.e. facilities who are open for lunch and supper may not serve the same meal for both meals).

•

Snacks are to be served mid-morning (if required), early afternoon, and late afternoon, usually 30-60 minutes before closing. Water can be used as the beverage while foods are served. Snack time is an excellent time to introduce fruits and vegetables.

•

Use only 100-percent-strength juice for snack no more than once a day. Give fruit for breakfast/morning snack instead of juice.

•

Juice should not be served as part of the snack when milk is the only other component. It is poor menu planning to offer such a combination since it provides too much liquid for children.

•

Fruit-flavored drinks, sport drinks, soft drinks, caffeinated beverages, artificially sweetened beverages shall not be served.

•

Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal.

•

Dry milk shall not be used as a milk beverage, but may be used for cooking purposes.

•

Guidelines from USDA FNS (US Department of Agriculture Food Nutrition Supplement) program are used as the standard for menu planning and guidelines. However, when one set of guidelines are stricter then the stricter guidelines shall be enforced (in comparing MSDH and USDA FNS). Emphasis shall be placed on serving more whole grains and fewer foods high in fat, sugar, and sodium.

•

Drinking water shall be freely available to children of all ages and offered at frequent 226

intervals. Extra water served with meals, snacks, and during and after physical activity is encouraged. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table. •

To prevent nutrient and vitamin loss from foods during preparation, cooking, or storage, try to o Serve fruits and vegetables raw as appropriate for the age. The risk of choking is greater for the child under the age of two. o Steam, boil, or simmer foods in a very small amount of water, or microwave for the shortest time possible. o Cook potatoes in their skins. Be sure to wash the dirt off the outside of the potato. o Refrigerate prepared juices and store them for no more than two to three days. o Store cut raw fruits and vegetables in an airtight container and refrigerate—do not soak or store in water. Nutrients may be diluted from soaking in water. Manufacturer packaged fresh fruits and vegetables are the exception due to packaging processes. MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: BREAKFAST

BREAKFAST

AGES 1YR-2YR ½ c. ¼ c.

AGES 3 YR-5 YR ¾ c. ½ c.

AGES 6 YR–12 YR 1 c. ½ c.

Milk (Must be fluid, skim/fat free) Fruit or Vegetable Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR Enriched, Whole Grain Pasta, Noodles, Rice Water

½ slice

¼ c. OR 1/3oz. ¼ c.

1/3 c. OR ½ oz. 1/3 c.

¾ c. OR 1oz. ½ c.

¼ c.

1/3 c.

½ c.

¾ c.

1 c.

Milk: Milk shall be served at Breakfast. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years of age. After age two, skim/fat free milk shall be served Soymilk may be served when indicated with dietary restrictions. Bread and Bread Alternates: 227

Use enriched whole-grain breads and bread alternatives. Dry cereals need to be of high fiber and not sugar coated. Hot cereals cannot be instant. Whole grain pasta, noodles, or brown rice may be used occasionally for the breakfast meal. Breakfast breads may include muffins, biscuit, toast, breakfast bread, no more than weekly pancake or waffle (with no syrup). Crust used as part of the main dish (i.e., for quiche) is allowed as a bread alternate. These items may not be served: doughnuts, honey buns, breakfast tarts, pastries, packaged snack cakes, and other high fat/sugar foods. Fruits and Vegetables: Use fresh, canned, dried, or frozen fruit for breakfast. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water - not syrup or sugar packed. Vegetables, such as tomatoes, may be used occasionally for the breakfast meal. Cultural differences may also dictate that items such as tomatoes, peppers, onions, or salsas may be served with brown rice for the vegetable and bread component at breakfast. Water: Water is to be made available with all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table. Meat and Meat Alternates: The Meat component is not required for the breakfast meal. IF the facility desires to serve a meat item with the breakfast, that would be allowed. Meats and meat alternates that would be acceptable include eggs, fat free yogurt, low fat cheese, fat free cottage cheese, lean ham, Canadian bacon, and peanut butter. MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: LUNCH/SUPPER/DINNER LUNCH/SUPPER/DINNER Meat/Meat Alternate Cooked Meat, No Bone Cooked Dry Beans/Peas Low Fat Cheese Egg

AGES 1 YR – 2 YR

AGES 3 YR - 5 YR

AGES 6 YR - 12 YR

1 oz. ¼ c. 1 oz. 1 small

1 ½ oz. 3/8 c. 1 ½ oz. 1 medium

2 oz. ½ c. 2 oz. 1 medium

228

Peanut Butter Fat Free Yogurt/Cottage Cheese Fruit or Vegetable: Must include 2 different foods- 1 vegetable/1 fruit OR 2 vegetable OR 2 fruit Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR Enriched, Whole Grain Pasta, Noodles, Rice Milk (Must be fluid, skim/fat free) Water

2 Tbsp. 4 oz/1/2 c. ¼ c. total 1/8 c. of 2 foods

3 Tbsp. 6 oz./3/4 c. ½ c. total ¼ c. of 2 foods

4 Tbsp. 8 oz./1 c. 3/4 c. total 3/8 c. of 2 foods

½ slice

¼ c. OR 1/3oz. ¼ c.

1/3 c. OR ½ oz. 1/3 c.

¾ c. OR 1oz. ½ c.

¼ c.

1/3 c.

½ c.

½ c. ½ c.

¾ c. ¾ c.

1 c. 1 c.

Meat and Meat Alternates: It is recommended to have at least one meatless meal a week. An alternate for meat could be cooked, dried beans, or peas. Cooked dried beans and peas cannot count for a vegetable and meat alternate in the same meal. Canned beans and peas will include the canned kidney, black bean, garbanzo, etc. Note: Canned beans are much higher in sodium/salt. Edible portion for meats and meat alternates is used. Bone and skin shall not be counted as servings. No bones may be served. Note: 1 ounce of cooked meat is equal to one medium cooked chicken leg wtih bone removed. Processed, pre-fried meats are not allowed due to the sodium/salt and fat content. Meats not allowed include hot dogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers. Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low fat or fat free cheese would be a meat alternate that is allowed. For menu variety, use meat, and low fat cheese in combination to equal a full serving portion. It is not recommended serving nuts and seeds due to nut/seed allergies prevalent in the youth today. Bread and Bread Alternates: 229

Use enriched whole-grain breads and bread alternatives. Whole grain pasta, noodles, brown rice, wheat rolls, and cornbread are encouraged for the lunch/supper/dinner meals. Bread alternates may include crust used as part of the main dish (i.e. pizza or quiche), Dry oatmeal used in a fruit crisp. Pre-fried items, such as hash browns, French fries, and tater tots are not recommended due to the fat and sodium content Any pre-fried item served is limited to once a week. Cookies, pastries, packaged snack cakes, and other high fat/sugar foods cannot be counted for any bread serving at the lunch/supper/dinner meal. Fruits and Vegetables: Must serve a Vitamin C source daily and must serve a Vitamin A source every other day, three times a week – refer to the guidelines. Fruits and vegetables supply these nutrients. More than once vitamin source a day is also encouraged. Use a different combination of two or more servings for the meal service. Use fresh, canned, dried, or frozen vegetables and fruits for lunch/supper/dinner. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water not syrup or sugar packed. Vegetables and fruits may be served as combination dishes (i.e., beef stew with meat, potatoes, carrots, English peas, OR shredded carrot salad with diced pineapple). Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal. It is highly recommended to either serve at least one raw vegetable and two raw fruits per week, for a meal or snack Limit serving starchy vegetables to once per meal. Starchy vegetables include white/sweet potatoes, lima beans, butter beans, English peas, black-eye peas, field peas, Crowder peas, cream and whole kernel corn, any dried bean/pea (unless counted for a meat alternate). Vegetables shall be seasoned with powders, spices, and herbs. The use of high sodium/salt and high fat seasonings should be restricted as much as possible. Small amounts (less than 1/8 cup) of lettuce, tomatoes, onions, relish, catsup, salsa, jams, jellies, or other condiments may be added for flavor or garnish as "other foods," but do not count as a fruit or vegetable. 230

Milk: Milk shall be served at Lunch/Supper/Dinner. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years of age. After age two, skim/fat free milk shall be served. Flavored milk may be served no more than once a week, using flavoring added to whole/skim/fat free milk. Soymilk may be served when indicated with dietary restrictions. Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions. If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, etc. All milk equivalent used as a meat alternate must be low in fat. Water: Water is to be made available at all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table. MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: SNACK SNACK – MUST SELECT TWO OF THE FOUR COMPONENTS, PLUS WATER Meat/Meat Alternate Cooked Meat, No Bone Cooked Dry Beans/Peas Low Fat Cheese Egg Peanut Butter Fat Free Yogurt/Cottage Cheese Fruit or Vegetable Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR

AGES 1YR2YR

AGES 3 YR-5 YR

AGES 6 YR–12 YR

1/2 oz. 1/8 c. 1/2 oz. 1 small 1 Tbsp. 2 oz/1/4 c. 1/2 c.

½ OZ. 1/8 c. 1/2 oz. 1 medium 1 Tbsp. 2 oz./1/4 c. ½ c.

1 oz. 1/4 c. 1 oz. 1 medium 2 Tbsp. 4 oz./1/2 c. 3/4 c.

½ slice

¼ c. OR 1/3oz. ¼ c.

1/3 c. OR ½ oz. 1/3 c.

¾ c. OR 1oz. ½ c.

¼ c.

1/3 c.

½ c.

231

Enriched, Whole Grain Pasta, Noodles, Rice Milk (Must be fluid, skim/fat free) Water

½ c. ½ c.

1/2 c. 1 c.

1 c. 1 c.

Meat and Meat Alternates: It is recommended to have at least one meatless meal a week. An alternate for meat could be cooked, dried beans or peas. Cooked dried beans and peas cannot count for a vegetable and meat alternate in the same meal. Canned beans and peas will include the canned kidney, black bean, garbanzo, etc. Note: Canned beans are much higher in sodium/salt. Edible portion for meats and meat alternates is used. Bone and skin shall not be counted as servings. No bones may be served. Note: 1 ounce of cooked meat is equal to one medium cooked chicken leg with bone removed. Processed, pre-fried meats are not allowed due to the sodium/salt and fat content. Meats not allowed include hot dogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers. Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low fat or fat free cheese would be a meat alternate that is allowed. For menu variety, use meat, and low fat cheese in combination to equal a full serving portion. Nuts or seeds may be used as a meat alternate for snack time, but is not recommended due to nut/seed allergies prevalent in the youth today. Bread and Bread Alternates: Use enriched whole-grain breads and bread alternatives. Whole grain pasta, noodles, brown rice, wheat rolls, and cornbread are encouraged for the lunch/supper/dinner meals. Bread alternates may include crust used as part of the main dish (i.e. pizza or quiche), dry oatmeal used in a fruit crisp. Pre-fried items, such as hash browns, French fries, tater tots are not recommended due to the fat and sodium content Any pre-fried item served is limited to once a week. Fresh, “homemade” oven baked fries or wedges would be allowed. Plain, low sugar type cookies may be served occasionally for a snack component. These cookies may include animal crackers, graham crackers, vanilla wafers, oatmeal, oatmeal raisin, peanut butter, and ginger snaps. Items that may not be served include chocolate chip, most packaged cookies/cakes. 232

Low fat granola bars, cereal bars, whole grain fruit bars, rice krispie treats may be used for a snack bread component. Packaged crackers with cheese/peanut butter filling are discouraged due to the fat/sodium content. The cheese/peanut butter filling cannot count as a meat serving. Baked chips, chips, popcorn, hard pretzels, and other low-moisture, high sodium foods cannot meet the bread requirement for a snack. Crackers, cheese and vegetable flavored crackers are allowed. Trail mixes made of various dry, no sugar coated cereals, dried fruits, and small marshmallows are a suggested snack item to meet a bread component. Fruits and Vegetables: Use fresh, canned, dried, or frozen vegetables and fruits for snack. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or waternot syrup or sugar packed. Vegetables and fruits may be served as combination dishes (i.e., shredded carrot salad with diced pineapple, fat free yogurt parfait with fresh fruit). Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal. It is highly recommended to either serve at least one raw vegetable and two raw fruits per week, for a meal or snack. Younger children may have an appropriate substitution due to the choking hazard or the item may be cooked first. Small amounts (less than 1/8 cup) of lettuce, tomatoes, onions, relish, catsup, salsa, jams, jellies, or other condiments may be added for flavor or garnish as "other foods," but do not count as a fruit or vegetable. Juice should not be served as part of the snack when milk is the only other component. It is poor menu planning to offer such a combination since it provides too much liquid for children. 100% Fruit juice is allowed once a day. Vitamin fortified fruit juices, such as apple juice, with extra Vitamin C, will not be recognized as a good vitamin source. The best time to serve this juice would be at the late 4:30/5:30 p.m., snack period. Milk: The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years or age. After age two, skim/fat free milk shall be served. 233

Flavored milk may be served no more than once a week, using flavoring added to whole/skim/fat free milk. Soymilk may be served when indicated with dietary restrictions. Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions. If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, etc. All milk equivalents used as a meat alternate must be low in fat. Water: Water is to be made available with all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table.

VITAMIN C SOURCES VITAMIN C SOURCE MUST BE SERVED DAILY **BEST CHOICE *GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size Food Serving Size Blackberries ¼ c. # Asparagus ¼ c. * Blueberries ¼ c. # Artichoke ¼ medium * Cantaloupe ¼c ** Bok Choy ¼ c. * Grapefruit ¼ medium ** Broccoli ¼ c. ** Grapefruit Juice ½c ** Brussel Sprouts ¼ c. ** Grapefruit-Orange ½ c. ** Cabbage ¼ c. * Juice Guava ¼ c. ** Cauliflower ¼ c. * Honeydew Melon ½ c. * Chicory ¼ c. * Kiwi ½ medium ** Collard Greens ¼ c. * Mandarin Orange ¼ c. * Kale ¼ c. # Sections Mango ¼ medium * Kohlrabi ¼ c. ** Melon balls ¼ c. * Orange ½ medium ** Mustard Greens ¼ c. # 234

Orange Juice ¼ c. Papaya ¼ c. Peach, frozen only ¼ c.

** * **

Pineapple Pineapple Juice Pineapplegrapefruit or orange juice Raspberries Starfruit Strawberries Tangelo Tangerine Tropical fruit mix Watermelon

¼ c. ¼ c. ¼c.

# * **

¼ c. ¼ c. ¼ c. ½ medium ½ medium ¼ c. ½ c.

* # ** ** ** * #

Okra, not fried Peppers, green & red Potato, White, or Red Skinned Baked only-no instant/fries/tots Rutabagas Snow Peas Spinach

¼ c. ¼ c. ½ medium

# ** *

¼c. ¼ c. ¼ c.

# # #

Sweet Potato Tomato Tomato or V-8 Juice Turnip Greens Miscellaneous

½ medium ½ medium ¼ c. ¼ c.

* * ** *

Liver, beef

1 oz.

VITAMIN A SOURCES VITAMIN A SOURCE MUST BE SERVED EVERY OTHER DAY, 3 TIMES PER WEEK ** BEST CHOICE * GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size Food Serving Size Avocado ¼ medium # Asparagus ¼ c. # Apricot 2 halves * Artichoke ½ # medium Cantaloupe ¼ c. * Bok Choy ¼ c. * Cherries, red sour ¼ c. * Broccoli ¼ c. * Mandarin Orange ¼ c. * Brussels Sprouts ¼ c. * Segments Mango ¼ medium ** Carrots ¼ c. ** Melon Balls ¼ c. * Collard Greens ¼ c. ** Nectarine ¼ medium # Papaya ¼ c. * Kale ¼ c. ** Peaches ¼ c. # Lettuce, Green, Romaine, or ½ c. # Red NOT Iceberg (Iceberg is not high in vitamins) 235

Plantain Prunes Tangerine

Egg Liver, beef Liver, chicken

¼ c. ¼ c. ½ medium

# * *

Miscellaneous 1 medium 1 oz. 1 oz.

* ** **

Mixed Vegetables Mustard Greens Okra, not fried Peas & Carrots Peppers, red Pumpkin Rutabagas Spinach Sweet Potato

¼ c. ¼ c. ¼ c. ¼ c. ¼ c. ¼ c. ¼ c. ¼ c. ½ medium Tomato or V-8 Juice ¼ c. Turnip Greens ¼ c. Winter Squash, Butternut or ¼ c. Hubbard

** ** # ** ** ** # ** ** ** ** **

DENTAL CARE Dental care is encouraged after each meal service. Parents shall supply toothbrushes and tooth powders or pastes for the child's individual use. Recommendations include replacing the brush every three months or when bristles are bent. Each toothbrush and powder or paste must be: • Labeled with the child's full name • Stored out of children's reach when not in use • Stored in a manner that prevents the toothbrushes from touching each other during storage Staff is encouraged to attend trainings on dental care that includes: • Proper tooth brushing technique as appropriate for the child’s age and skills. • Education to train parents about proper oral healthcare techniques. • Education for staff and parents to learn the appropriate techniques to feed infants and children that minimize damage to teeth and facial development. Children must have adult supervision during tooth brushing activities. GARDENING AND FRESH PRODUCE Gardening is an excellent opportunity to incorporate physical activity with nutrition education. Facilities are encouraged to have gardening projects with the children. Produce that is grown in the gardens may be washed and handled properly to allow the items to be served for a snack time or education activity.

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Purchasing local produce from Mississippi farmers is one way to offer fresh items to the children. This also helps the local economy and raising families’ awareness of food sources. The child care center must ensure the safety of foods served. Steps must be taken to demonstrate reasonable care has been taken to ensure the safety of foods purchased. Steps include: Investigating the local farm and production practices, communicating with the local farmer on the needs of the facility including packaging, delivery, and payment procedures, and promoting the use of local produce with families and the community. There are several resources available to use as a safety checklist, such as the Iowa State University Checklist for Retail Purchasing of Local Produce. The checklist is on the www.Healthyms.com website under Nutrition and Farm to School and Preschool. REFERENCES Dietary Guidelines for Americans, 2005. http://www.health.gov/dietaryguidelines/dga2005/document/ United States Department of Agriculture; Food and Nutrition Service; Child and Adult Care Food Program: Nutrition Guidance for Child Care Centers. http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns. Dietary Reference Intakes, (DRIs), Food and Nutrition board, Institute of Medicine, National Academies USDA National Nutrient Database for Standard Reference, Release 18. Promoting good Nutrition and Physical Activity in Child-Care Settings, A Research Brief, May 2007, Robert Wood Johnson Foundation. Position of the American Dietetic Association: Benchmarks for Nutrition Programs in Child Care Settings, Journal of the American Dietetic Association, June 2005. Nemours, Health and Prevention Services, Best Practices for Health Eating: A Guide to Help Children Grow Up Healthy, Version 2, 2008 The Wellness Child Care Assessment Tool: A Measure to Assess the Quality of Written Nutrition and Physical Activity Policies, The American Dietetic Associations, December 2011 Institute of Medicine, Child and Adult Care Food Programs: Aligning Dietary Guidance for All, November 4, 2011

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APPENDIX D See Public Playground Safety Handbook. As published by the United States Consumer Product Safety Commission – Saving Lives and Keeping Families Safe. This document is located at http://www.cpsc.gov/ . This document is available only in .pdf format. To read and print a PDF file, you must have Adobe® Acrobat® Reader installed on your PC. You can download a version suitable for your system, free of charge, from Adobe (http://www.adobe.com/).

