441—109.14 (237A) Get-well center. A get-well center shall comply with the licensing requirements for centers contained in Iowa Code chapter 237A and this chapter with the additional requirements and exceptions set forth below.
	 109.14(1) Staff requirements.
	  a.   	 The center shall have a medical advisor for the center’s health policy. The medical advisor shall be a medical doctor or a doctor of osteopathy currently in pediatrics or family practice.
	  b.   	 A center shall have a licensed LPN or RN on duty at all times that children are present. If the nurse on duty is an LPN, the medical advisor or an RN shall be available in the proximate area as defined in state board of nursing rules at 655—6.1(152).
	 109.14(2) Health policies.
	  a.   	 The center shall have a written health policy, consistent with the National Health and Safety Performance Standards, approved and signed by the owner or the chair of the board and by the medical advisor before the center can begin operations. Changes in the health policy shall be approved by the medical advisor and submitted in writing to the department. A written summary of the health policy shall be given to the parent when a child is enrolled in the center. The center’s health policy at a minimum shall address procedures in the following areas:
	 (1) 	 Medical consultation, medical emergencies, triage policies, storage and administration of medications, dietary considerations, sanitation and infection control, categorization of illness, length of enrollment periods, exclusion policy, and employee health policy.
	 (2) 	 Reportable disease policies as required by the state department of public health.
	  b.   	 The child shall be given a brief evaluation by an LPN or RN upon each arrival at the center.
	  c.   	 The parent shall receive a brief written summary when the child is picked up at the end of the day. The summary must include:
	 (1) 	 Admitting symptoms.
	 (2) 	 Medications administered and time they were administered.
	 (3) 	 Nutritional intake.
	 (4) 	 Rest periods.
	 (5) 	 Output.
	 (6) 	 Temperature.
	 109.14(3) Exceptions. The following exceptions to 441—Chapter 109 shall be applied to get-well centers:
	  a.   	 A center shall maintain a minimum staff ratio of one-to-four for infants and one-to-five for children over the age of two.
	  b.   	 All staff that have contact with children shall have a minimum of 17 clock hours of special training in caring for mildly ill children. Current certification of the training shall be contained in the personnel files. Special training shall be department-approved and include the following:
	 (1) 	 Four hours’ training in infant and child cardiopulmonary resuscitation (CPR), four hours’ training in pediatric first aid, and one hour of training in infection control within the first month of employment.
	 (2) 	 Six hours’ training in care of ill children, and two hours’ training in child abuse identification and reporting within the first six months of employment and every five years thereafter.
	  c.   	 There shall be 40 square feet of program space per child.
	  d.   	 There shall be a sink with hot and cold running water in every child-occupied room.
	  e.   	 Outdoor space may be waived with the approval of the department if the program is in an area adjacent to the pediatrics unit of a hospital.
	  f.   	 Grouping of children shall be allowed by categorization of illness or by transmission route without regard to age, and shall be in separate rooms with full walls and doors.