441—109.15 (237A) Food services. Centers participating in the USDA Child and Adult Care Food Program (CACFP) may have requirements that differ from those outlined in this rule in obtaining CACFP reimbursement and shall consult with a state CACFP consultant.
	 109.15(1) Nutritionally balanced meals or snacks. The center shall serve each child a full, nutritionally balanced meal or snack as defined by the USDA Child and Adult Care Food Program (CACFP) guidelines and shall ensure that staff provide supervision at the table during snacks and meals. Children remaining at the center two hours or longer shall be offered food at intervals of not less than two hours or more than three hours apart unless the child is asleep.
	 109.15(2) Menu planning. The center shall follow the minimum CACFP menu patterns for meals and snacks and serving sizes for children aged infant to 13 years. Menus shall be planned at least one week in advance, made available to parents, and kept on file at the center. Substitutions in the menu, including substitutions made for infants, shall be noted and kept on file. Foods with a high incident rate of causing choking in young children shall be avoided or modified. Provisions of this subrule notwithstanding, exceptions shall be allowed for special diets because of medical reasons in accordance with the child’s needs and written instructions of a licensed physician or health care provider.
	 109.15(3) Feeding of children under two years of age.
	  a.   	 All children under 12 months of age shall be fed on demand, unless the parent provides other written instructions. Meals and snacks provided by the center shall follow the CACFP infant menu patterns. Foods shall be appropriate for the infant’s nutritional requirements and eating abilities. Menu patterns may be modified according to written instructions from the parent, physician or health care provider. Special formulas prescribed by a physician or health care provider shall be given to a child who has a feeding problem.
	  b.   	 All children under six months of age shall be held or placed in a sitting-up position sufficient to prevent aspiration during feeding. No bottles shall be propped for children of any age. A child shall not be placed in a crib with a bottle or left sleeping with a bottle. Spoon feeding shall be adapted to the developmental capabilities of the child.
	  c.   	 Single-service, ready-to-feed formulas, concentrated or powdered formula following the manufacturer’s instructions or breast milk shall be used for children 12 months of age and younger unless otherwise ordered by a parent or physician.
	  d.   	 Whole milk for children under age two who are not on formula or breast milk unless otherwise directed by a physician.
	  e.   	 Cleaned and sanitized bottles and nipples shall be used for bottles prepared on site. Prepared bottles shall be kept under refrigeration when not in use.
	 109.15(4) Food brought from home.
	  a.   	 The center shall establish policies regarding food brought from home for children under five years of age who are not enrolled in school. A copy of the written policy shall be given to the parent at admission. Food brought from home for children under five years of age who are not enrolled in school shall be monitored and supplemented if necessary to ensure CACFP guidelines are maintained.
	  b.   	 The center may not restrict a parent from providing meals brought from home for school-age children or apply nutritional standards to the meals.
	  c.   	 Perishable foods brought from home shall be maintained to avoid contamination or spoilage.
	  d.   	 Snacks that may not meet CACFP nutrition guidelines may be provided by parents for special occasions such as birthdays or holidays.
	 109.15(5) Food preparation, storage, and sanitation. Centers shall ensure that food preparation and storage procedures are consistent with the recommendations of the National Health and Safety Performance Standards and provide:
	  a.   	 Sufficient refrigeration appropriate to the perishable food to prevent spoilage or the growth of bacteria.
	  b.   	 Sanitary and safe methods in food preparation, serving, and storage sufficient to prevent the transmission of disease, infestation of insects and rodents, and the spoilage of food. Staff preparing food who have injuries on their hands shall wear protective gloves. Staff serving food shall have clean hands or wear protective gloves and use clean serving utensils.
	  c.   	 Sanitary methods for dish-washing techniques sufficient to prevent the transmission of disease.
	  d.   	 Sanitary methods for garbage disposal sufficient to prevent the transmission of disease and infestation of insects and rodents.
	 109.15(6) Water supply. The center shall ensure that suitable water and sanitary drinking facilities are available and accessible to children. Centers that serve infants and toddlers shall provide individual cups for drinking in addition to drinking fountains that may be available in the center.
	  a.   	 Private water supplies shall be of satisfactory bacteriological quality as shown by an annual laboratory analysis. Water for the analysis shall be drawn between May 1 and June 30 of each year. When the center provides care for children under two years of age, a nitrate analysis shall also be obtained.
	  b.   	 When public or private water supplies are determined unsuitable for drinking, commercially bottled water certified as chemically and bacteriologically potable or water treated through a process approved by the health department or designee shall be provided.