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APPENDIX E DISHWASHING PROCEDURE The best way to wash, rinse, and disinfect dishes and eating utensils is to use a dishwasher with a sanitizing cycle. The final sanitizing rinse of a dishwasher must reach a temperature of 180 degrees. If a dishwasher is not available or cannot be installed, a three-compartment sink will be needed to wash, rinse, and disinfect dishes. A two-compartment or one-compartment sink can be used in child care facilities (located in an occupied residence) licensed for 12 or fewer children by adding one or two dishpans, as needed. In addition to three compartments or dishpans, you will need a dish rack with a drain board to allow dishes and utensils to air dry. To wash, rinse, and disinfect dishes by hand: o Fill one sink compartment or dishpan with hot tap water and a dishwashing detergent. o Fill the second compartment or dishpan with hot tap water. o Fill the third compartment or dishpan with hot tap water and 1-1/2 tablespoons of liquid chlorine bleach for each gallon of water. o Scrape dishes and utensils and dispose of excess food. o Immerse scraped dish or utensil in first sink compartment or dishpan and wash thoroughly. o Rinse dish or utensil in second dishpan of clear water. o Immerse dish or utensil in third dishpan of chlorinated water for at least 1 minute. o Place dish or utensil in a rack to air dry. Note: Food preparation and dishwashing sinks should only be used for these activities and should never be used for routine hand washing or diaper changing activities. Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.

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APPENDIX F HAND WASHING PROCEDURE !Always use warm, running water and a mild, preferably liquid, soap. Antibacterial soaps may be used, but are not required. Pre-moistened cleansing toweletts do not effectively clean hands and do not take the place of hand washing. !Wet the hands and apply a small amount (dime to quarter size) of liquid soap to hands. !Rub hands together vigorously until a soapy lather appears and continue for at least 15 seconds. Be sure to scrub between fingers, under fingernails, and around the tips and palms of the hands. !Rinse hands under warm running water. Leave the water running while drying hands. !Dry hands with a clean, disposable (or single use) towel, being careful to avoid touch the faucet handles or towel holder with clean hands. !Turn the faucet off using the towel as a barrier between your hands and the faucet handle. !Discard the used towel in a trash can lined with a fluid-resistant (plastic) bag. Trash cans with foot-petal operated lids are preferable. !Consider using hand lotion to prevent chapping of hands. If using lotions, use liquids or tubes that can be squirted so that the hands do not have direct contact with container spout. Direct contact with the spout could contaminate the lotion inside the container. !When assisting a child in hand washing, either hold the child (if an infant) or have the child stand on a safety step at a height at which the child’s hands can hang freely under the running water. Assist the child in performing all of the above steps and then wash your own hands. Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.

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APPENDIX G PROCEDURE FOR DIAPERING A CHILD Either of the following two procedures is acceptable in a child care facility for licensing purposes. Procedure #1 1. Organize needed supplies within reach: a. fresh diaper and clean clothes (if necessary) b. dampened paper towels or premoistened toweletts for Cleaning child’s bottom c. child’s personal, labeled, ointment (if provided by parents) d. trash disposal bag 2. Place a disposable covering (such as roll paper) on the portion of the diapering table where you will place the child’s bottom. Diapering surfaces should be smooth, nonabsorbent, and easy to clean. Don’t use areas that come in close contact with children during play such as couches, floor areas where children play, etc. 3. If using gloves, put them on now. 4. Using only your hands, pick up and hold the child away from your body. Don’t cradle the child in your arms and risk soiling your cloths. 5. Lay the child on the paper or towel. 6. Remove soiled diaper (and soiled clothes). 7. Put disposable diapers in a plastic-lined trash receptacle. 8. Put soiled reusable diaper and /or soiled clothes WITHOUT RINSING in a plastic bag to give to parents. 9. Clean child’s bottom with some premoistened disposable toweletts or a dampened, single-use, disposable towel. 10. Place the soiled toweletts or towel in a plastic-lined trash receptacle. 11. If the child needs a more thorough washing, use soap, running water, and paper towels. 12. Remove the disposable covering from beneath the child. Discard it in a plastic-lined receptacle. 13. If you are wearing gloves, remove and dispose of them now in a plastic-lined receptacle. 242

14. Wash your hands. NOTE: The diapering table should be next to a sink with running water so that you can wash your hands without leaving the diapered child unattended. However, if a sink is not within reach of the diapering table, don’t leave the child unattended on the diapering table to go to a sink; wipe your hands with some premoistened toweletts instead. NEVER leave a child alone on the diapering table. 15. Wash the child’s hands under running water. 16. Diaper and dress the child. 17. Disinfect the diapering surface immediately after you finish diapering the child. 18. Return the child to the activity area. 19. Clean and disinfect: a. The diapering area, b. all equipment or supplies that were touched, and c. soiled crib or cot, if needed. 20. Wash your hands under running water. Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention. Procedure #2 1. Caregiver washes hands 2. Prepare for diapering by gathering wipes, diaper, plastic bag, clean clothes, gloves and other supplies needed. Bring materials to the diaper changing area but not on the changing table 3. Place child on diapering table. Remove clothing to access diaper. If soiled, place clothes into plastic bag. 4. Remove soiled diaper and place into plastic-lined, hands-free covered trash container. (To limit odor, seal in a plastic bag before placing into trash containers.) 5. Use wipes to clean child’s bottom from front to back. Use a fresh wipe for each swipe. 6. If gloves were used, remove at this point. 7. Use a wipe to remove soil from adult’s hands. 243

8. Use another wipe to remove soil from child’s hands. 9. Throw soiled wipes into plastic-lined, hands-free covered trash container. 10. Put on clean diaper and redress child. 11. Place child at sink and wash hands using the proper hand washing procedure. Return child to a supervised play area without contaminating any surface 12. Spray the surface of the diapering table with soap-water solution to remove gross soil. Wipe clean using a disposable towel and throw away in a plastic-lined, hands-free covered trash container. Be sure the surface is dried completely. 13. Spray the surface of the diapering table with clear water (recommended). Wipe dry using a disposable towel and throw away in a plastic-lined, hands-free covered trash container. 14. Spray the diapering surface with disinfecting strength bleach-water solution (completely cover table; table should glisten) and wait for 2 minutes before wiping dry with a disposable towel or allow to air dry. Dispose of the towel in a plastic-lined, hands-free covered trash container. 15. Adult washes hands using the proper hand washing procedure. Source: Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education, 2011. Source: Miss. Code Ann. §43-20-8

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APPENDIX H CLEANING AND DISINFECTION PROCEDURES Keeping the child care environment clean and orderly is very important for health, safety, and the emotional well-being of both children and providers. One of the most important steps in reducing the number of germs, and therefore the spread of disease, is the thorough cleaning of surfaces that could possibly pose a risk to children or staff. Surfaces considered most likely to be contaminated are those with which children are most likely to have close contact. These include toys that children put in their mouths, crib rails, food preparation areas, and surfaces likely to become very contaminated with germs, such as diaper-changing areas. Routine cleaning with soap and water is the most useful method for removing germs from surfaces in the child care setting. Good mechanical cleaning (scrubbing with soap and water) physically reduces the numbers of germs from the surface, just as hand washing reduces the numbers of germs from the hands. Removing germs in the child care setting is especially important for soiled surfaces which cannot be treated with chemical disinfectants, such as some upholstery fabrics. However, some items and surfaces should receive an additional step, disinfection, to kill germs after cleaning with soap and rinsing with clear water. Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs. The disinfection process uses chemicals that are stronger than soap and water. Disinfection also usually requires soaking or drenching the item for several minutes to give the chemical time to kill the remaining germs. Commercial products that meet the Environmental Protection Agency’s (EPA’s standards for “hospital grade” germicides (solutions that kill germs) may be used for this purpose. One of the most commonly used chemicals for disinfection in child care settings is a homemade solution of household bleach and water. Bleach is cheap and easy to get. The solution of bleach and water is easy to mix, is nontoxic, is safe if handled properly, and kill most infectious agents. (Be aware that some infectious agents are not killed by bleach. For example, cryptosporidia is only killed ammonia or hydrogen peroxide.) A solution of bleach and water loses its strength very quickly and easily. It is weakened by organic material, evaporation, heat, and sunlight. Therefore, bleach solutions should be mixed fresh each day to make sure it is effective. Any leftover solution should be discarded and the end of the day. NEVER mix bleach with anything but fresh tap water! Other chemicals may react with bleach and create and release a toxic chlorine gas. Keep the bleach solution you mix each day in a cool place out of direct sunlight and out of the reach of children. (Although a solution of bleach and water mixed as shown in the accompanying box should not be harmful if accidentally swallowed, you should keep all chemicals away from children.) 245

If a child care facility uses a commercial cleaner, sanitizer, or disinfectant it must be a U.S. Environmental Protection Agency (EPA)-registered product that has an EPA registration number on the label. Such products shall only be used according to the manufacturer’s instructions. NOTE: All EPA-registered products may not be appropriate for use in a child care facility. Therefore, it is the responsibility of the facility to make sure any product use is appropriate for use in a child care facility.

Recipe for Bleach Disinfecting Solution (For use on non-porous surfaces such as diaper change tables, counter tops, door and cabinet handles toilets, etc.) ¼ - ¾ cup bleach 1 gallon of cool water OR 1 - 3 tablespoon bleach 1 quart of cool water Apply as a spray or poured fresh solution, not by dipping into a container with a cloth that has been in contact with a contaminated surface. Add the household bleach (5.25% sodium hypochlorite) to the water.

Recipe for Weaker Bleach Sanitizing Solution For food contact surfaces sanitizing (dishes, utensils, cutting boards high chare trays), toys that children may place in their mouths, and pacifiers. 1 tablespoon bleach 1 gallon cool water Add the bleach to the water Washing and Disinfecting Toys !

Infants and toddlers should not share toys. Toys that children (particularly infants and toddlers) put in their mouths should be washed and disinfected between uses by individual children. Toys for infants and toddlers should be chosen with this in mind. If you cannot wash a toy, it probably is not appropriate for an infant or toddler. 246

When an infant or toddler finishes playing with a toy, you should retrieve it form the play area and put it in a bin reserved for dirty toys. This bin should be out of reach of the children. Toys can be washed at a later, more convenient time, and then transferred to a bin for clean toys and safely reused by the other children.

To wash and disinfect a hard plastic toy: • Scrub the toy in warm, soapy water. Use a brush to reach into the crevices. • Rinse the toy in clean water. • Immerse the toy in a mild bleach solution (see above) and allow it to soak in the solution for 10-20 minutes. • Remove the toy from the bleach and rinse well in cool water. • Air dry.

Hard plastic toys that are washed in a dishwasher or cloth toys washed in the hot water cycle of the hot water cycle of a washing machine do not need to be additionally disinfected.

Children in diapers should only have washable toys. Each group of children should have its own toys. Toys should not be shared with other groups.

Stuffed toys used by only a single child should be cleaned in a washing machine every week or more frequently if heavily soiled.

Toys and equipment used by older children and not put into their mouths should be cleaned at least weekly and when obviously soiled. A soap and water wash followed by clear water rinsing and air drying should be adequate. No disinfection is required. (These types of toys and equipment include blocks, dolls, tricycles, trucks, and other similar toys.).

Do not use wading pools for children in diapers.

Water play tables can spread germs. To prevent this: • Disinfect the table with chlorine bleach solution before filling it with water. • Disinfect the all toys to be used in the table with chlorine bleach solution. Avoid using sponge toys. They can trap bacteria and are difficult to clean. • Have all children wash their hands before and after playing in the water table. • Do not allow children with open sores or wounds to play in the water table. • Carefully supervise the children to make sure they do not drink the water. • Discard water after play is over

cleaner/disinfectants can be used in these areas. Surfaces that infants and young toddlers are likely to touch or mouth, such as crib rails, should be washed with soap and water and disinfected with a nontoxic disinfectant, such as bleach solution, at least once every day, more often if visibly soiled. After the surface has been drenched or soaked with the disinfectant for at least 10 minutes, surfaces likely to be mouthed should be thoroughly wiped with a fresh towel moistened with tap water. Be sure not to use a toxic cleaner on surfaces likely to be mouthed. Floors should be washed and disinfected at least once a day and whenever soiled. Washing and Disinfecting Diaper Changing Areas Diaper Changing Areas should: • Only be used for changing diapers. • Be smooth and nonporous, such as Formica (NOT wood). • Have a raised edge or low fence around the area to prevent a child from falling off. • Be next to a sink with hot and cold running water. • Not be used to prepare food, mix formula, or rinse pacifiers. • Be easily accessible to providers. • Be out of reach of children. Diaper changing areas should be cleaned and disinfected after each diaper changer as follows: • Clean the surface with soap and water and rinse with clear water. • Dry the surface with a paper towel. • Thoroughly wet the surface with the recommended bleach solution. • Wipe dry with a clean disposable towel or air dry. If using a commercial disinfectant/sanitizer, follow labeled manufacturer’s instructions. Washing and Disinfecting Clothing, Linen, and Furnishings Do not wash or rinse clothing soiled with fecal material in the child care setting. You may empty solid stool into the toilet, but be careful not to splash or touch toilet water with your hands. Put the soiled clothes in a plastic bag and seal the bag to await pick up by the child’s parent or guardian at the end of the day. Always wash your hands after handling soiled clothing. Explain to parents that washing or rinsing soiled diapers and clothing increases the chances that you and the children may be exposed to germs that cause diseases. Although receiving soiled clothes is not pleasant, remind parents that this policy protects the health of all children and providers. Each item of sleep equipment, including cribs, cots, mattresses, blankets, sheets, etc., should be cleaned and sanitized before being assigned to a specific child. The bedding items should be labeled with that child’s name, and should only be used by that child. Children shall not share bedding. Infants linens (sheets, pillowcases, blankets) shall be cleaned and sanitized daily, and crib mattresses shall be cleaned and sanitized weekly and when soiled or wet. Linens from beds of older children shall be laundered at least weekly and whenever soiled. However, if a child inadvertently used another child’s bedding, you shall change the linen and mattress cover 248

before allowing the assigned child to use it again. All blankets shall be changed and laundered routinely at least once a week. Cleaning up Body Fluid Spills Spills of body fluids, including blood, feces, nasal and eyed discharges, saliva, urine, and vomit shall be cleaned up immediately. Wear gloves unless the fluid can be easily contained by the material (e.g., paper tissue or cloth) that is being used to clean it up. Be careful not to get any of the fluid you are cleaning in your eyes, nose, mouth or any open sores you may have. Clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Discard fluid-contaminated material in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be (1) cleaned, (2) rinsed with a disinfecting solution, (3) wrung as dry as possible, and (4) hung to dry completely. Be sure to wash your hands after cleaning up any spill. Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention (as amended by MSDH). Source: Miss. Code Ann. §43-20-8.

APPENDIX I TABLE OF CONTENTS INTRODUCTION ..........................................................................................................................3 GENERAL INFORMATION .........................................................................................................4 IMMUNIZATION REQUIREMENTS ..........................................................................................5 EXCLUSION CRITERIA ..............................................................................................................7 CHICKENPOX (VARICELLA) & SHINGLES (VARICELLA ZOSTER) ..................................8 CYTOMEGALOVIRUS (CMV) ....................................................................................................9 DIARRHEAL DISEASES ..............................................................................................................9 E. COLI O157:H7 .........................................................................................................................10 FIFTH DISEASE ..........................................................................................................................10 249

“FLU” (INFLUENZA) .................................................................................................................11 HAND-FOOT-AND-MOUTH DISEASE ....................................................................................11 HEAD LICE...................................................................................................................................12 HEPATITIS A ..............................................................................................................................12 HEPATITIS B ...............................................................................................................................13 HEPATITIS C ...............................................................................................................................13 HIV/AIDS .....................................................................................................................................13 IMPETIGO ...................................................................................................................................14 MEASLES ....................................................................................................................................14 MENINGITIS ...............................................................................................................................15 MUMPS ........................................................................................................................................15 “PINK EYE” (CONJUNCTIVITIS) .............................................................................................16 PINWORMS .................................................................................................................................16 RESPIRATORY SYNCYTIAL VIRUS (RSV) ...........................................................................16 RINGWORM ................................................................................................................................17 SCABIES ......................................................................................................................................17 “STREP THROAT” (STREPTOCOCCAL PHARYNGITIS) & SCARLET FEVER. .......................................................................................................18 TUBERCULOSIS (TB) ................................................................................................................18 WHOOPING COUGH (PERTUSSIS) .........................................................................................18 EXAMPLE PERMISSION SLIP TO COLLECT STOOL SPECIMENS AND RECEIVE TEST RESULTS FOR OUTBREAKS OF DIARRHEAL DISEASES .....................20 ATTACHMENT A “RECOMMENDATIONS FOR THE CONTROL OF HEAD LICE IN THE CHILD CARE SETTING” 250

INTRODUCTION COMMUNICABLE DISEASES/CONDITIONS AND RETURN TO CHILD CARE Childcare providers frequently must make decisions regarding when children with communicable diseases/conditions should be allowed to attend or return to the out-of-home child care setting (a large child care center or where child care is provided in a private residence for more than one child). We hope the information provided in this booklet will help with these decisions. It contains information about the most common or important communicable diseases/conditions and how they are spread. Information is listed about the different times during which infectious agents may be transmitted from one person to another, and when it is usually safe for someone who has one of these conditions to return to the center. The “return to child care times” are based on the usual period of time that a person is considered to be contagious — not on the period of time that may be necessary for full clinical recovery from the signs or symptoms of an illness which may vary a great deal from person to person. While this booklet will serve as a guide for child care attendance of children with communicable conditions, the Mississippi State Department of Health (MSDH) welcomes the opportunity to help with your decisions. You may contact your district health department office (see district map on page18) or the Division of Epidemiology at the MSDH in Jackson to speak with a consultant. ****

*** THIS booklet is NOT intended to be used to DIAGNOSE an illness or infection. It SHOULD NOT REPLACE a diagnosis by trained MEDICAL personnel.***

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GENERAL INFORMATION Small children who are cared for in out-of-home group settings are at a greater risk of acquiring and spreading a contagious disease. Small children are highly susceptible to contagious diseases since most of them have not been exposed to many of the most common germs and therefore do not have any immunity to them. Young children also have certain habits (e.g., putting their fingers and other objects in their mouths) that can easily spread germs. Even though contagious diseases/conditions will occur in a child care setting, the child care provider must do everything he or she can to prevent and control the spread of disease. The use of common sense hygienic practices, especially frequent and thorough hand washing cannot be stressed enough! Also, making sure that staff and children are up to date on their immunizations helps to lessen the risk of exposure to contagious diseases. Reportable diseases: There are 4 classes of reportable diseases. Class I diseases are those of major public health importance and are to be reported upon first knowledge or suspicion and are usually reported by the physician, hospital or laboratory. However, the MSDH encourages child care providers who know of a child in their facility who has been diagnosed with a disease such as meningitis or measles to report it to the Health Department. This can sometimes help to expedite the investigation. Class II diseases may require public health intervention also, especially if there are several cases in one room (e.g., diarrheal diseases such as shigella and giardia). When a Class I reportable disease is reported to the MSDH, there will be an investigation. The immediacy of the response by the MSDH and the extent of the investigation depends on the disease the person has. For example, if a child has been reported to have meningococcal meningitis, an investigation would take place as soon as the report is received. It is the goal of the MSDH to provide preventive medication to those for whom it would be indicated within 24 hours of receiving the report. A current list of the reportable diseases is provided in Appendix B of the Child Care Rules and Regulations. Outbreaks/parental permission for laboratory tests: During times when there are outbreaks of Giardia, Shigella infection, etc., large numbers of stool specimens may be requested by the MSDH. The MSDH recommends that child care facilities obtain permission from parents or guardians at the time of enrollment for the child care facility to collect these stool specimens and receive the laboratory results if and when such an outbreak occurs. These laboratory tests would be done by the MSDH Laboratory free of charge. The laboratory test results would be sent to the child care facility and given to the parents/guardians by the child care facility for them to give to the child’s physician. (See sample permission slip on page 17) Handouts: It is good practice to keep parents informed as to what diseases might be occurring in the child care facility so that they can be alert to signs and symptoms of diseases and observe their children for them. We have provided a packet with fact sheets/handouts on certain diseases for you to give to parents. 252

CHILD CARE IMMUNIZATION REQUIREMENTS (FOR ATTENDEES AND STAFF) ATTENDEES The MSDH regulations governing the licensure of child care facilities mandate that each child in a licensed facility have immunizations according to the recommended immunization schedule. These children are to be age-appropriately immunized and must have a Certificate of Immunization Compliance (Form 121) or a Certificate of Medical Exemption (Form 122) on file at the child care facility and readily accessible for review by the MSDH. The Form 121 must be signed by the District Health Officer, a physician, nurse or designee. The medical exemption, Form 122, MUST be signed by the District Health Officer. Children enrolled in licensed child care facilities and public and private schools in Mississippi may be exempt for medical reasons only and not for religious reasons. Children usually begin their routine immunizations between 6 weeks and 2 months of age. The immunizations that are currently required at the age-appropriate times for child care are: DTaP (diphtheria, tetanus, pertussis), polio, MMR (measles, mumps, rubella), and HIB (H. Influenzae type b). Hepatitis B vaccine is a recommended vaccine, and is usually started at birth to 2 months of age. Hepatitis B is not required for child care attendance but is required for entry into 5 year old kindergarten. As of August 01, 2002, one (1) dose of Varicella (chicken pox) vaccine is required on or after the 1st birthday and is required for entry into five (5) year-old kindergarten. Varicella is not required if a history of the disease is documented. Children enrolled in a licensed child care facility or Head Start Center are expected to be age appropriately immunized. All children must have one of the following forms before enrollment in a licensed Child Care/Head Start facility. 1.

Certificate of Immunization Compliance (Form 121). This form must be signed by the District Health Officer, a physician, nurse or designee.

Certificate of Medical Exemption (Form 122). This form must be approved and signed by the Mississippi Department of Health District Health Officer from the public health district or the State Epidemiologist.

STAFF Anyone (whether full or part-time and even if they are the owner/director) who works in a licensed child care facility must have a Certificate of Immunization Compliance (Form 121) or a Certificate of Medical Exemption from Immunization Requirements for Adults (Form 132) on file and readily accessible for review by the MSDH. The requirement for adults is that they must show proof of immunity to measles (rubeola or “red” measles) and rubella (“German”or “3-day” measles). 253

Proof of immunity to measles: Persons born prior to 01-01-1957 are assumed to have natural immunity to measles. Persons born on or after 01-01-1957 must show proof of immunity in one of the following ways: 1. A physician’s statement saying that the person has had measles disease. 2. Serological (a blood test) confirmation of measles immunity. 3. A record of 2 doses of measles-containing vaccine (usually given as MMR) given on or after the first birthday and on or after 01-01-1968. There must be a minimum time interval of 30 days between the 2 doses. Proof of immunity to rubella: All child care workers, regardless of age, must show proof of immunity to rubella in one of the following ways: 1. Serological (blood test) confirmation of rubella immunity. 2. A rubella vaccination received on or after 12 months of age and on or after 01-01-1969. The MSDH does not provide serological testing for measles and rubella for the purpose of child care/school attendance or private employment. Those who wish to have a blood test for proof of immunity to measles and/or rubella should see their private physician. The Child Care Licensure Division of the MSDH checks the immunization records in child care facilities during regular program reviews. District Immunization Representatives also visit child care centers on a random basis to inspect the immunization records of the children and the employees. The purpose of these visits is to verify the presence of the Certificates of Immunization Compliance. These visits also help to ensure adequate immunization of children enrolled in child care facilities. EXCLUSION CRITERIA Small children can become ill very quickly. The child care provider should observe each child’s health throughout the time the child is in their care. If the child care provider observes signs and symptoms of illness that would require removal from the facility, he/she should contact the parents/guardians to have the child picked up and continue to observe the child for other signs and symptoms. If the child is not responding to you, is having trouble breathing, or is having a seizure or convulsion, call 911. The following conditions require exclusion from child care: Fever :

Defined as 100°F or higher taken under the arm, 101°F taken orally, or 102°F taken rectally. For children 4 months or younger, the lower rectal temperature of 101°F is considered a fever threshold.

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Diarrhea:

Frequent (3 or more episodes in a 24-hour period) runny, watery, or bloody stools. According to CDC recommendations, a child who is not toilet trained and has diarrhea should be excluded from child care settings regardless of the cause.

Vomiting:

Two or more times in a 24-hour period

Rash:

Body rash with a fever

Sore throat:

Sore throat with fever and swollen glands

Severe coughing:

The child gets red or blue in the face or makes high-pitched whooping sound after coughing.

Eye discharge:

Thick mucus or pus draining from the eye

Jaundice:

Yellow eyes and skin

Irritability:

Continuous irritability and crying

CHICKENPOX (VARICELLA) Chickenpox is a highly infectious viral disease that begins with small red bumps that turn into blisters after several hours. The blisters generally last for 3-4 days and then begin to dry up and form scabs. These lesions (bumps/blisters) almost always appear first on the trunk rather than the extremities. Mode of transmission: Airborne droplets of nose and throat secretions coughed into the air by someone who has chickenpox. Also by direct contact with articles freshly soiled with discharge from the blisters and/or discharge from the nose and mouth (e.g., tissues, handkerchiefs, etc.). Notification: Notify parents/guardians and staff members that a case of chickenpox has occurred, especially those parents whose child is taking steroid medications, being treated with cancer or leukemia drugs or has a weakened immune system for some reason. Staff members who are pregnant and have never had chickenpox disease or the chickenpox vaccine should consult their physician immediately. A special preventive treatment may be indicated for those with a weakened immune system and non-immune pregnant women. This treatment must be given within 96 hours of the exposure to be effective. Vaccine: As of August 01, 2002, one (1) dose of Varicella (chicken pox) vaccine is required on or after the 1st birthday and is required for entry into five (5) year-old kindergarten. Varicella is not required if a history of the disease is documented.

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Return to child care: Once the diagnosis has been made, determine the day that the blisters first appeared. The child may return to child care on the 6th day after the blisters first appeared or earlier if all the lesions are crusted and dry and no new ones are forming. Keeping the child home until all the lesions are completely healed is unnecessary and results in excessive absences. SHINGLES (VARICELLA ZOSTER) Shingles (varicella zoster) is a reactivation of the chickenpox virus (varicella). After the initial infection with chickenpox, the virus continues to lie dormant (inactive) in a nerve root. We tend to think of the elderly and immunosuppressed individuals as the ones who have shingles; however, it can and does occur sometimes in children. The lesions or blisters of shingles resemble those of chickenpox and usually appear in just one area or on one side (unilateral) of the body and run along a nerve pathway. A mild shingles-like illness has been reported in healthy children who have had the chickenpox vaccine. This is a rare occurrence. Mode of transmission: It is possible for someone who has never had chickenpox disease or the vaccine to get chickenpox by coming in contact with the fluid from the lesions of someone who has shingles. Shingles itself is not transmissible. A person who has shingles does not transmit chickenpox through the air as does someone who has chickenpox disease. Return to child care: The child who has shingles may attend child care if the lesions can be covered by clothing. If the lesions cannot be covered, the child should be excluded until the lesions are crusted and dry. Staff members who have shingles pose little risk to others since the lesions would be covered by clothing or a dressing on exposed areas. Thorough hand washing is warranted whenever there is contact with the lesions. NOTE: Staff members, especially those who are pregnant, who have no history of chickenpox disease or chickenpox vaccine, should not take care of children with shingles during the time they have active or fluid-filled lesions. CYTOMEGALOVIRUS (CMV) CMV is a viral illness that most people become infected with during childhood. Small children usually have no symptoms when they become infected, but older children may develop an illness similar to mononucleosis with a fever, sore throat, malaise or feeling very tired and an enlarged liver. Mode of transmission: CMV is spread from person to person by direct contact with body fluids such as urine, saliva or blood. The virus can also be passed from the mother to the baby before birth. Pregnancy: Rarely, a woman may contract the disease for the first time during pregnancy which may pose a risk to the fetus causing certain birth defects. CDC recommends that women who are 256

child care providers and who expect to become pregnant should be tested for antibodies to CMV and if the test shows no evidence of previous CMV infection, they should reduce their contact with infected children by working, at least temporarily, with children 2 years of age and older where there is less circulation of the virus. Also, they should avoid kissing an infected child on the lips, and as with any child care situation, wash hands thoroughly after each diaper change and contact with a child’s saliva. If contact with children does not involve exposure to saliva or urine, there should be no fear of potential infection with CMV. Return to child care: There is no need to exclude children with CMV from child care as long as they do not have a fever since the virus may be excreted in urine and saliva for many months and may persist or there may be recurring episodes for several years following the initial infection. CMV is a virus that may persist as a latent infection and recur when a person becomes immunosuppressed with conditions such as cancer, AIDS, etc. DIARRHEAL DISEASES (e.g., campylobacteriosis, cryptosporidiosis, giardiasis, rotavirus, salmonellosis, shigellosis) - See E. coli O157:H7 and Hepatitis A sections for specific return-tochild- care recommendations regarding these 2 diseases. Diarrhea is defined as frequent (3 or more episodes within a 24 hour period), runny, watery stools and can be caused by different types of organisms such as viruses, bacteria and parasites. Mode of transmission: Diarrheal diseases are generally transmitted or spread by ingesting food or water or by putting something in the mouth such as a toy that has been contaminated with the feces (stool/poop) of an infected person or animal. In some cases such as with Salmonella and E. coli O157:H7, the disease is transmitted by eating raw or undercooked meats (especially ground beef and poultry) and unpasteurized milk and fruit juices. Notification: Notify parents/guardians of children in the involved room of the illness. Ask that they have any child with diarrhea, severe cramping or vomiting evaluated by a physician and that they inform the day care of diarrheal illness in their child and family. Outbreak situation: Most diarrheal diseases are reportable to the State Department of Health. When there are 2 or more cases of a diarrheal disease in one room, more extensive notification may need to be done as stool specimens may need to be collected. In this case, the director of the child care should consult with the Public Health District Epidemiology Nurse or the Division of Epidemiology at the State Department of Health. (See Public Health District Map on page 18 for addresses and telephone numbers) Return to child care: In most cases, a child may return to child care after a diarrheal illness once he or she is free of fever and the diarrhea has ceased. E.COLI O157:H7 257

Escherichia (E.) coli bacteria are found in the intestines of most humans and many animals. These infections are usually harmless. However, certain strains of the bacteria such as the O157:H7 can cause severe illness. Some persons who are infected with E. coli O157:H7 may have a mild disease while others develop a severe, bloody diarrhea. In some cases, the infection may cause a breakdown of the red blood cells which can lead to HUS or hemolytic uremic syndrome. Mode of transmission: E. coli O157:H7 is usually the result of eating undercooked meat, especially hamburger. There have also been cases reported from drinking unpasteurized apple juice. Person-to-person transmission may occur by contact with the feces or stool of an infected person. Notification: Notify the staff and parents/guardians that a case of E. coli O157:H7 has occurred and ask that they have their child evaluated by a physician if they have diarrhea, especially bloody diarrhea. E. coli O157:H7 is a Class I reportable disease and a follow-up investigation will be done by the Health Department. Return to child care: The infected child should not be in or allowed to return to a child care center until his/her diarrhea has ceased and 2 consecutive negative stool samples are obtained (collected not less than 24 hours apart and not sooner than 48 hours after the last dose of antibiotics). FIFTH DISEASE (ERYTHEMA INFECTIOSUM) This is an infectious disease characterized by a “slapped -face” (redness) appearance of the cheeks followed by a rash on the trunk and extremities. Mode of transmission: Person-to-person spread by direct contact with nose and throat secretions of an infected person. Transmission of infection can be lessened by routine hygienic practices which include hand washing and the proper disposal of facial tissues containing respiratory secretions. Notification: Notify parents/guardians and staff members that fifth disease is occurring in the child care facility. Staff members who are pregnant should consult their obstetrician if children in their room have fifth disease. Return to child care: Children with fifth disease may attend child care if they are free of fever, since by the time the rash begins they are no longer contagious. The rash may come and go for several weeks. “FLU” (INFLUENZA)

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Influenza is an acute (sudden onset) viral disease of the respiratory tract characterized by fever, headache, muscle aches, joint pain, malaise, nasal congestion, sore throat and cough. Influenza in children may be indistinguishable from diseases caused by other respiratory viruses. Mode of transmission: Direct contact with nose and throat secretions of someone who has influenza - airborne spread by these secretions coughed into the air. Return to child care: The child may return to child care when free of fever and feeling well. The closing of individual schools and child care centers has not proven to be an effective control measure. By the time absenteeism is high enough to warrant closing, it is too late to prevent spread. HAND-FOOT- AND- MOUTH DISEASE This is a common childhood disease caused by a strain of coxsackievirus. In some people, the virus causes mild to no symptoms. In others, it may result in painful blisters in the mouth and on the palms of the hands and the soles of the feet. Mode of transmission: The virus can be spread through saliva from the blisters in the mouth and from the fluid from the blisters on the hands and feet. It is also spread through the feces or stool of an infected person. Notification: Notify parents/guardians and staff that there are cases of hand-foot-and-mouth disease in the child care facility so that they can be alert to the signs and symptoms. Return to child care: The virus may be excreted in the stool for weeks after the symptoms have disappeared. Children who have blisters in their mouths and drool or who have weeping or active lesions/blisters on their hands should be excluded from child care until the lesions are crusted and dry and the child is free of fever.

HEAD LICE This is an infestation of the scalp by small “bugs” called lice. They firmly attach egg sacs called “nits” to the hairs, and these nits are difficult to remove. Treatment may be accomplished with prescription or over-the-counter medicines applied to the scalp. Mode of transmission: Direct contact with an infested person’s hair (head-to-head) and, to a lesser extent, direct contact with their personal belongings, especially shared clothing and headgear. Head lice do not jump or fly from one person to another, but they can crawl very quickly when heads are touching.

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Notification: When a case of head lice occurs in a room, notify the parents/guardians that a case of head lice has occurred. Check the other children in that room for head lice and if found, notify their parents/.guardians that the child needs treatment. Ask the parents/guardians to be alert to anyone in their family who may have signs and symptoms of head lice (e.g., excessive itching of the scalp, especially at the nape of the neck and around the ears) so that they may also receive treatment. Infants and children less than 2 yrs. of age: It is a rare occurrence for children in this age group to have head lice. It is generally not recommended to treat this age group prophylactically or just because someone else in the family has been treated. If a child of this age is found to have head lice, the parent/guardian should consult the child’s physician for treatment recommendations. Return to child care: The child may return to child care after the first treatment has been given. (See Attachment A - “ Recommendations for the Control of Head Lice in the Child Care Setting”) HEPATITIS A This is an infectious viral disease characterized by jaundice (yellowing of the eyes and skin), loss of appetite, nausea, and general weakness. Child care centers can be a major source of hepatitis A spread in the community. This is because small children usually do not show any specific signs and symptoms of the disease. Symptomatic illness primarily occurs among adult contacts of infected, asymptomatic children. Mode of transmission: Hepatitis A virus is found in the stool of persons infected with hepatitis A. The virus is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of an infected person; for this reason, the virus is more easily spread under poor sanitary conditions, and when good personal hygiene, especially good handwashing, is not observed. Rarely, the virus is contracted by eating raw seafood (e.g., raw oysters) that has been collected from contaminated waters. Notification: Notify the staff and parents/guardians that a case has occurred. Hepatitis A is a Class I reportable disease. A follow-up investigation will be done by the MSDH to determine who in the center may need to receive preventive treatment. Return to child care: The child may return to child care one week after the onset of jaundice (yellowing of the eyes and skin) or one week after the onset of other signs and symptoms if no jaundice is present. HEPATITIS B Hepatitis B is a viral disease that affects the liver. It is a contagious condition characterized by loss of appetite, abdominal discomfort, jaundice (yellowing of the eyes and skin), joint aches, and fever 260

in some cases. It is different from Hepatitis A. There should not be any risk of exposure to hepatitis B in a normal child care setting unless a child who is infected with hepatitis B is bleeding. Also, since the hepatitis B vaccine is now a part of the routine immunization schedule, more and more children should be immune. Mode of transmission: The most common mode of transmission is through having sex with someone who has the virus; however, it can be transmitted when infected blood enters the body through cuts, scrapes or other breaks in the skin. Injecting drug users are at risk when they share needles with an infected person. It is also possible for infected pregnant women to transmit the virus to their babies during pregnancy or at delivery. If an exposure to a person who is infected with hepatitis B has occurred, the person exposed should be referred to his/her physician since hepatitis B vaccine and hepatitis B immune globulin may be indicated. Since hepatitis B and HIV/AIDS are both transmitted through blood exposure, the precautionary measures for HIV/AIDS would also apply to hepatitisB. (See HIV/AIDS section below) HEPATITIS C Hepatitis C is also a viral disease that affects the liver. Again, hepatitis C should pose no risk of exposure in the normal child care setting unless the infected child is bleeding. There is no vaccine available for hepatitis C at this time. Since it is also transmitted through blood exposure, the same precautionary measures for hepatitis B and HIV/AIDS would be apply to hepatitis C. (See HIV/AIDS section below) HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION/ ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Mode of transmission: The most common mode of transmission is through having sex with someone who has the virus; however, it can be transmitted when infected blood enters the body through cuts, scrapes or other breaks in the skin. Injecting drug users are at risk when they share needles with an infected person. It is also possible for infected pregnant women to transmit the virus to their babies during pregnancy or at delivery. Although HIV and hepatitis B are transmitted in the same way, HIV is much more difficult to transmit from one person to another than hepatitis B. HIV infection in children causes a broad spectrum of disease manifestations and a varied clinical course. Children with HIV infection should be monitored closely by their physician. They are more susceptible to infectious diseases than other children. Parents of children known to have HIV infection should be notified when certain infectious diseases occur in the child care facility. There is no vaccine available for HIV at this time. According to CDC, HIV is not likely to be spread from one child to another in the child care setting and no case has ever been reported. Parents or guardians of HIV-positive children should inform the child care director of their child’s HIV status. 261

Because of concern over stigmatization, the person aware of a child’s HIV infection should be limited to those who need such knowledge to care for the children in the child care setting. In a situation where there is concern of possible exposure of others to the blood or body fluids of an infected person, CDC recommends that a team including the child’s parents or guardians, the child’s physician, public health personnel, and the proposed child care provider evaluate the situation to determine the most appropriate child care setting. The team should weigh the risks and benefits to both the infected child and to others in the child care setting. It should always be remembered that there those who are known to be infected with HIV, hepatitis B and C and other blood borne diseases, but on the other hand there are those we do not know about and some people are not even aware themselves that they may have an infectious blood borne disease. Therefore, we must always employ universal precautions (treating everyone’s blood as though it is infectious) when dealing with blood and body fluids. There is no evidence that HIV, hepatitis B or hepatitis C is transmitted through tears, perspiration, urine or saliva unless these body fluids contain visible blood. Child care providers should be prepared to handle blood and blood-containing body fluids using the principles of universal precautions. Supplies of gloves, disposable towels and disinfectants should be readily available. The Mississippi State Department of Health is available for consultation in these situations. IMPETIGO This is a contagious skin disease characterized by spreading pustular lesions (sores with pus) and should receive medical treatment. This is quite important to avoid the risk of complications involving the heart and kidneys. Mode of transmission: Skin-to-skin contact with the sores. Return to child care: The child may return to child care 24 hours after treatment has been started if free of fever and the lesions are not draining. MEASLES Measles is a serious viral infection characterized by a rash (red, flat lesions) starting on the head and neck, which enlarge and coalesce (run together), and spread to the trunk, then to the extremities. Other symptoms include a high fever, conjunctivitis (red, inflamed eyes), cough and nasal congestion. The Health Department must be notified on first suspicion. With our present immunization laws, measles is a rare occurrence today. It is imperative, however, that immunization records be kept current. 262

Mode of transmission: Direct contact with nose and throat secretions of an infected person. May be airborne by droplets of these secretions coughed into the air. Tiny droplets can be suspended in the air for two hours or more. Measles is very easily spread. Notification: Notify staff and parents/guardians that a case has occurred. Measles is a Class I reportable disease and there will be a follow-up investigation by the Health Department. Parents of children with weakened immune systems (those being treated for cancer, leukemia or taking steroid medication, etc.) should consult their child’s physician and keep the child out of the center until after the investigation by the Health Department and it is considered safe for them to return. Return to child care: The child may return to child care when free of fever and the rash is fading (this usually takes 5-7 days). MENINGITIS Meningitis is an inflammation or infection of the meninges ( the membranes that cover the brain and spinal cord). Meningitis can be caused by a variety of organisms or germs. Most people exposed to these germs do not develop meningitis or serious illness. Some people may carry a particular germ and have no symptoms at all. Anyone exhibiting signs and symptoms of meningitis (e.g., severe headache, fever, vomiting, stiffness and pain in the neck, shoulders and back, drowsiness) should seek medical attention promptly. Meningitis is a reportable disease. The Department of Health evaluates each case individually to determine what public health intervention, if any, might be required. The two types of meningitis that require public health intervention most often are caused by the organisms Haemophilus influenzae type b (HIB) and Neisseria meningitidis (meningococcal). Mode of transmission: These germs are most commonly spread by direct contact with nose and throat secretions from a infected person. Notification: Notify parents/guardians that a case has occurred and to have their children evaluated by a physician should they have any of the signs or symptoms listed above. Return to child care: The child may return to the center whenever he or she has been released by his/her personal physician. MUMPS Mumps is an infectious disease that is characterized by swelling and pain of the salivary glands. Mode of transmission: Person- to- person spread by direct contact with the saliva of an infected person. 263

Return to child care: The child may return to child care 9 days after the beginning of the salivary gland swelling. “PINK EYE” (CONJUNCTIVITIS) This is an infectious disease characterized by redness of the eye(s), excessive tearing, itching, and discharge. Some cases may require antibiotics; therefore, the child should see a physician. Mode of transmission: Contact with discharges from the eye, nose or throat of an infected person. Also, from contact with fingers, clothing and other articles that have been contaminated with the discharge. Return to child care: Children may return to child care after they have seen a physician or when the redness/discharge is improving. PINWORMS Pinworms are tiny worms that live in the large intestine and can cause anal itching, sleeplessness and irritability. They may also be present without any symptoms. Pinworms occur worldwide and affect all socioeconomic classes. They are the most common worm infection in the United States. Prescription medication must be obtained to treat the infection. Mode of transmission: Pinworms can be spread when an uninfected person touches the anal area of an infected person and then puts their hands/fingers in their mouth. They can also be spread when an infected person scratches the anal area and then contaminates food or other objects that are touched or eaten. Pinworms can be spread as long as the worms or the eggs are present. Return to child care: The child may return to child care 24 hours after they have received the first treatment. Employ thorough hand washing especially before eating and after toilet use and change and wash any bed linens and towels in hot water that have been used for those children. Ask the parents/guardians to do the same at home. Also, discourage children from scratching the anal area. RESPIRATORY SYNCYTIAL VIRUS (RSV) RSV can cause an upper respiratory disease like a cold or a disease of the lower respiratory tract such as pneumonia. It is the most common cause of lower respiratory tract infections and pneumonia in infants and children under the age of 2. Almost 100% of children in child care programs get RSV during the first year of life. This usually occurs during outbreaks in the winter months. RSV can range from a very mild disease to life-threatening. 264

Mode of transmission: Direct contact with nose and throat secretions of an infected person. A young child can be infectious with RSV 1 to 3 weeks after signs and symptoms have subsided. Return to child care: Most of the time a child is infectious before signs and symptoms appear. An infected child does not need to be excluded from child care unless he/she has a fever and/or is not well enough to participate in the activities. Make sure that procedures pertaining to hand washing, proper disposal of tissues and disinfection of toys are followed. RINGWORM Ringworm is a skin infection caused by a fungus that can affect the scalp, skin, fingers, toe nails and feet. Ringworm anyplace except on the scalp or under the nails can be successfully treated with several over-the-counter medicines. Ringworm of the scalp is characterized by inflammation, redness, and hair loss and does not respond to over-the-counter medicines; therefore, the child should see his/her physician. Mode of transmission: Direct skin-to-skin contact or indirect contact (e.g., toilet articles such as combs and hair brushes, used towels, clothing and hats contaminated with hair from infected persons or animals). Notification: When the lesions (red, circular places) are found, notify the parent/guardian that the child needs treatment. Return to child care: The child may return to child care after the treatment has been started. Treatment for ringworm of the scalp and nails usually lasts for several weeks. Strict infection control measures should be taken (e.g., blankets, towels or anything that is used on the infected child should not be used on another child, make sure that staff caring for these children practice good handwashing and that disinfecting procedures are followed. SCABIES Scabies is a disease of the skin caused by a mite. The mite burrows beneath the skin and causes a rash that is usually found around finger webs, wrists and elbows. The rash may appear on the head, neck and body on infants. Any child with evidence of severe itching especially in these areas should be referred to his/her physician. Scabies requires treatment by prescription drugs. Mode of transmission: Direct skin-to-skin contact with an infested person. Transfer of the mites from undergarments and bedclothes can occur, but only if contact takes place immediately after the infested person has been in contact with the undergarments and bedclothes. Notification: Notify parents/guardians and staff that scabies has occurred in the facility so that they can be alert to signs and symptoms and seek treatment. 265

Return to child care: The child may return to child care 24 hours after the treatment has been completed. It must be noted that itching may continue for several days, but this does not indicate treatment failure or that the child should be sent home. “STREP THROAT” (STREPTOCOCCAL PHARYNGITIS) & SCARLET FEVER Strep throat is a communicable disease characterized by sore throat, fever, and tender, swollen lymph glands in the neck. The child should see a physician to obtain prescription medication; this is quite important to avoid the risk of complications involving the heart and kidneys. Scarlet fever is a streptococcal infection with a rash (scarlatinaform rash). It is most commonly associated with strep throat. In addition to the signs and symptoms of strep throat, the person with scarlet fever has an inflamed, sandpaper-like rash and sometimes a very red or “strawberry” tongue. The rash is due to a toxin produced by the infecting strain of bacteria. The treatment and exclusion criteria for scarlet fever would be the same as for strep throat. Mode of transmission: Direct or indirect contact (e.g., contaminated hands, drinking glasses, straws) with throat secretions of an infected person. Return to child care: The child may return to child care 24 hours after treatment has been started if free of fever. TUBERCULOSIS (TB) Mode of transmission: Airborne droplets of respiratory secretions coughed or sneezed into the air by a person with active TB disease. Notification: TB is a class one reportable disease. If a child or a staff member in a child care facility is diagnosed with active TB, the MSDH will conduct an investigation. The MSDH will notify the facility and the parents/guardians of the type of follow-up that will be necessary. Return to child care: Persons diagnosed with TB infection are evaluated by the Mississippi State Department of Health on an individual basis. Those who have a positive TB skin test only may attend child care since they have no disease process that is contagious. Persons suspected of or diagnosed with active TB disease will need written permission from the Mississippi State Department of Health Tuberculosis Control Program to return to the center. Small children are highly susceptible to contracting TB disease, but do not transmit the disease as easily as an older child or adult. Children who do not have active TB disease, but who have been exposed to an active case in their household are considered high risk contacts and are placed on preventive medication. These children may attend child care since they are not infectious.

266

WHOOPING COUGH (PERTUSSIS) Pertussis or whooping cough is a contagious disease characterized by upper respiratory tract symptoms with a cough, often with a characteristic inspiratory (breathing in) whoop. Mode of transmission: Direct or indirect contact (contaminated articles) with nose and throat secretions of an infected person. Airborne transmission can also occur by droplets of these secretions coughed into the air. Notification: Notify parents/guardians that a case has occurred. Pertussis is a class one reportable disease. The Health Department will conduct an investigation to determine those who may need preventive treatment. Return to child care: The child may return to child care 5 days after their treatment has begun.

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PERMISSION TO COLLECT STOOL SPECIMENS AND RECEIVE TEST RESULTS

If and when an outbreak of diarrheal diseases such as giardiasis, salmonellosis, shigellosis, etc. occurs in a child care facility, the Mississippi State Department (MSDH) investigates and may request that stool specimens be collected. In an outbreak situation, the stool specimen collection bottles are provided by the MSDH and the tests are done in the MSDH Lab free of charge. The collection bottle, with instructions, would either be given to the parent/guardian to collect the stool specimen or it may need to be collected at the child care facility. The child care facility would receive the test results and recommendations would be made by the MSDH. The test results would be given to the parents/guardians by the child care facility and the parents/guardians should give them to their child’s physician.

I give my permission for (name of child care facility) to collect stool specimens from (name of child) when it is recommended by the MSDH and also for them to receive the test results. I understand that I will receive a copy of the test results and be informed of the recommendations made by the MSDH.

Date Parent/Guardian

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ATTACHMENT - A

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RECOMMENDATIONS FOR THE CONTROL OF HEAD LICE IN THE CHILD CARE SETTING

Head lice, Pediculus humanus capitis, are a common problem in children who attend child care in Mississippi. Although they do not transmit any human disease, they may be a considerable nuisance, and require conscious effort on the part of the child care staff and parents to control. It should be understood that head lice can only be controlled in the child care center, not eliminated; they will occur sporadically, and will recur even after control efforts. The goal of control efforts is to reduce the problem and its impact, and minimize spread. Head lice are not a product of poor personal hygiene or lack of cleanliness, and their presence is not a reflection on the child care center or the family. More harm is probably caused by misconceptions about head lice than by the lice themselves. 1. IDENTIFYING INFESTED CHILDREN By Screening: It is important to establish a screening program. Children should be screened for head lice upon entry into the child care setting and periodically during the year. Staff members should be instructed in the technique of detecting head lice. By Individual Case: Any child suspected of having head lice (usually because he/she is scratching his/her head a lot) should be examined by a staff member who has been instructed in the technique. If infested, the child should be handled as described in Section 2, "HANDLING OF INFESTED CHILDREN." If one child in a room is found to be infested, the whole room should be screened. 2. HANDLING OF INFESTED CHILDREN Exclusion: An infested child’s parent/guardians should be notified that the child has been found to have head lice and must receive the proper treatment before returning to child care. Treatment and removal of nits are described in Section 3, "TREATMENT." Care must be taken not to embarrass or stigmatize the child. Return to Child Care: The child should return to the child care center as soon as the first treatment has been given. Nits (eggs) may still be seen even in an adequately treated child. This is not evidence of continuing infestation if the child has been properly treated and no adult lice are present. 3. TREATMENT Individual: Several effective pediculicides (lice-killing products) are available such as Nix®* (permethrin) creme rinse (10 minute hair rinse) which is available over the counter and has ovicidal 271

(egg or nit-killing) capability. It is the only over-the-counter pediculicide covered by Medicaid. The pyrethrin/pyrinate products (10 minute shampoos) include such products as Rid®*, A-1000®*, R&C®*, Clear®* and Triple-X®* and are available over the counter at pharmacies. Kwell®* (1% lindane), a 4 minute shampoo, requires a prescription. Central nervous system toxicity with lindane has been documented with prolonged administration. Ovide®* lotion (Malathion 0.5%) has been re-approved by the Food and Drug Administration (FDA) as a prescription drug for the treatment of head lice infestation in the United States. Treatment with any approved pediculicidal (lice-killing) product should be adequate. One Treatment vs. Two Treatments: Most products require 2 treatments. An initial treatment will kill adult and larval lice, but will not kill all the eggs. A second treatment 7 to 10 days later, after the eggs left by the first treatment have all hatched, will kill the newly hatched lice before they mature and reproduce and will complete the treatment process. Nix®* requires only one treatment since it is an ovicidal (also kills the eggs or nits); however, a second treatment is desirable since the product is not likely to kill 100% of the nits. Ovide®* lotion is also ovicidal and requires a second treatment 7 to 10 days after the first one only if crawling lice are seen. Retreatment: Pediculicides should kill lice soon after application. However, in some situations (e.g., a person is too heavily infested, pediculicide is used incorrectly, reinfestation or possible resistance to the medication), the lice may still be present. Immediate retreatment with a different class or type of pediculicide is generally recommended if live lice are detected on the scalp 24 hours or longer after the initial treatment. Treatment of Infants and Children Less Than 2 Years of Age: It is a rare occurrence for children in this age group to have head lice. It is generally not recommended to treat this age group preventively or just because someone else in the family has been treated. If a child of this age is found to have head lice, the parent/guardian should consult the child’s physician for treatment. The safety of head lice medications has not been tested in children 2 years of age and under. Removal of nits: The need to remove nits is somewhat controversial. However, removing the nits may prevent reinfestation by those nits hatching that may have been missed by the treatment. It may also decrease confusion about infestation when the person who has been treated is being reexamined for the presence of head lice, and it will avoid possible embarrassment to the infested child. Nits may be removed by the use of a nit comb or by manually (“nit-picking”) removing them. Most of the nits that are easily seen and more easily removed with the nit comb are those that are grayish-white in color, have grown out one or more inches on the hair shaft and have already hatched. The new, viable nits are closer to the scalp (within about 1/4 inch) and are more of a brownish color. These nits are firmly attached to the hair shaft with a glue-like substance. There are commercial products available to help loosen the glue-like substance for easier removal. Family: Household members of a child with head lice should be examined for lice (by a family member who knows how or someone else knowledgeable about lice) and any infested persons treated as described above. The one exception is any person over 2 years of age who shares a bed with the infested child should simply be treated presumptively. If the child is less than 2 years of age, consult the child’s physician for treatment recommendations. 272

4. ENVIRONMENTAL CONTROL Child Care Facility/Household: Clothing, cloth toys, and personal linens (such as towels and bedclothes used within the previous 48 hours by an infested person) can be disinfected by washing in hot water and drying in the dryer using hot cycles. Non-washables should be dry cleaned, or stored in airtight plastic bags for 2 weeks. Spraying with insecticides is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin. If there are cloth surfaces, such as furniture or carpet, with which the infested person's hair has had extensive contact, they should be vacuumed thoroughly. The head louse will not survive off the human scalp for more than 24 - 48 hours. ************ Questions about control methods, specific treatments, or special problems can be addressed to the local health department, the district public health office, or to the Office of Community Health Services - Division of Epidemiology, State Department of Health in Jackson. ************ (*Use of specific product names is for example purposes only, and is not intended as endorsement of specific brands over others.) SAMPLE LETTER TO PARENTS/GUARDIANS Dear Parent or Guardian: Your child has been found to have head lice. Head lice do not transmit disease and they are not a result of lack of cleanliness. Children in child care settings get them commonly, sometimes more than once. You should consult a pharmacist or your child’s physician for a recommendation as to which of several effective products to use to treat your child. As soon as you have treated your child with an approved pediculicidal (lice-killing) product, he or she may return to child care. There are 3 steps in the successful management of head lice: 1. Treatment (killing the lice with an approved medical treatment) - It is very important to follow the instructions given by your physician when using prescription medication. If you use over-the-counter medication, you should follow the package directions. The other members of your family should be checked for head lice and treated if they are found to have them. Persons over 2 years of age who sleep in the same bed with the infested child should be treated regardless. If a child less than 2 years of age is found to have head lice, consult the child’s physician for treatment recommendations. 2. Removal of the nits - The Mississippi State Department of Health recommends that you attempt to remove the nits to avoid reinfestation by those nits hatching that may have been missed by the treatment. The nits can be removed by dividing the hair into sections and working each section separately. Look for 273

small grayish-white or yellowish-brown specks that are attached to the hair shaft close to the scalp. Nits are attached to the hair shaft very firmly with a glue-like substance and are not easily brushed out. They must be picked out with the fingernails or combed with the nit comb that usually comes with the lice-killing product. This can be done outdoors under bright sunlight or indoors with a good reading lamp as nits are sometimes hard to see. 3. Environmental control - Clothing and personal linens (such as towels and bedclothes used by infested persons) should be machine washed using hot water and dried using the hot cycle. Non-washables can be dry cleaned or stored in an airtight plastic bag for 2 weeks. Cloth-covered furniture and carpet that have been in extensive contact with an infested person’s head should be thoroughly vacuumed. Lice-killing sprays are generally not necessary.

Signature:

Date

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APPENDIX J RULES AND PROCEDURES FOR STATE LEVEL ADMINISTRATIVE HEARINGS 1. Hearing Officer - The Hearing Officer shall be appointed by the State Health Officer or his/her designee. The Hearing Officer shall preside at the hearing, shall be charged with maintaining order at the hearing, and shall rule on all questions of evidence and procedure in accordance with the provisions of these rules. 2. Appearance by Licensee/registrant - The licensee/registrant shall appear at the date and time set for the hearing, and failure to do so without reasonable notice to the Department may result in admission of the charges and adverse action taken against the licensee/registrant. 3. Representation by Counsel - The licensee /registrant may, but is not required to be, represented by counsel at the hearing and shall have the right to cross-examine all witnesses, present evidence, written or oral, on his or her own behalf, and to refute any testimony or evidence presented by the Department. The Department shall be represented by the Office of the Attorney General. 4. Rules of Evidence and Discovery - Formal rules of evidence and procedure, including Discovery, do not apply in administrative hearings; however, the rules of evidence may be used as a guide during the hearing. A record of the hearing shall be made by a court reporter. 5. Attendance of Witnesses - The licensee/registrant or counsel for the Department may make a written request to the Hearing Officer at least 10 days prior to the hearing to ensure the attendance of a witness or the production of documents through the issuance of an administrative subpoena. The issuance of the subpoena shall be at the discretion of the Hearing Officer. 6. Order of Proceedings - The Department shall present its case first, followed by the licensee/registrant, and any rebuttal evidence by either party. At the request of either party, all prospective witnesses shall be excluded from the proceedings except while actually testifying. 7. Standard of Proof - In order for the Department’s decision to be upheld, the Hearing Officer must find that the regulatory violation has been proved by clear and convincing evidence and that the disciplinary action is supported by substantial evidence. 8. Recommendation and Final Decision - At the conclusion of the hearing, or within a reasonable time thereafter, considering the amount of testimony and evidence and the complexity of the issues, the Hearing Officer shall submit his/her “Findings of Fact, Conclusions of Law and Recommendation” to the State Health Officer, outlining the proof presented and containing his/her recommendation to the State Health Officer as to the appropriate action to be taken. The State Health Officer shall in a reasonable time thereafter issue his/her Final Order adopting, modifying, or rejecting the Recommendation. This Final Order becomes the final appealable order of the Mississippi State Department of Health as to those proceedings. 9. Appeal of the Department’s Final Order shall be accomplished as provided by the appropriate statute. 275

Source: Miss. Code Ann. §43-20-8

CHAPTER 3: REGULATIONS GOVERNING LICENSURE OF CHILDCARE FAMILY HOMES FOR 5 OR FEWER CHILDREN Subchapter 1.

GENERAL

Rule 3.1.1 Legal Authority: The "Mississippi Childcare Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for childcare facilities defined under the law. Source: Miss. Code Ann. §43-20-8 Rule 3.1.2

Purpose:

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of childcare family homes as defined herein to assure that certain minimum standards are maintained in such homes. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing.

A childcare family home may exceed the minimum quality standards required in these regulations but may not operate without meeting the minimum standards set forth in these regulations.

Source: Miss. Code Ann. §43-20-8 Rule 3.1.3 Severability: If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable. Source: Miss. Code Ann. §43-20-8 Rule 3.1.4 1.

Definitions: Act: The "Mississippi Childcare Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972. 276

Accident: Accident means an incident that results in damage or creates observable injuries (scratch, bite mark, scraped knee, first aid given, etc.).

Agency Representative: An authorized representative of the Mississippi State Department of Health.

Caregiver: An individual at least 18 years of age with a minimum of one-year prior documented experience caring for children who are under thirteen years of age who provides direct childcare, supervision, and guidance to children.

Caregiver Assistant: An individual at least 16 years of age. Caregiver assistants shall always work under the direct on-site supervision of a director or caregiver. They shall not have direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children.

Children with Special Needs: A child needing adaptation in a particular childcare family home to access programming and the physical environment.

Critical Violation: Violation of rules(s) identified by the Mississippi State Department of Health (MSDH) in the Regulations Governing Licensure of Childcare Facilities as most critical because noncompliance with those rules pose a threat to the health, safety, or wellbeing of the children in care and to the operation of the center.

Developmentally Appropriate Practice (DAP): Principles of guidelines that are appropriate to each child’s age and developmental status and responsive to the social and cultural context in which they live.

Director: An individual at least 21 years of age with a minimum of high school diploma or equivalent GED and two years prior documented experience caring for children who are under 13 years of age who provides direct childcare, supervision, and guidance to children.

10.

Emergency Preparedness Plan: Each childcare family home is required to have an emergency preparedness plan which includes all activities and processes designed to prepare for an unsafe event and deal with the immediate emergency conditions created by or associated with the event, per the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42U.S.C. 5195a(a)(1 .

11.

Childcare Family Home: Homes that care for five or fewer children. In a licensed childcare home, the registered primary caregiver provides care in the caregiver's residence for not more than five children from 277

birth through 13 years and may provide care after school hours for elementary school children. The total number of children in care at any given time, including the children related to the caregiver, must not exceed five. 12.

Field Trip: Activities conducted off the premises of the childcare family home, or outside of the approved playground areas, while under the supervision of center staff, whether a child walks or is transported.

13.

Group: The children assigned to a caregiver or team of caregivers occupying an individual classroom or well-defined physical space within a larger room.

14.

Hazardous Condition: A situation or place that presents a possible source of injury or danger.

15.

Health: The condition of being sound in mind and body and encompassing an individual's physical, mental, and emotional welfare.

16.

Health-Care Professional: A licensed physician, nurse practitioner, dentist, or other licensed medical personnel who provide health care to the child.

17. Infant:

Children from birth through 12 months.

18. Licensing Agency: The Mississippi State Department of Health. 19.

Operator: Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a childcare family home. The childcare family home license shall be issued in the name of the operator or operators. If there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all, including a spouse who jointly owns, operates, or maintains the childcare family home regardless of which operator is named on the license.

20.

21. Person: 22.

Any person, firm, partnership, corporation, or association.

Personal Care: Assistance rendered by personnel of the home in performing one or more of the activities of daily living, which includes but is not limited to the feeding, personal grooming, supervising, and dressing of children placed in the home. 278

23. Physical Confines: The space inside the walls of the home. 24.

Premises: Includes any parcel of land where the childcare center is located and any building, other structure, body of water, play equipment, street, sidewalk, walkway, driveway, parking garage, or parking lot on the parcel.

25.

Preschool Aged Children: Children from three years of age up to their first day of kindergarten.

26.

Professional Development: Participation by family home staff, in workshops, conferences, educational or provider associations, formal education, in-service training, or planned learning opportunities provided by qualified individuals. Training shall be age appropriate for the child population served by the family home and in such subject areas related to: childcare, child growth and development and/or early childhood education, nutrition, infection control/communicable disease management and causes, health and safety, signs and treatment of child abuse and/or neglect and shall include alternatives to corporal punishment. Training for directors may also be in areas related to supervision of childcare staff or program administration.

27.

Resident: Any person living in the childcare family home.

28. Safety:

The condition of being protected from hurt, injury or loss.

29.

School Age Child: A child five years of age or older and eligible to be enrolled in a public school. A child that is five years old must have turned five on or before September 1 to be considered a school-age child.

30.

Serious Occurrence: A serious occurrence includes but is not limited to, accidents or injuries requiring care by a health-care professional, deaths, alleged abuse and neglect, or other emergencies requiring the presence of law enforcement, fire personnel, EMT, or other emergency responders. Additionally, transportation accidents involving children in vehicles are considered serious occurrences and must be addressed by the appropriate authorities and childcare staff.

31.

Supervision: Care that is provided to an individual child or a group of children. Children shall always be supervised appropriate to the individual age, needs, and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. Adequate supervision means that the appropriate number of staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children and volunteers. The persons supervising in the childcare area must be alert, positioned to maximize their ability to always hear and see the children, 279

able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers, provide timely attention to the children's actions and needs and promptly intervene in the case of an emergency. Staff shall also be attentive and participate with children during mealtimes and shall stay within proximity to the children while they are eating. 32.

Time Out: The child is given time away from an activity which involved inappropriate behavior.

33. Toddler:

Any child aged 12 months and under the age of 24 months.

34.

Watchful Oversight: The process of actively monitoring a child’s activities.

35.

Weather Permitting: Daily weather conditions that do not pose any concerns for health and safety. This includes conditions in which children may still play safely outdoors for shorter periods with appropriate adjustments to clothing and access to water, shade, or shelter.

Source: Miss. Code Ann. §43-20-8

Subchapter 2. Rule 3.2.1 1.

LICENSURE Types of Licenses:

Temporary License: The licensing agency may issue a temporary license to any childcare family home. This license will allow the childcare family home to operate six months pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the home is licensed. Before a Temporary License is issued and the home is allowed to begin operation, the following items must be submitted to and approved by the licensing agency: a.

License application and $130.00 application fee.

License fee - $50.00

Documentation that the provider has a qualified director for the childcare program that meets the standards set forth in Rule 3.5.3.

“Letter of Suitability for Employment” for every employee as appropriate that is to begin work when the provider starts operation. 280

An MSDH Certificate of Immunization Form #121 or Medical Exemption Form #122 for every employee. Religious Exemption Form #122 does not apply to staff.

Valid MSDH Fire Inspection Form #333.

Wastewater disposal approval.

Potable water source approval for drinking water.

Zoning approval. Follow local zoning requirements.

Lead Testing approval: i.

Building – required when high levels of lead are identified.

ii.

Playground

Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the home during all hours of operation.

Daily Schedule of Activities - developed by provider.

m. Arrival and Departure Procedures - developed by provider.

Emergency Policy – Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a mancaused event (such as violence at a childcare home), within the meaning of those terms under section 602(a)(1) of the Robert

T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5195a(a)(1 that shall include procedures for evacuation, relocation, shelter-in-place, and lockdown; staff emergency preparedness training and practice drills; communication and reunification with families, continuity of operations; and accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions. o.

Verification of Emergency Relocation Site – developed by provider. i.

One site must be a minimum of one mile from the family home.

ii.

One site must be a minimum of five miles from the 281

family home. iii.

Alternate site in case the other two locations are compromised.

Transportation Policy-If children are transported daily. If children are not transported daily, the provider must include a statement in the Parent Handbook.

Emergency Transportation Policy-An emergency transportation policy shall encompass such events as emergency evacuation of the family home and emergency transporting of a child to receive medical attention. It is required even if the provider does not plan to transport children.

Vehicle Insurance-Proof of insurance is required if the provider transports children.

Verification, in writing, that the provider has or does not have accident/liability insurance covering the business.

Verification, in writing, that the provider has or does not have accident/liability insurance covering the children enrolled at the family home.

Discipline Policy

Verification that the owner/operator and director have completed mandatory training on: i.

Regulations Governing Licensure of Childcare Family Homes: Five or Fewer

ii.

Health and Safety

Regular License: The licensing agency may issue a regular license when all conditions and requirements for licensure have been approved.

Probational License: The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months.

Restricted License: The licensing agency may issue any type of license with conditions or restrictions when the health and safety of children require such limitations. These conditions or restrictions may 282

include, but are not limited to, barring certain individuals from the premises or addressing any other situation that could endanger children, and such details must be recorded on the license. Any violation of these conditions or restrictions will result in the immediate emergency suspension of the license. Once the conditions or restrictions no longer pose a threat to the children, they may be lifted from the license. Source: Miss. Code Ann. §43-20-8 Rule 3.2.2 Application for License: An electronic application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require. Source: Miss. Code Ann. §43-20-8 Rule 3.2.3 License Fee: Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health by electronic means. Renewal of licenses shall occur on an annual basis. Fees are nonrefundable order, or electronic means. Source: Miss. Code Ann. §43-20-8 Rule 3.2.4 Certificate of Inspection by Fire Department: A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the childcare family home is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the family home is located, the State Fire Marshall shall certify the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333, or other approved inspection forms used and completed by the local fire authority or State Fire Marshal designee, along with any other fire safety inspection forms required by the city and/or county and shall be signed by a signatory authority of the fire inspection authority making the inspection. Source: Miss. Code Ann. §43-20-8 Rule 3.2.5 Inspection: An agency representative(s) shall inspect each childcare family home prior to issuing or renewing a license to assure compliance with these regulations. Agency representatives have the right to enter upon arrival. Source: Miss. Code Ann. §43-20-8 283

Rule 3.2.6 Record of Inspection: Whenever an inspection is made of a childcare family home, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative. Rule 3.2.7 1.

Renewal of License: The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall email a renewal notice to the address of the operator registered with the licensing agency. The operator shall: a.

Complete the renewal application.

Submit all required documents for approval by the licensing agency.

Submit the renewal fee.

File the above with the licensing agency at least 30 days prior to the expiration date on the license. Renewal applications submitted online less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. Application and fees are to be paid online at the Mississippi State Department of Health website (healthyms.com).

An operator who does not file the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. In its discretion, the license may be reinstated by the licensing agency, by payment of both the renewal and the reinstatement fee, provided the application for reinstatement is made within one month of the expiration date of the license.

After the one-month reinstatement period, an application for an initial license must be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met.

Source: Miss. Code Ann. §43-20-8 Rule 3.2.8 License Not Transferable or Assignable: Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the childcare family home, home, or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included. Source: Miss. Code Ann. §43-20-8 284

Rule 3.2.9 Display of Licenses: The current license issued by the licensing agency to the named childcare family home and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the childcare family home. The home operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the family home. Rule 3.2.10 Changes in Home Operations: Before implementing any changes, the operator must obtain approval from the licensing agency for any significant alterations affecting areas of the family home. Such major changes include, but are not limited to, changes in operator, director, location, hours of operation, renovations, use of areas within the home, or the number and ages of children served. Additional examples include changes in the evacuation plan or emergency relocations, damages to or changes in the condition of the family home, loss of electricity, heat, air conditioning, or water supply to the family home for over one hour while children are present.

Subchapter 3.

RIGHT OF ENTRY AND VIOLATIONS

Rule 3.3.1 Right of Entry: A representative from the licensing agency has the authority to conduct inspections or investigations at any childcare family home to ensure compliance with these regulations. Applying for a license or permit to operate a center, or receiving one from the agency, implies consent from the applicant, the prospective license holder, and the premises owner for the agency's representative, upon displaying proper identification, to enter the premises. The home shall provide access to personnel from other state agencies or any individuals conducting inspections at the agency’s request. Source: Miss. Code Ann. §43-20-8 Rule 3.3.2 Failure to Allow Access: Refusing the agency's representative access to all areas of the childcare family home, including the premises, staff, children, and all records maintained by or for the family home (including but not limited to audio, video, photos, written documents, social media posts, and electronic data), may warrant restrictions, revocation, or suspension of a license. The agency is entitled to photocopy or reproduce any record held by or for the center as necessary for inspections or investigations. Rule 3.3.3 Right of Entry-Parent(s)/Guardian(s): Parent(s)/Guardian(s) of enrolled children must be granted permission for access to all areas of the childcare family home used by the child(ren). Access shall be defined as a parent/guardian having access to areas of the family home available to their 285

child and non-disruptive to normal daily activities Rule 3.3.4 Violations: If violations noted on the inspection or investigation form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations. Source: Miss. Code Ann. §43-20-8 Subchapter 4.

FAMILY HOME POLICY AND PROCEDURES

Rule 3.4.1 Parental Information: Before a child's enrollment, the parent shall be provided with the following: 1.

Operating Information: a.

Name(s), business phone number, business address, and home phone number of the operator, director or an individual in authority who can be reached after the family home’s normal hours of operation.

The phone number of the childcare family home.

The program and services provided, and the ages of children accepted.

The hours and days of operation and holidays or other times closed.

The procedures for admission and registration of children.

Family home tuition, payment methods, and late payment policies.

Types of insurance coverage for children, or a statement that accident insurance is not provided or available.

If a home does not provide liability insurance there shall be a statement in the child’s record, signed by the parent indicating that the parent is aware that the family home does not carry liability insurance.

Arrival and departure procedures for children.

Health and Emergency Procedures: a.

Procedures for storing and giving a child medication. Medications for children shall be kept in a storage cabinet or container that is locked or otherwise not accessible to children and shall be stored separate from cleaning chemicals, supplies or poisons. Medication 286

requiring refrigeration shall be placed in a leakproof container in a refrigerator that is not accessible to the children.

Policy for reporting suspected child abuse.

Policy for reporting accidents.

Provision for emergency medical care, treatment of illnesses and serious occurrences, which include: i.

A plan to handle a child in a medical crisis including choking and allergic reactions.

ii.

A plan to obtain prompt services of physicians and hospitalization, if needed.

iii.

A plan for immediately notifying the parent of any illness, or serious incidents involving children.

iv.

A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds.

Evacuation plan including procedures for notifying the parents of the relocation sites.

Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering the home with weapons, bomb threats, or conditions posing an immediate threat to children.

State regulations: a.

A statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency.

The name and phone number of the MSDH licensing official responsible for the inspection of the home.

The childcare family home complaint hot line or web link.

Source: Miss. Code Ann. §43-20-8 Rule 3.4.2

Smoking, Tobacco Products, and Prohibited Substances:

Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a childcare family home.

The use of alcohol, illegal use of prescription drugs, or use of illegal 287

drugs is prohibited within the physical confines or the campus of a childcare family home.

Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a childcare family home, regardless of title or occupation. This definition includes parents.

Source: Miss. Code Ann. §43-20-8 Rule 3.4.3 Documents to Post: The following items shall be posted conspicuously in the childcare family home: 1.

MSDH License

Daily activity schedule

Evacuation route

MSDH complaint form

Source: Miss. Code Ann. §43-20-8 Rule 3.4.4 Weapons Prohibited: All firearms in the home shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under a lock in a room not accessible to children. Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc. Source: Miss. Code Ann. §43-20-8 Rule 3.4.5 Serious Occurrences Involving Children: The childcare family home must report to the licensing agency, notify the child’s parents, and place a copy in the child’s record immediately after the serious occurrence. If the family home is unable to contact the parent, documentation should be recorded in the record. Written reports must be submitted within two days of the occurrence. Examples of serious occurrences may include the following: 1.

Any incident that results in a child requiring a visit to a medical professional or hospitalization.

Alleged abuse, neglect, or inappropriate physical contact with child or adult

A lost or unsupervised child 288

Transportation incident or accident

Death

Incorrect medication given to a child or children

Physical altercation between adults on the premises.

Any other incident that poses a danger to the life, health, and/or wellbeing of a child, children, or staff member at the family home

Rule 3.4.6 Child Abuse: Any operator or employee of a childcare family home who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Child Protective Services in accordance with Miss. Code Ann. § 43-21-353; 43-21-357; 43-21-261; 43- 21-267; 43-21-105(m). A provider must not interview staff or children regarding the specific allegation(s) of child abuse or child neglect until the Department of Child Protective Services and/or local law enforcement agency has had the opportunity to interview all appropriate individuals and completed their investigation.

Rule 3.4.7 Prevention of Shaken Baby Syndrome and Abusive Head Trauma: Each childcare family home licensed to care for children up to five years of age shall develop and adopt policies to prevent shaken baby syndrome and abusive head trauma prior to licensure. The policy shall include the following: 1. How to recognize, respond to, and report the signs and symptoms of shaken baby syndrome and abusive head trauma. Signs and symptoms include irritability, difficulty staying awake, difficulty breathing, inability to lift the head, seizures, lack of appetite, vomiting, and bruises. 2. Strategies to assist staff members in coping with a crying, fussing, or distraught child. 3. Strategies to assist staff members in understanding how to care for infants. 4. Strategies to ensure staff members understand the brain development of children up to five years of age. 5. A list of prohibited behaviors that shall include, but not be limited to, shaking a child, tossing a child into the air or into a crib, chair, or car seat, and pushing a child into walls, doors, and furniture; and 6. Resources to assist staff members and families in preventing shaken baby syndrome and abusive head trauma.

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Subchapter 5: Rule 3.5.1

PERSONNEL REQUIREMENTS General Requirements for Personnel:

1. Each employee or potential employee of a childcare family home, whether full-time, part-time, temporary, or substitute, shall meet the minimum qualifications for the respective job classification, as set forth in these regulations. 2. Any individual who, in the opinion of the licensing agency, appears to be unable to physically or mentally care for the children daily and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing agency, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a.

Physical ability to exit the children during a fire drill in under two minutes;

Ability to read medication directions and properly dispense medication to children (required only if the family home dispenses medication)

Source: Miss. Code Ann. §43-20-8 Rule 3.5.2 Comprehensive Background Check: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Childcare Development Block Grant Act of 2014, and Federal Rules and Regulations .43, a comprehensive, finger-print based, criminal history records check, consisting of a FBI national criminal history records check (NCIC), state criminal history records check (MCIC), state child abuse registry check, National Sex Offender Registry check (NSOR), a state sex offender registry check and an interstate check, if applicable, must be completed on all operators, employees, and prospective employees of a licensed, regulated, and/or registered childcare family home as well as all childcare providers eligible to deliver services for which Childcare Development Funds assistance is provided. Further, a comprehensive background must be completed every five years. 1. Before a prospective staff member may begin work in a childcare family home, a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. 2. Each licensed, regulated, and/or registered childcare family home provider will electronically access, monitor, verify, and maintain the 290

suitability status of any submitted employee through the agency maintained website. 3. If an individual has been separated from employment (break in service) in a childcare family home for more than 180 consecutive days a new comprehensive criminal history records check must be submitted and approved before the individual may begin work in a childcare family home. 4. In the event a childcare applicant has a disqualifying event a letter of non-suitability will be issued. Both the childcare family home provider and the applicant will be notified through the agency- maintained website. 5. Individuals under the age of 18 who are employed by a family home provider for compensation are required to complete a comprehensive background check. 6. A comprehensive background check must be completed on any individual 18 years of age and older residing in a residence designated as a childcare family home. Source: Miss. Code Ann. §43-20-8 Rule 3.5.3 Childcare Director Qualifications: A childcare family home director shall be at least 21 years of age and shall have at a minimum high school diploma or equivalent (GED) and two years prior documented experience caring for children who are under 13 years of age. Source: Miss. Code Ann. §43-20-8 Rule 3.5.4 Caregivers: Caregivers shall be at least 18 years of age and shall have at a minimum one-year prior documented experience caring for children who are under 13 years of age. Source: Miss. Code Ann. §43-20-8 Rule 3.5.5 Caregiver Assistants: Caregiver assistants shall be at least 16 years of age and shall work under the direct supervision of a director or caregiver. They shall not have direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children. Source: Miss. Code Ann. §43-20-8 291

Rule 3.5.6

Staff Development:

Owners and Directors. Before a new license to operate is issued, owners and directors of the childcare family home shall each complete mandatory training on courses covering Regulations Governing Licensure of Childcare Family Homes of 5 or Fewer and Health and Safety. If a new director is appointed by the childcare family home after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first three months of appointment.

The owner/director is required to obtain Health and Safety training prior to the home being licensed. All staff members must acquire it within 90 days of being hired. Health and Safety training must be completed every two years thereafter that consists of the following topics: a.

Prevention and control of infectious diseases including immunizations;

Prevention of sudden infant death syndrome and use of safe sleeping practices;

Administration of medication, consistent with standards for parental or guardian consent;

Prevention and response to emergencies due to food and allergic reactions;

Building and physical premises safety, including identification of and protection from hazards, bodies of water, and vehicular traffic;

Prevention of shaken baby syndrome, abusive head trauma, and child maltreatment;

Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a man-caused event (such as violence at a childcare family home);

Handling and storage of hazardous materials and the appropriate disposal of bio-contaminants;

Precautions in transporting children, if applicable;

Infant, child, and adult first aid and infant, child, and adult CPR;

Recognition and reporting of child abuse and neglect; and 292

Child development (including the major domains: cognitive, social, emotional, physical development and approaches to learning).

All childcare employees shall be required to complete five contact hours of staff development, accrued during the licensure year, annually. Training should address the following: a.

Health and safety.

Child growth and development.

Nutrition.

Planning learning activities.

Guidance and discipline techniques.

Linkages with community services.

Communications and relations with families.

Detection of child abuse.

Advocacy for early childhood programs.

Professional issues.

First aid and cardiopulmonary resuscitation (CPR) for infant, child, and adult.

Special needs, as applicable.

Contact hours for staff development shall be approved by the licensing agency.

Source: Miss. Code Ann. §43-20-8 Rule 3.5.7

Review by Licensing Agency:

The satisfaction of the personnel requirements applicable to any individual shall be determined by the licensing agency acting pursuant to its authority under applicable statutes and regulations.

The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual. 293

Source: Miss. Code Ann. §43-20-8 Subchapter 6.

RECORDS

Rule 3.6.1 Records: Records listed in this section shall be kept in the childcare family home and shall be made available to the licensing agency on request. Source: Miss. Code Ann. §43-20-8 Rule 3.6.2

Records Retention:

All records, unless otherwise specified, shall be kept for a period of at least three years, whether the childcare family home is open or closed.

A child's records shall be retained for a period of one year after the child is no longer in attendance at the family home.

Source: Miss. Code Ann. §43-20-8 Rule 3.6.3

Childcare Family Home Records:

Attendance records for children and employees.

A current alphabetical roster of children enrolled in the childcare

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family home, to include the child's full name and date of birth. 3.

A current alphabetical roster of staff employed in the childcare family home.

Current license.

Records of monthly fire/disaster evacuation drills and 9-1-1 drills.

Each family home shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the home. The notebook shall contain separate current alphabetical rosters of both staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters. Children enrolled in a licensed family childcare home are expected to be age appropriately immunized. All children must have one of the following forms before enrollment in a licensed family childcare home: Certificate of Immunization Compliance (Form 121) or Certificate of Medical/Religious Exemption (Form 122).

Each family home shall maintain a notebook containing a copy of the Letter of Suitability from the licensing agency on all employees. The notebook shall contain an alphabetical roster of staff including, staff name, date of birth, and the initial date of hire. The Letter of Suitability shall be filed in an order matching the alphabetical roster.

Each licensed family home provider is required to enter into the childcare LARS Database the hourly rate that they charge to care for a child in a particular age group they serve, i.e., Infant, Preschool, School Age. The following is used for calculating the hourly rate for each age group. Calculated Daily Rate = (Calculated Weekly Rated ÷ 5) Current Monthly Rate (CMR)Calculated Yearly Rate = (CMR X 12 months) Calculated Weekly Rate = (Calculated Yearly Rate ÷ 52)

Source: Miss. Code Ann. §43-20-8 Rule 3.6.4 1.

Personnel Records: Employee Records: Each employee's personnel record shall contain 295

the following:

Name, date of birth, address, phone number and photo identification.

Documentation of education, training, and experience necessary for employment.

Documentation of staff development accrued during each licensure year, beginning with the date employed.

Date of employment and date of separation.

Mississippi State Department of Health Certificate of Immunization Compliance Form 121 or Form 122 Medical Exemption.

Valid Letter of Suitability for employment.

Documentation of orientation, within one week of being hired, including, but not limited to, emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect.

Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment. The required Employee Information to be entered into the Childcare Licensure and Reporting System (LARS) for the Owner, Director, and all staff of the childcare family home is as follows: a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address h. Contact Phone Number 296

The above information will be entered at the time of initial application, renewal, and contacts must be updated within the “Manage Contacts” section. The required information entered under this rule is confidential and not viewable by the public. Source: Miss. Code Ann. §43-20-8 Rule 3.6.5 Child Records: The family home shall maintain an individual file for each child under its current care, and for any child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: Identification and Contact Information:

The name of the child and names of parents/guardians.

Home address and phone number.

The parent’s business name, address and phone number.

The child’s date of birth.

Date of acceptance at family home and date of withdrawal, if any, with the parents’ stated reason for withdrawal.

Other contact information required to be maintained in accordance with family home’s policy manual.

Parental Instructions: a.

If the parent provides written instructions to the family home, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and updated as provided from time to time.

Written identification of an authorized, responsible person(s) for pick-up of the child.

Official legal documentation of any limitation of parental rights of the other parent or stepparent.

Documentation of any limitation or restriction, if any, on activities of a child, or other participation by the child in certain events such as holiday celebrations.

Authorizations: a.

Signed, written authorization to obtain emergency medical treatment and to administer medication. 297

Election by a parent to either i. provide written authorization consenting to any and all field trips, excursions, or series of events outside the childcare family home, or ii. provide written consent only for those specific field trips, excursions, or series of events for which date, time and location are specifically approved.

Signed acknowledgment by a parent that the written policies and procedures described in Rule 3.4.1 have been received by the parent.

Signed acknowledgment by a parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent.

Parental authorization of child being photographed, having photos posted or shared on social media, or other parental concerns.

Documents Required by Policy Manual or Contract: a.

If agreed by the family home in its policy manual or caregiver contracts, the method in which the provider will inform the parent or contact person if a child does not arrive at the family home within a reasonable time after a scheduled drop-off.

Any other documents or identification records agreed to be maintained by the family home.

Confidentiality of Records and Information: a.

Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent.

Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee.

Source: Miss. Code Ann. §43-20-8 Subchapter 7. PLANNING

EMERGENCY PREPAREDNESS AND EVACUATION

Rule 3.7.1 Emergency and Evacuation Plan: The provider shall establish and follow a written, multi-hazard emergency preparedness, response, and recovery plan to protect children in the event of emergencies that at a 298

minimum shall: 1.

Address any potential disaster, natural or human-caused event, related to the area in which the family home is located;

Include procedures to control access to buildings and outdoor play areas;

Include procedures for evacuation, relocation to one of the family home’s pre-determined places, shelter-in-place, lock down, communication with families, and continuity of operations;

Include specific procedure for accommodations for infants and toddlers, including food and formula;

Include specific procedures for caring for children with disabilities and chronic medical conditions, including the evacuation and transportation, as well as any required medication or medical equipment;

Include a system to quickly account for all children;

Include a system, and a back-up system, for contacting parents and authorized third party release caretakers;

Include a system to reunite children and parents following an emergency;

Include procedures for providing information about the emergency plan to parents at the time of enrollment and when changes and/or updates occur;

10.

Be reviewed annually for accuracy and updated as changes are needed;

11.

Be reviewed with all staff and volunteers during orientation and at least once every six months;

12.

Be available at the time of inspection and any other time requested by the licensing agency.

Source: Miss. Code Ann. §43-20-8

Rule 3.7.2 Individualized Emergency Plan: An individual emergency plan shall be in place for each child with special health care needs and shall include medical contact information and additional supplies and equipment as needed. Source: Miss. Code Ann. §43-20-8 299

Rule 3.7.3 Evacuation Pack: The family home shall have an evacuation pack, the location of which shall be known to all staff, that at a minimum shall contain: 1.

A list of area emergency phone numbers;

An updated list of emergency contact information and emergency medical authorization for all enrolled children;

An emergency pick up form;

First aid supplies, hand sanitizer, wet wipes, and tissue;

Diapers for children who are not toilet trained and plastic bags for diaper disposal;

A battery-powered flashlight and radio and batteries or a crank flashlight and radio;

Disposable cups and bottled water.

A designated staff member shall be responsible for maintaining the pack to ensure that all contents, including medications are current and not expired.

Source: Miss. Code Ann. §43-20-8

Rule 3.7.4 Records: A childcare family home shall maintain a copy of records, documents, and computer files necessary for its continued operation following an emergency in ether a portable file or at an off-site location (an electronic back up copy of all information is strongly recommended). Source: Miss. Code Ann. §43-20-8

Rule 3.7.5 Drills: The provider shall conduct fire and tornado drills monthly and all other disaster drills at least once every six months. The provider shall vary the days and times on which fire and other disaster drills are held. The provider shall keep documentation of the previous 12 months of all drills onsite for review by licensing agency. Documentation of the drill shall include: 1. The type of drill (i.e.,fire, tornado, flood, violence, loss of electrical power) 2. The date and time of the drill; 3. The number of children participating; 4. The name of the individual supervising the drill; 300

5. The total time to complete the drill; and 6. Any problems encountered and remediation. Source: Miss. Code Ann. §43-20-8

Rule 3.7.6

First Aid and CPR

During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present, at any location where the children are present, who holds a valid infant, child, and adult first aid certificate. This certificate shall be issued by an agent recognized by the licensing agency.

During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present who holds a valid infant, child, and adult CPR certification, at any location where the children are present. Said certificate shall beissued by an agent recognized by the licensing agency.

When initially acquiring or renewing the CPR and First Aid certifications, online (internet, etc.) training is not acceptable. Training must be face-to-face and hands on.

Subchapter 8. SUPERVISION

STAFF TO CHILD RATIO, GROUP SIZE, AND

Rule 3.8.1

General:

1. During all hours of operation, including arrival and departure of children, a childcare family home employee shall be present to whom administrative and supervisory responsibilities have been assigned. This employee shall meet the minimum qualifications of a director. 2. During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present who holds a valid infant, child, and adult CPR certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing agency. 3. During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present, at any location where the children are present, who holds a valid infant, child, and adult first aid certificate. This certificate shall be issued by an agent recognized by the licensing agency. Source: Miss. Code Ann. §43-20-8 301

Rule 3.8.2

Staff-to-Child Ratio: The minimum staff to child ratio present shall be five children to one staff.

Source: Miss. Code Ann. §43-20-8 Rule 3.8.3

Grouping: When children are placed in groups, the maximum group size shall be five children to one staff.

Source: Miss. Code Ann. §43-20-8 Rule 3.8.4

Supervision: A caregiver must maintain watchful oversight. Staff must always be aware of all children in their care and must be alert, able to respond quickly to children’s actions and needs, and be able to intervene promptly in case of an emergency. 1. Staff shall refrain from using electronic devices or any object that will distract one’s attention while supervising children or performing classroom duties. 2. The responsible caregiver shall stay on the same floor or level of the house with the children. 3. When children are outdoors, the caregiver must be present outside providing direct supervision to the children. 4. Provide closer supervision to ensure children are within easy reach when risks are higher and when children’s age and behavioral tendencies require it.

Subchapter 9. Rule 3.9.1

PROGRAM OF ACTIVITIES General:

The childcare family home shall provide a basic program of activities geared to the age levels and developmental needs of the children served.

The childcare family home shall provide for the reading of ageappropriate materials to children.

Source: Miss. Code Ann. §43-20-8 Rule 3.9.2 Daily Routines: All daily routines, such as eating and rest periods, shall be scheduled for the same time each day. Source: Miss. Code Ann. §43-20-8 Rule 3.9.3

Eating: Meal periods are breakfast, lunch, dinner, and snacks. 302

Source: Miss. Code Ann. §43-20-8 Rule 3.9.4

Rest Periods:

Rest period shall be individualized to meet each child’s needs.

Physical force shall not be used in requiring children to lie down or go to sleep during rest periods.

Rule 3.9.5 Infant Safe Sleep: A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: 1. An infant MUST be placed on his/her back for sleeping unless written physician orders to the contrary, with medical reasons listed, are in the child's record. Sleeping infants shall be within site or sound of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. All children MUST be visually checked during naptime. 2. Infants shall be dressed in clothing appropriate for sleeping that is

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designed to keep the infant warm without the possible hazard of head covering or entrapment. Clothing used for swaddling and swaddling blankets are not to be used at any time. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. Facilities shall use a firm mattress covered by a fitted sheet. 3. The lighting in the room must allow the caregiver to see each infant’s face, to view the color of the infant’s skin, and to check on the infant’s breathing. 4. Item such as but not limited to pillows, blankets, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib. Additionally, no items shall be hanging on the crib. Source: Miss. Code Ann. §43-20-8 Rule 3.9.6

Outdoor Activities:

1. All children shall have daily outdoor activities appropriate for the children’s chronological ages and developmental levels unless the weather poses a significant health risk identified by the National Weather Service. 2. Sun safe practices shall be used during outdoor activities throughout the year. 3. Sun safe practices shall be evident in the planning of all outdoor activities. 4. Outdoor activities shall be held in areas providing shade or covered spaces. Source: Miss. Code Ann. §43-20-8 Rule 3.9.7 1.

Infant, Toddler, and Preschool Activities: Infants, toddlers, and preschoolers shall be free to creep, crawl, toddle, and walk as they are physically able. a.

Cribs, car seats, and highchairs are to be used appropriately only for their primary purpose, i.e., cribs for sleeping, car seats for vehicle travel, and highchairs for eating.

Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they 304

are awake. c.

Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time.

Providers should use strollers for toddlers and preschoolers only when necessary.

2. For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about. 3.

Television viewing shall be kept at a minimum.

Source: Miss. Code Ann. §43-20-8 Rule 3.9.8 Indoor or Outdoor Physical Activity: Family home providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. Source: Miss. Code Ann. §43-20-8 Subchapter 10. Rule 3.10.1

EQUIPMENT, TOYS, AND MATERIALS General:

Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served.

Equipment, toys, and materials for both indoor and outdoor shall be clean, safe, and in good repair.

Rule 3.10.2 Paint: Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous. Source: Miss. Code Ann. §43-20-8 Rule 3.10.3 High Chairs: High chairs, if used, shall have a wide base and a T-shaped safety strap. They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing 305

Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs). Source: Miss. Code Ann. §43-20-8

Rule 3.10.4 Rest Period Equipment: In accordance with the U.S. Consumer Product Safety Act of 2008, any crib provided by a childcare family home must meet federal safety standards. To verify compliance with federal standards, any crib manufactured prior to June 28, 2011, there shall be a Certificate of Compliance on file in the family home and the crib must have a label attached to show the date of manufacture. Any crib manufactured after June 28, 2011, must have a label attached to show the date of manufacture. 1.

The family home shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Children shall not be placed directly on the floor for rest periods.

Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be commercially purchased, flame retardant, a minimum of two inches thick, and designated for the purpose of sleeping.

Cribs, cots, and mats are to be a minimum of 24 inches apart or separated by a solid barrier. A minimum of 36 inches is recommended.

Once a sheet or blanket has been used by a child, it shall not be used by another child until it has been laundered.

Rest period equipment shall be covered with a waterproof cover.

Nap pads/cots are designed for use by one child only at a time and sanitized after each use or when soiled.

Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately.

Stackable cribs are not allowed.

Source: Miss. Code Ann. §43-20-8 Subchapter 11. Rule 3.11.1

BUILDINGS AND GROUNDS Building: 306

A childcare family home shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the childcare family home for the purpose of entering the building or exiting the building or passing through the childcare home for the purpose of gaining access to another part of the building.

A childcare family home can only utilize approved, lower-level areas of the home.

All childcare family homes shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances.

A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent.

The ceiling, floor, and/or floor covering shall be properly installed, kept clean and in good condition, and maintained in good repair.

All parts of the childcare family home used by children shall be leadsafe, well-lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as, open stairs and unprotected low windows.

All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safety-grade glass or polymer (e.g., Lexan®) are not required to have a protective barrier. Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be certified by the installer and the statement kept on file at the childcare family home.

Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork.

A childcare family home shall maintain a primary and secondary communication device, one of which shall be a telephone.

10.

All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician.

11. Unused electrical outlets shall be protected by a safety plug cover. 12. No extension cords shall be used in areas accessible to children. 13.

Every childcare family home that uses nonelectric heating and/or 307

cooling systems, cooking stoves, and/or water heaters, or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the childcare family home. 14. All childcare family homes are to be kept clean and in good repair. Source: Miss. Code Ann. §43-20-8 Rule 3.11.2

Openings:

Each window, exterior door, and basement or cellar hatchway shall be weather-tight and watertight.

The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities, if applicable

Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.3

Kitchens:

Children shall only be permitted in meal preparation areas when under direct supervision of staff, when there is no danger of injury from equipment, or for instruction/teaching purposes.

The following regulations shall apply: a.

No game or home canned foods shall be served.

Other than fresh or frozen vegetables and fruit, all foods shall be from commercial sources.

Food shall be cooked or reheated to a temperature of 165 degrees Fahrenheit. Hot food shall be held at a minimum temperature of 140 degrees Fahrenheit.

Cold food shall be stored at a temperature of 41 degrees Fahrenheit or below.

All food shall be covered while in the refrigerator or freezer.

Any prepared foods not properly refrigerated at a temperature of 41 degrees Fahrenheit or less, or frozen, shall be discarded.

If manual washing is utilized, a sanitizer shall be used. Rinsing in a chlorine solution using one and one-half tablespoons of household bleach per gallon of water is sufficient. If a dishwasher 308

is utilized, the nozzle ports shall be free of obstructions, and the interior of the machine shall be clean.

Hot water, under pressure, shall be available.

Insecticides, poisons, cleaning agents, and medications, shall be stored away from food, separately from each other, and out of the reach of children.

Children shall not be exposed to insecticides or pesticides, or other toxic agents.

Hands shall be washed frequently, when switching between working with raw and ready-to-eat foods, and after all non-food preparation activities.

Clean clothing shall be worn.

Gloves shall be worn if there are any cuts or abrasions on the hands.

All kitchens and/or food/snack preparation areas in a childcare family home shall be inspected as part of the childcare inspection process.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.4

Toilets and Hand Washing Lavatories:

Toilets and hand washing lavatories shall be located within the physical confines of childcare family home and shall be convenient to outside playground areas.

All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit.

Toilets, and hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.5 Water: The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1.

Disposable paper cups; or 309

Labeled cup for each child that shall be washed and sanitized daily.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.6

Exits: Must comply with local fire codes and municipalities.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.7

Heating, Cooling, and Ventilation: 1.

A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained.

Ventilation may be in the form of openable windows.

Electric fans, if used, shall be guarded to limit the size of the opening in the blade guard to less than one-half inch.

When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children.

Filters on recirculation systems shall be checked and cleaned or replaced as needed.

Thermometers that do not present a hazard to children shall be present.

Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating.

Electric space heaters shall be UL-approved, inaccessible to children, and utilized in compliance with all manufacturer’s recommendations.

10.

Fireplaces and fireplace inserts shall be properly vented, inaccessible to children through a barrier device, and in compliance with all manufacturer’s recommendations.

11.

Heating units, including water pipes and baseboard heaters shall be made inaccessible to children.

Source: Miss. Code Ann. §43-20-8 310

Rule 3.11.8 Outside Grounds and Play Area: Outside play areas shall be free of hazardous or potentially hazardous objects and/or conditions that may result in injury. The outdoor play area shall be well arranged so that all areas are visible to staff. 1.

Outside play areas shall be protected from traffic or other hazards by barriers approved by the licensing agency.

All equipment shall be securely anchored to prevent accidents or injuries.

Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, and other bodies of water.

Outdoor spaces shall be laid out to ensure ample shaded space for children.

Protective surfacing is required beneath climbing and swinging equipment.

Source: Miss. Code Ann. §43-20-8 Rule 3.11.9 Garbage Removal: Garbage and trash shall be removed from the childcare family home daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children and in insect and rodentresistant containers. Source: Miss. Code Ann. §43-20-8 Rule 3.11.10 Pest Control: The home shall be free of insects and rodents. Use of agricultural chemicals for pests is strictly prohibited. Source: Miss. Code Ann. §43-20-8 Subchapter 12. Rule 3.12.1

HEALTH, HYGIENE, AND SAFETY

Employee Health:

Staff shall use universal precautions when changing diapers or being exposed to blood, fecal material, or urine. 311

Refer to the MSDH website for proper handwashing procedures.

Source: Miss. Code Ann. §43-20-8 Rule 3.12.2

Child Health:

A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible.

A child having a serious contagious condition shall not be allowed to return to the childcare family home until they have been certified by a physician to be no longer contagious.

A child with a physical injury shall be treated by a staff member with infant, child, and adult valid first aid certificate issued by an agent recognized by the licensing agency. A child with a serious physical injury shall be treated by a staff member with a valid first aid certificate issued by an agent recognized by the licensing agency and transported to a hospital or medical facility as soon as appropriate.

Source: Miss. Code Ann. §43-20-8 Rule 3.12.3

Child Hygiene:

A child's wet or soiled clothing shall be changed immediately.

A child's hands shall be washed: a.

Immediately before and after eating.

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After using the toilet or having their diapers changed.

After playing on the playground.

After handling pets, pet cages, or other pet objects.

Whenever hands are visibly dirty.

Before going home.

A child shall have a shower, tub, or sponge bath to ensure bodily cleanliness when necessary.

Source: Miss. Code Ann. §43-20-8 Rule 3.12.4 Toys and Equipment: Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution. Refer to the National Resource Center for Health and Safety in Childcare and Early Education for cleaning and disinfecting procedures. Source: Miss. Code Ann. §43-20-8 Rule 3.12.5

First Aid Supply:

A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children.

A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children.

All vehicles used by the family home in transporting children shall be equipped with a first aid kit.

All first aid kits should be periodically inspected for contents. Depleted and out-of-date materials should be replaced.

Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs.

For additional information on supplies for first aid kits contact your local office of the American Red Cross.

Source: Miss. Code Ann. §43-20-8 Rule 3.12.6 1.

Animals and Pets: Any pet or animal present at a childcare family home, indoors or 313

outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children. 2.

Dogs or cats, where allowed, shall be immunized for any disease thatcan be transmitted to humans and shall be maintained on a flea, tick, and worm control program.

All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the childcare family home, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the home where the pet is kept.

A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when near these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space as the children.

Each child’s and staff’s hands shall be properly washed after being exposed to animals.

Source: Miss. Code Ann. §43-20-8 Subchapter 13. Rule 3.13.1

NUTRITION, MEALS, AND FOOD SAFETY

General:

A childcare family home shall provide adequate and nutritious meals prepared in a safe and sanitary manner.

Meal periods are breakfast, lunch, dinner, and snacks.

Meals shall be served where each child may be seated.

Meals shall be served by employees only.

Employees shall wash their hands before preparing or serving food.

Children shall not share food.

Source: Miss. Code Ann. §43-20-8 Rule 3.13.2 Nutritional Standards: Meals shall meet the nutritional standards as prescribed in Appendix “A” Minimum Standards for Nutritional Care in Childcare Facilities. 314

Source: Miss. Code Ann. §43-20-8 Rule 3.13.5 Snacks: All snacks shall meet acceptable nutritional standards, as prescribed in Appendix “A” Minimum Standards for Nutritional Care in Childcare Facilities.

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Subchapter 14.

DISCIPLINE AND GUIDANCE

Rule 3.14.1 Prohibited Behavior: The following behaviors are prohibited by anyone (parent, caregiver, or child) in all family home settings: 1.

Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain.

Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities.

Abusive or profane language, yelling, and/or harsh tones toward or around children is not allowed.

Any form of public or private humiliation, including threats of physical punishment.

Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating, or corrupting a child.

Use of any food product or medication in any manner or for any purpose other than that for which it was intended.

Inappropriate disciplinary behavior including putting soap or pepper in a child's mouth is not allowed.

Any acceptable disciplinary action that is not age-appropriate for the child or is excessive in time or duration.

Source: Miss. Code Ann. §43-20-8 Rule 3.14.2 Restraint of a Child: Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs. Source: Miss. Code Ann. §43-20-8 Rule 3.14.3 Time Out: "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, considering the child's developmental stage and the usefulness of "time out" for the child. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than (3) three years of age. Source: Miss. Code Ann. §43-20-8 316

Rule 3.14.4 Children Shall Not Discipline Other Children: Children shall neither be allowed nor be instructed to discipline other children. Source: Miss. Code Ann. §43-20-8 Subchapter 15.

TRANSPORTATION

Rule 3.15.1 General: The childcare family home is responsible for the safety of the children. Source: Miss. Code Ann. §43-20-8 Rule 3.15.2

Requirements:

All drivers shall be appropriately licensed.

All vehicles shall have current licenses and registrations.

Insurance is required and shall adequately cover the transportation of children.

Children shall board or leave the vehicle from the curbside of the street and shall be safely accompanied to their destinations.

A parent shall be present if the child is delivered home.

Age and weight appropriate seat restraints shall be used.

Source: Miss. Code §43-20-8. Rule 3.15.3 1.

Occupant Restraints: All children will be properly restrained whenever they are being transported in a motor vehicle. a.

Every person transporting a child under the age of four years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards.

Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four years of age, but less than seven years of age and measures less than four feet nine inches in height or weighs less than 65 pounds. 317

Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above

No vehicle shall be occupied by more individuals than its rated capacity.

No children shall be transported in the front seat of vehicles equipped with passenger-side airbags.

An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed.

Source: Miss. Code Ann. §43-20-8 Rule 3.15.4 Staff-to-Child Ratio: The staff to child ratio shall be always maintained. The driver of the vehicle shall not be counted as a caregiver while transporting the children. Source: Miss. Code Ann. §43-20-8 Subchapter 16.

DIAPERING AND TOILETING

Rule 3.16.1 Diaper Changing Area: A diapering area shall be in a designated place of the home accessible to a hand-washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plastic-lined, covered garbage receptacle, and sanitizing solution. Refer to the National Resource Center for Health and Safety in Childcare and Early Education for proper diaper changing procedures. Source: Miss. Code Ann. §43-20-8 Rule 3.16.2 Non-Disposable Diapers and Training Pants: The fecal contents of non-disposable diapers or training pants shall be disposed of into a toilet. The soiled non-disposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container. Source: Miss. Code Ann. §43-20-8 Rule 3.16.3 Disposable Diapers: Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle. Source: Miss. Code Ann. §43-20-8 Rule 3.16.4 Potty Chairs: Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use. 318

Rule 3.16.5 Parental Consultation: A parent-caregiver consultation is required prior to toilet training. Source: Miss. Code Ann. §43-20-8 Subchapter 17. FEEDING OF INFANTS AND TODDLERS Rule 3.17.1 Hand Washing: Employees shall wash their hands with soap and water and dry their hands with individual or disposable towels before and after each feeding. The infant and toddler's hands shall be washed with soap and water and dried with individual or disposable towels before and after each feeding. Source: Miss. Code Ann. §43-20-8 Rule 3.17.2 Bottle Feeding: Infants shall be held while being bottle-fed. Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep. Source: Miss. Code Ann. §43-20-8 Rule 3.17.3 Formula Storage: Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival. Source: Miss. Code Ann. §43-20-8 Rule 3.17.4 Baby Food: Foods stored or prepared in jars shall be served from a separate dish for each infant or toddler. Any leftovers from the serving dish shall be discarded. Leftovers in the jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or discarded. Source: Miss. Code Ann. §43-20-8 Rule 3.17.5 Refrigerator: A refrigerator shall be available and easily accessible to the infant or toddler's room(s). Source: Miss. Code Ann. §43-20-8 Rule 3.17.6

Heating Unit and Microwave Use:

A heating unit for warming bottles and food shall be accessible only to adults.

Microwave ovens shall not be used for warming bottles or baby/infant food. 319

Source: Miss. Code Ann. §43-20-8 Rule 3.17.7 Breast-Feeding Accommodations and Staff Training: This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1.

Source: Miss. Code Ann. §43-20-8 Subchapter 18.

SWIMMING AND WATER ACTIVITIES

Rule 3.18.1 General: This section shall apply to any childcare family home that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on-site or at any other location during the time staff has responsibility for children enrolled. Source: Miss. Code Ann. §43-20-8 Rule 3.18.2 1.

Lifeguard Supervision: Swimming pools, lakes, etc.: a.

A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities.

Lifeguards, or the equivalent as recognized by the licensing agency, are not counted in the staff-to-child ratio.

The staff-to-child ratio shall be always maintained.

Staff, as well as lifeguards, shall be responsible for enforcing general safety rules.

Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can 320

understand what is expected. 2.

Wading pools: For activities taking place in wading pools with a water depth of one foot or less the following is required: a.

There shall always be a person(s) with a valid CPR and first aid certificate present.

The staff-to-child ratio shall be always maintained.

Wading pools shall be cleaned after each use.

Source: Miss. Code Ann. §43-20-8

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Rule 3.18.3

Health and Safety:

Swimming pools equipped with a diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines.

Swimming pools, when in use, shall be properly maintained and monitored for appropriate concentration of disinfectant based on the manufacturer’s guidelines.

A testing kit for measuring the concentration of the disinfectant, shall be available at each swimming pool.

The water in a swimming pool shall have sufficient clarity to ensure visibility to the floor of the pool. The pool shall be closed immediately if this requirement cannot be met.

Source: Miss. Code Ann. §43-20-8 Subchapter 19. Rule 3.19.1

CHILDREN WITH SPECIAL NEEDS

Family Home Adaptation:

The family home areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate.

A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures.

Source: Miss. Code Ann. §43-20-8 Rule 3.19.2 Activity Plan: A child with special needs shall have an individual activity plan. The individual activity plan shall have been developed by a person with a bachelor’s or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months. Source: Miss. Code Ann. §43-20-8 Rule 3.19.3 Caregiver Staff Development: Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served. Source: Miss. Code Ann. §43-20-8 Rule 3.19.4

Staffing: Caregiver staffing shall be appropriate and adequate to 322

meet the specific physical and/or developmental needs of the special needs children served at the childcare home. Staff-to-child ratio shall be determined by the needs of the child rather than child’s chronological age as

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based upon the child’s individual plan (individual education plan, individual habilitation plan, individual family service plan, etc.). The family home is encouraged to be an active participant in the child’s individual plan development. Source: Miss. Code Ann. §43-20-8 Subchapter 20. Rule 3.20.1

HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES

Emergency Suspensions of License:

Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the childcare family home constitutes a substantial hazard to the health or safety of the children cared for by the childcare family home.

Source: Miss. Code Ann. §43-20-8 Rule 3.20.2 Denial, Revocation, or Suspension of License: The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any childcare family home upon one or more of the following grounds: 1.

Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license.

Violation of any of the provisions of the act or of these rules and regulations.

Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child.

Failure by the childcare family home to have all criminal records and child abuse central registry checks on file at the family home.

Information received by the licensing agency as a result of the criminal 324

records check or the child abuse central registry check on an operator. Source: Miss. Code Ann. §43-20-8

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Rule 3.20.3 Notification: Prior to the denial, refusal to renew, suspension, revocation or restriction of a license, and at the time of the imposition of any monetary penalty, written notice of the contemplated action shall be given to the applicant or person named on the license of the childcare family home, at the address on record with the licensing agency. Such notice shall specify the reasons for the proposed action and shall notify the operator of the right to a hearing on the matter. Source: Miss. Code Ann. §43-20-8 Rule 3.20.4

District Level Hearing for Monetary Penalties:

Any hearing requested shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period.

Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level.

Source: Miss. Code Ann. §43-20-8 Rule 3.20.5

State Level Hearing:

If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee.

Within 30 calendar days of the hearing, or such period as determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health 326

Officer. The State Health Officer shall decide what, if any, action is to

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be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator. 3.

At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense.

Source: Miss. Code Ann. §43-20-8 Rule 3.20.6

Appeal:

1. Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the childcare family home is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. 2. If a family home is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the family home, review of family home and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties. Source: Miss. Code Ann. §43-20-8 Rule 3.20.7 Injunction: Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a childcare family home with or without a license under the act, or otherwise in violation of these regulations. Source: Miss. Code Ann. §43-20-8 Rule 3.20.8 Criminal Penalties: Any person establishing, conducting, managing, or operating a childcare family home without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense. 328

Source: Miss. Code Ann. §43-20-8

329

Rule 3.20.9 Violations and Penalties: In the event of an emergency occurring at a childcare family home which makes it difficult or impossible to comply with any of these Rules, the family home shall not be in violation of those specific Rules. T he term “emergency” shall include only the following: 1.

Inclement weather;

Damage to the family home and/or structure which might require moving, transferring or consolidation of children;

Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises;

Declaration of a state of emergency by local or state officials;

An injury or illness of a child at the family home requiring the immediate attention of one or more caregivers, resulting in noncompliance of child-to-staff ratio or room ratio; and/or

During a period when licensing agency inspectors or other government officials require childcare family home staff to temporarily not be able to perform their normal supervisory duties.

Any violation of these regulations, in the discretion of the licensing agency, is punishable by a monetary penalty. Subchapter 21.

RELEASE OF INFORMATION

Rule 3.21.1 Information in the possession of the licensing agency concerning the license of individual childcare family homes may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a childcare family home. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 43-21353(8) and Section 43-21-257 Mississippi Code of 1972, annotated. Source: Miss. Code Ann. §43-20-8

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APPENDIX A

Nutritional Standards for Family Childcare Home Meals shall meet the nutritional standards as prescribed in this section. A childcare family home shall provide adequate and nutritious meals prepared in a safe and sanitary manner. Healthy diets help children grow, develop, and perform well in learning environments. Proper nutritional care during the early years is essential for intellectual, social, and emotional growth. It is also necessary that a meal environment be provided which encourages the development of good eating habits. Nutritional Goals: 1.

Menus shall be nutritionally adequate.

Foods shall be provided in quantities that balance energy and nutrients with children’s ages, appetites, activity levels, special needs, and cultural and ethnic differences in food habits.

Parents shall be involved in the nutrition component of the childcare family home.

A variety of fruits, vegetables, and whole-grain products shall be offered to children for meals and snacks. Mealtime should be used as an opportunity to teach nutrition concepts.

The addition of fat, sugar, and sources of sodium shall be minimal in food preparation and service.

Food preparation and service shall be consistent with best practices for food safety and sanitation.

Furniture and eating utensils shall be age-appropriate and developmentally suitable to encourage children to accept and enjoy mealtime.

Childcare caregivers shall encourage positive experiences with food and eating.

Childcare family homes shall obtain assistance as needed from the MSDH Childcare Licensure Bureau.

10.

Nutrition education for children and for their parents shall be encouraged as a component of the childcare program. 331

11.

Family style dining is encouraged.

Mealtime Environment: 1.

Meals and snacks shall be served at regularly scheduled times each day. 2. Age-appropriate utensils, plates, bowls, cups, and dining area shall be provided. 3.

Children shall not wait longer than fifteen minutes at the table for food to be served.

Sufficient time shall be allowed for children to wash their hands and prepare for the meal.

Mealtime shall be used for socialization, and shall be a relaxed, happy time for the children. No televisions, videos, or DVD’s may be viewed during meal and snack times.

Family style dining is encouraged with serving platters, bowls, and pitchers on the table so that everyone can serve him/herself. Children are encouraged to assist with table setting.

A caregiver shall sit and join the children while they are eating. It is suggested that the staff eat the same food items that are served to the children. The staff will encourage social interaction, conversation, and use the mealtime for education purposes. Extra assistance and time shall be provided for slow eaters.

Additional servings shall be provided for the child who requests more food at a meal or snack. This is a time to teach children on portion control, monitoring extra intake, and better food selections.

Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation.

10. Children will be permitted in meal preparation areas when under the direct supervision of a staff person, when there is no danger of injury from equipment, and for instruction/teaching purposes only. Choking Prevention 1. Raw vegetables and foods that may cause choking in young children shall not be served to children less than two years of age. 332

2. Children should be encouraged to eat slowly, take small bites, and chew well before swallowing. 3. Cook food until soft and cut into thin slices or small pieces. Remove bones from meat, chicken, and fish, and remove seeds and pits from fruit. With toddlers, cutting foods into “pea” size is recommended. FOODS THAT MAY CAUSE CHOKING Sausage shaped meats (hot dogs)*

Pop Corn Hard Candy* Chips*

Nuts

Dried Fruits

Grapes

Chunks of peanut butter

Gum*

Marshmallows

Thick Pretzels Rods* Thin pretzel sticks and rounds would be allowed. *Not allowed to be served Child Requiring a Special Diet: A child requiring a special diet due to medical reasons, allergic reactions, or religious beliefs, shall be provided meals and snacks in accordance with the child's needs. If medical reasons exist for the special diet, a medical diagnosis from the child’s physician stating that the special diet is medically necessary is required. Information required for dietary modifications include: •

Child’s full name and date of instructions, updated annually

•

Any dietary restrictions based on the special needs

•

Any special feeding or eating utensils

•

Any foods to be omitted from the diet and any foods to be substituted

•

Limitations of life activities

•

Any other pertinent special needs information

•

What, if anything, needs to be done if the child is exposed to restricted foods.

1. Religious or ethnic requests should include the above information as needed, plus a certified statement of request based upon the religious or ethnic beliefs of the family. 2. The child’s parent shall meet with the operator to review the written 333

instructions. 3. Parents of children with severe restrictions and special dietary needs will need to provide written documentation to the operator. 4. The childcare family home may request the parent to supplement food served by the childcare family home. When food is supplied by the parent, the childcare family home shall be responsible for assuring that it is properly stored and served to the child in accordance with the diet instructions on file. Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation. 5. Records of food intake shall be maintained when indicated by the child's physician. 6. Request for a vegetarian/vegan diet shall be accommodated with the same information completed as for dietary modifications. Specialty items may be supplied by the parent to meet nutritional needs. Infants 1. Breast milk or formula shall be brought to the childcare family home daily, ready to be warmed and fed. Each bottle shall be labeled with the infant's name and the date. No cereal, juice or other foods may be added to the infant’s breast milk/formula without a physician’s written request. 2. Bottles should not be warmed in the microwave. 3. At the end of each feeding, discard any milk left in the bottle. Staff will send all used bottles home with the parent for proper cleaning and sanitizing. 4. Age-appropriate solid foods (complimentary foods) may be introduced no sooner than when the child has reached four months of age, but ideally at six months. The first food introduced usually is cereal mixed with breast milk or formula (not in a bottle). Adding juice to dry cereal is not allowed. 5. Commercially prepared baby foods shall be brought in unopened jars and labeled with the infant's name. A childcare family home may choose to mash and puree the foods served to older children for the infants seven months to one year. No additional juice, sauces, or fats may be added to the pureed foods. 6. Iron-fortified dry infant cereal shall be brought in sealed container premeasured for each feeding and labeled with the infant’s name. 7. Breast milk is the recommended feeding for infants and should be 334

encouraged and supported by childcare family home personnel. The mother may choose to come to the childcare family home to nurse her infant or may choose to supply bottles of expressed breast milk for the childcare personnel to feed the infant. To help a mother be successful with breastfeeding the childcare family home may provide the following:

•

A quiet, comfortable and private place for feeding.

•

A place to wash the hands.

•

A comfortable chair, stool for feet while breast feeding.

8. If infant is breast-fed, encourage the mother to provide a back-up supply of frozen breast milk that is labeled with the infant’s name and date of expression. The mother’s expressed milk shall be used for her infant only. 9. Refer to the Centers for Disease Control for guidelines on the storage and preparation of breast milk. 10. For a breast fed infant, it is acceptable to introduce iron-fortified cereal earlier, at four months if desired, but preferably at 6 months. 11. A written schedule for feeding a breast-fed infant shall be provided by the parent and posted for reference by the childcare family home staff. 12. Feeding should be by hunger cues whenever possible. Hunger cues

may include: •

Sucking on tongue, lips, hands, or fingers while asleep

•

Moving his arms and hands toward mouth

•

Restless movements while asleep

•

Opening mouth when his lips are touched

•

“Rooting” or searching for the nipple

13. Infants are fed when hungry by noting hunger cues, such as crying, being restless. Feeding is stopped when it is determined that the infant is satisfied. Signs of satiety include, refusing the nurse, turning away from the nipple, falling asleep. 14. Infants shall be held cradled in the arms during feeding. At no time shall an infant be fed by propping a bottle. 335

15. Introduction of solid foods to an infant should be done in consultation with the parent. 16. Juice shall not be served to infants (children less than 12 months of age). 17. A small amount of water is encouraged at 8-12 months. 18. Solid foods must be spoon-fed. No solid food shall be fed by bottle or infant feeder without written direction from a physician. 19. Infants are encouraged to start using a cup at six to nine months, based upon motor skills. By the age of one, all children should be off a bottle. 20. Older infants are encouraged to hold and drink from cups and to use child appropriate eating and serving utensils. Self-feeding should be encouraged. 21. Breast milk or formula is served to at least 12 months of age. Children ages one to two, shall be served whole milk, after age two, toddlers should be served fat-free/skim milk or 1% milk. 22. When centers are reimbursed for meals and must supply formula for

their infants, only ready to use formula may be purchased for use. The center may require the parents to supply clean bottles daily. If the center supplies the bottles, there must be provisions in place for the proper cleaning, sanitizing, and drying of all bottles and supplies outside of the infant room. Meal Planning for Infants through One Year 1. Infant food needs are based on the amount of time spent in the childcare family home. 2. Any infant in a childcare family home at the time of a meal or snack, shall be served foods appropriate to age. Meal/Snack

Birth through 5

6 Months through 12 Months

Months Breakfast

4-6 fl. oz. breast milk 6-8 fl. oz. breast milk or formula or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or Vegetable (infant or mashed)

336

Lunch or Supper

4-6 fl. oz. breast milk 6-8 fl. oz. breast milk or formula or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable (infant or mashed) 1-4 Tbsp. infant meat

Supplement/Snack

4-6 fl. oz. breast milk 2-4 fl. oz. breast milk or formula or formula 0-1/2 dry bread or 0-2 crackers (optional)

Meal Schedule for Children One year and older:

1. Children’s food needs are based on the amount of time spent in the childcare family home. 2. Any child in a childcare family home at the time of a meal or snack will be served that meal or snack. IF YOU ARE OPEN

YOU MUST SERVE

Nine hours or less

Two snacks and one meal

One snack and two meals

Over nine hours

Two snacks and two meals

Three snacks and one meal

24 hours or during all

Three meal and three snacks: one snack should be a late night

meals

snack only served to children who are awake.

Parties and Special Occasions: Parties and party events should not be held more than once a month.

Meal Planning for Children in Family Childcare Homes: Breakfast/Lunch/Dinner/Snack Milk: Milk shall be served at breakfast, lunch, and dinner. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than two years of age. After age two fat-free/skim milk or 1% milk shall be served. Milk alternatives may be served when indicated with dietary restrictions. Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions. 337

If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, cheese, etc. Bread and Bread Alternates: Use enriched whole-grain breads and bread alternatives. Dry cereals need to be high fiber and not sugar coated. Whole grain pasta, noodles, or brown rice are encouraged at all meals. The following breakfast breads may be served: muffin, biscuit, toast, breakfast bread, pancake or waffle. These items should be limited: doughnuts, honey buns, breakfast tarts, pastries, packaged snack cakes, and other high fat/sugar foods. Plain, low sugar type cookies and snacks, including animal crackers, graham crackers, vanilla wafers, oatmeal, oatmeal raisin, peanut butter, low-fat granola bars, whole grain fruit and cereal bars, and Rice Krispie treats, and ginger snaps may be served as a snack occasionally. Other snack suggestions include cheddar cheese, plain or vegetable flavored crackers or trail mix made of various dry, no sugar-coated cereals, dried fruits, and small marshmallows Items that may not be served include chocolate chip cookies and most pre-packaged cookies/snack cakes. Fruits and Vegetables: Use fresh, canned, dried, or frozen fruit for every meal. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water - not syrup or sugar packed. Vegetables may be used for the breakfast meal. Serve a variety of fruits and vegetables. Use a different combination of two or more fruit/vegetables during meals. Use fresh, canned, dried, or frozen vegetables and fruits for meals. Avoid serving two forms of the same fruit or vegetable in the same day. Limit serving starchy vegetables. Starchy vegetables include white/sweet potatoes, lima beans, butter beans, English peas, black-eye peas, field peas, crowder peas, cream and whole kernel corn, and any dried bean/pea (unless counted for a meat alternate). The use of high sodium/salt and high fat seasonings should be limited. Fruit juice (100%) is allowed once a day. 338

Water: Water is to be made available with all meals and snacks. Tap or bottled water may be served. Water should be encouraged before and after all meals and snacks. Meat and Meat Alternates: Meats and meat alternates that would be acceptable include eggs, fat-free yogurt, low-fat cheese, fat-free cottage cheese, lean ham, Canadian bacon, and peanut butter. Bacon is not considered a meat and shall not be served infrequently. Edible portion for meats and meat alternates is used. No bones may be served. One ounce of cooked meat is equal to one medium cooked chicken leg with bone removed. Processed, pre-fried meats should be limited due to the sodium/salt and fat content. Meats not allowed include hot dogs, corndogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers. Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low-fat or fat-free cheese can be served. Serving nuts and seeds is not recommended due to the prevalence of nut/seed allergies.

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VITAMIN C SOURCES VITAMIN C SOURCE MUST BE SERVED DAILY **BEST CHOICE *GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Food

Vegetables

Serving Size

Food

Serving Size

Blackberries

¼ c.

Asparagus

¼ c.

Blueberries

¼ c.

Artichoke

¼ medium

Cantaloupe

¼c

Bok Choy

¼ c.

Grapefruit

¼ medium

Broccoli

¼ c.

Grapefruit Juice

½c

Brussel Sprouts

¼ c.

Grapefruit-Orange Juice

½ c.

Cabbage

¼ c.

Guava

¼ c.

Cauliflower

¼ c.

Honeydew Melon

½ c.

Chicory

¼ c.

Kiwi

½ medium

Collard Greens

¼ c.

Mandarin Orange

¼ c.

Kale

¼ c.

Mango

¼ medium

Kohlrabi

¼ c.

Melon balls

¼ c.

Orange

½ medium

Mustard Greens

¼ c.

Orange Juice

¼ c.

Okra, not fried

¼ c.

Papaya

¼ c.

Peppers, green & red

¼ c.

Peach, frozen only

¼ c.

Potato, White, or Red Skinned Baked only-no instant/fries/tots

½ medium

Sections

340

Pineapple

¼ c.

Rutabagas

¼ c.

Pineapple Juice

¼ c.

Snow Peas

¼ c.

Pineapple-

¼ c.

Spinach

¼ c.

Raspberries

¼ c.

Sweet Potato

½ medium

Starfruit

¼ c.

Tomato

½ medium

Strawberries

¼ c.

Tomato or V-8 Juice

¼ c.

Tangelo

½ medium

Turnip Greens

¼ c.

Tangerine

½ medium

Tropical fruit mix

¼ c.

Watermelon

½ c.

grapefruit or orange juice

Miscellaneous

Liver, beef

341

1 oz.

VITAMIN A SOURCES VITAMIN A SOURCE MUST BE SERVED EVERY OTHER DAY, 3 TIMES PER WEEK ** BEST CHOICE * GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Food

Vegetables

Serving Size

Food

Serving Size

Avocado

¼ medium

Asparagus

¼ c.

Apricot

2 halves

Artichoke

½ medium

Cantaloupe

¼ c.

Bok Choy

¼ c.

Cherries, red sour ¼ c.

Broccoli

¼ c.

Mandarin Orange ¼ c.

Brussels Sprouts

¼ c.

Segments Mango

¼ medium

Carrots

¼ c.

Melon Balls

¼ c.

Collard Greens

¼ c.

Nectarine

¼ medium

Papaya

¼ c.

Kale

¼ c.

Peaches

¼ c.

Lettuce, Green, Romaine, or Red - NOT

½ c.

Iceberg Plantain

¼ c.

Mixed Vegetables

¼ c.

Prunes

¼ c.

Mustard Greens

¼ c.

Tangerine

½ medium

Okra, not fried

¼ c.

Peas & Carrots

¼ c.

Peppers, red

¼ c.

342

Miscellaneous

Pumpkin

¼ c.

Egg

1 medium

Rutabagas

¼ c.

Liver, beef

1 oz.

Spinach

¼ c.

Liver, chicken

1 oz.

Sweet Potato

½ medium

Tomato or V-8 Juice

¼ c.

Turnip Greens

¼ c.

Winter Squash, Butternut ¼ c.

or Hubbard

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APPENDIX B CLEANING AND DISINFECTION PROCEDURES Keeping the childcare environment clean is very important for the health and safety of both children and providers. One of the most important steps in reducing the number of germs, and therefore the spread of disease, is the thorough cleaning of surfaces that could possibly pose a risk to children or staff. Surfaces considered most likely to be contaminated are those which the children are most likely to have close contact. These include toys that children put in their mouths, crib rails, food preparation areas, and other surfaces, such as diaper-changing areas. Routine cleaning with soap and water is the most useful method for removing germs from surfaces in the childcare setting. Physically scrubbing with soap and water reduces the number of germs from the surface, just as hand washing reduces the numbers of germs from the hands. Removing germs in the childcare setting is especially important for soiled surfaces which cannot be treated with chemical disinfectants, such as some upholstery fabrics. However, some items and surfaces should receive an additional disinfection, to kill germs after cleaning with soap and rinsing with clean water. Items that can be washed in a dishwasher on the hot cycle of a washing machine are not required to be disinfected because these machines use high temperature water for a period long enough to kill most germs. The disinfection process uses chemicals that are stronger than soap and water. Disinfection also usually requires soaking the item for several minutes to give the chemical time to kill the remaining germs. Commercial products that meet the Environmental Protection Agency’s (EPA) standards may be used for this purpose. One of the most used chemicals for disinfection in childcare settings is a homemade solution of household bleach and water. The solution of bleach and water is easy to mix, is nontoxic, is safe if handled properly, and kills most infectious agents. Be aware that some infectious agents are not killed by bleach. A solution of bleach and water loses its strength quickly and easily. It is weakened by organic material, evaporation, heat, and sunlight. Therefore, bleach solutions should be mixed fresh each day to ensure its effectiveness. Any leftover solution should be discarded at the end of the day. NEVER mix bleach with anything but fresh tap water! Other chemicals may react with bleach and create and release a toxic gas. Keep the bleach solution you mix each day in a cool, dry place out of direct sunlight and out of the reach of children. If a childcare family home uses a commercial cleaner, sanitizer, or disinfectant it must be a EPA registered product that has an EPA registration number on the label. Such products shall only be used according to the manufacturer’s instructions. NOTE: All EPA-registered products may not be appropriate for use in a childcare family home. Therefore, it is the responsibility of the operator to make sure any product use is appropriate for use in a childcare family home.

Recipe for Bleach Disinfecting Solution 344

For use on non-porous surfaces such as diaper change tables, counter tops, door cabinet handles toilets, etc. 1/3 cup or 5 tablespoons bleach added to 1 gallon of cool water OR 4 teaspoo ns bleach added to 1 quart of cool water

Recipe for Weaker Bleach Sanitizing Solution For food contact surfaces sanitizing, e.g., dishes, utensils, cutting boards, highchair trays, toys that children may place in their mouths, and pacifiers. 1 tablespo on bleach added to 1 gallon of cool water Washing and Disinfecting Toys Infants and toddlers should not share toys. Toys that children (particularly infants and toddlers) put in their mouths should be washed and disinfected between uses by individual children. Toys for infants and toddlers should be chosen with this in mind. If you cannot wash a toy, it probably is not appropriate for an infant or toddler. When an infant or toddler finishes playing with a toy, you should retrieve it from the play area and put it in a bin reserved for dirty toys. This bin should be out of reach of the children. Toys can be washed at a later, more convenient time, and then transferred to a bin for clean toys and safely reused by the other children.

345

To wash and disinfect a hard plastic toy: •

Scrub the toy in warm, soapy water. Use a brush to reach into the crevices.

•

Rinse the toy in clean water.

•

Immerse the toy in a mild bleach solution (see above) and allow it to soak in the solution for 10-20 minutes.

•

Remove the toy from the bleach and rinse well in cool water.

•

Air dry.

Hard plastic toys that are washed in a dishwasher or cloth toys washed in the hot water cycle of the hot water cycle of a washing machine do not need to be additionally disinfected. Children in diapers should only have washable toys. Each group of children should have its own toys. Toys should not be shared with other groups. Stuffed toys used by only a single child should be cleaned in a washing machine every week or more frequently if heavily soiled. Toys and equipment used by older children and not put into their mouths should be cleaned at a minimum of weekly and/or when soiled. A soap and water wash followed by clear water rinsing and air drying should be adequate. No disinfection is required. (These types of toys and equipment include blocks, dolls, tricycles, trucks, and other similar toys.). Do not use wading pools for children in diapers. Water play tables can spread germs. To prevent this: •

Disinfect the table with chlorine bleach solution before filling it with water.

•

Disinfect all toys to be used in the table with chlorine bleach solution. Avoid using sponge toys. They can trap bacteria and are difficult to clean.

•

Have all children wash their hands before and after playing in the water table.

•

Do not allow children with open sores or wounds to play in the water table.

•

Carefully supervise the children to make sure they do not drink the water.

•

Discard the water after play is over.

346

Washing and Disinfecting Bathroom and Other Surfaces Bathroom surfaces, such as faucet handles and toilet seats, should be washed and disinfected several times a day, if possible, but at least once a day or when soiled. The bleach and water solution or chlorine-containing scouring powers or other commercial bathroom surface cleaner/disinfectants can be used in these areas. Surfaces that infants and young toddlers are likely to touch or mouth, such as crib rails, should be washed with soap and water and disinfected with a nontoxic disinfectant, such as bleach solution, at least once every day, more often if visibly soiled. After the surface has been cleaned with the disinfectant, it should be thoroughly wiped with a fresh towel moistened with tap water. Be sure not to use a toxic cleaner on surfaces likely to be mouthed. Floors should be washed and disinfected at least once a day and whenever soiled. Washing and Disinfecting Diaper Changing Areas Diaper Changing Areas should: •

Only be used for changing diapers.

•

Be smooth and nonporous, such as Formica (NOT wood).

•

Have a raised edge or low fence around the area to prevent a child from falling off.

•

Be next to a sink with hot and cold running water.

•

Not be used to prepare food, mix formula, or rinse pacifiers.

•

Be easily accessible to providers.

•

Be out of reach of children.

Diaper changing areas should be cleaned and disinfected after each diaper changer as follows: •

Clean the surface with soap and water and rinse with clear water.

•

Dry the surface with a paper towel.

•

Thoroughly wet the surface with the recommended bleach solution.

•

Wipe dry with a clean disposable towel or air dry. If using a commercial disinfectant/sanitizer, follow labeled manufacturer’s instructions.

347

Washing and Disinfecting Clothing, Linen, and Furnishings Do not wash or rinse clothing soiled with fecal material in the childcare setting. You may empty solid stool into the toilet. Put the soiled clothes in a plastic bag and seal the bag to await pick up by the child’s parent or guardian at the end of the day. Always wash your hands after handling soiled clothing. Explain to parents that washing or rinsing soiled diapers and clothing increases the chances that you and the children may be exposed to germs that cause disease. Although receiving soiled clothes is not pleasant, remind parents that this policy protects the health of all children and providers. Each item of sleep equipment, including cribs, cots, mattresses, blankets, sheets, etc., should be cleaned and sanitized before being assigned to a specific child. The bedding should be labeled with that child’s name and should only be used by that child. Children shall not share bedding. Infant linens (sheets, pillowcases, blankets) shall be cleaned and sanitized daily, and crib mattresses shall be cleaned and sanitized weekly or when soiled. Linens from beds of older children shall be laundered at least weekly and whenever soiled. However, if a child inadvertently uses another child’s bedding, you shall change the linen and mattress cover before allowing the assigned child to use it again. Cleaning Body Fluid Spills Spills of body fluids, including blood, feces, nasal and eyed discharges, saliva, urine, and vomit shall be cleaned up immediately. Wear gloves while cleaning. Be careful not to get any of the fluid you are cleaning in your eyes, nose, mouth or any open sores you may have. Clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Discard fluid-contaminated material in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be cleaned, rinsed with a disinfecting solution, wrung dry, and hung to dry. Be sure to wash your hands after cleaning up any spill. Source: Centers for Disease Control

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