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    CHAPTER 109CHILD CARE CENTERS[Filed as Chapter 108, 2/14/75 and renumbered 7/1/75][Prior to 7/1/83, Social Services[770] Ch 109][Prior to 2/11/87, Human Services[498]]PreambleThe intent of this chapter is to specify minimum requirements for licensed child care centers and preschools and to define those child-caring environments that are governed by the licensing standards. The licensing standards govern licensing procedures, administration, parental participation, personnel, records, health and safety policies, physical facilities, activity programs, and food services.441—109.1(237A)  Definitions.  
    "Adult" means a person 18 years of age or older.
    "Child" means either of the following:
    1. A person 12 years of age or younger.
    2. A person 13 years of age or older but younger than 19 years of age who has a developmental disability, as defined under the federal Developmental Disabilities Assistance and Bill of Rights Act of 2000, Public Law No.106-402, codified in 42 U.S.C. 15002(8).
    "Child care" means the care, supervision, or guidance of a child by a person other than the child’s parent, guardian, or custodian for periods of less than 24 hours per day per child on a regular basis in a place other than the child’s home, but does not include care, supervision, or guidance of a child by any of the following:
    1. An instructional program for children who are attending prekindergarten as defined by the state board of education under Iowa Code section 256.11 or a higher grade level and are at least four years of age, or at least three years of age and eligible for special education under Iowa Code chapter 256B, and administered by a public or nonpublic school system accredited by the department of education or the state board of regents or a nonpublic school system which is not accredited by the department of education or the state board of regents.
    2. Any of the following church-related programs:
    3. An instructional program.
    4. A youth program other than a preschool, before or after school child care program, or other child care program.
    5. A program providing care to children on church premises while the children’s parents are attending church-related or church-sponsored activities on the church premises.
    6. Short-term classes of less than two weeks’ duration held between school terms or during a break within a school term.
    7. A child care center for sick children operated as part of a pediatrics unit in a hospital licensed by the department of inspections and appeals pursuant to Iowa Code chapter 135B.
    8. A program operated not more than one day per week by volunteers that meets all the following conditions:
    9. Not more than 11 children are served per volunteer.
    10. The program operates for less than 4 hours during any 24-hour period.
    11. The program is provided at no cost to the children’s parent, guardian, or custodian.
    12. A program administered by a political subdivision of the state which is primarily for recreational or social purposes and is limited to children who are five years of age or older and attending school.
    13. An after-school program continuously offered throughout the school year to children who are at least five years of age and enrolled in school and attend the program intermittently, or a summer-only program for such children. The program must be provided through a nominal membership fee or at no cost.
    14. A special activity program which meets less than four hours per day for the sole purpose of the special activity. Special activity programs include but are not limited to music or dance classes, organized athletic or sports programs, recreational classes, scouting programs, and hobby or craft clubs or classes.
    15. A nationally accredited camp.
    16. A structured program for the purpose of providing therapeutic, rehabilitative, or supervisory services to children under any of the following:
    17. A purchase of service or managed care contract with the department.
    18. A contract approved by a local decategorization governance board.
    19. An arrangement approved by a juvenile court order.
    20. Care provided on site to children of parents residing in an emergency, homeless, or domestic violence shelter.
    21. A child care facility providing respite care to a licensed foster family home for a period of 24 hours or more to a child who is placed with that licensed foster family home.
    22. A program offered to a child whose parent, guardian, or custodian is engaged solely in a recreational or social activity, remains immediately available and accessible on the physical premises on which the child’s care is provided, and does not engage in employment while the care is provided. However, if the recreational or social activity is provided in a fitness center or on the premises of a nonprofit organization, the parent, guardian, or custodian of the child may be employed to teach or lead the activity.
    "Child care center" "center" means a facility providing child day care for seven or more children, except when the facility is registered as a child development home. For the purposes of this chapter, the word “center” shall apply to a child care center or preschool, unless otherwise specified.
    "Child care facility" "facility" means a child care center, a preschool, or a registered child development home.
    "Department" means the department of human services.
    "Direct responsibility for child care" means being charged with the care, supervision, or guidance of a child.
    "Extended evening care" means child care provided by a child care center between the hours of 9 p.m.and 5 a.m.
    "Facility" means a building or physical plant established for the purpose of providing child day care.
    "Get-well center" means a facility that cares for a child with an acute illness of short duration for short enrollment periods.
    "Involvement with child care" means licensed or registered as a child care facility, employed in a child care facility, residing in a child care facility, receiving public funding for providing child care, providing child care as a child care home provider, or residing in a child care home.
    "National Health and Safety Performance Standards" means the National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs produced by the American Public Health Association and the American Academy of Pediatrics with the support of the Maternal and Child Health Bureau, Department of Health and Human Services.
    "Parent" means parent or legal guardian.
    "Person subject to an evaluation" means a person who has committed a transgression and who is described by any of the following:
    1. The person is being considered for licensure or is licensed.
    2. The person is being considered by a child care facility for employment involving direct responsibility for a child or with access to a child when the child is alone, or the person is employed with such responsibilities.
    3. The person will reside or resides in a child care facility.
    4. The person has applied for or receives public funding for providing child care.
    "Preschool" means a child day care facility which provides care to children aged three through five, for periods of time not exceeding three hours per day. The preschool’s program is designed to help the children develop intellectual, social and motor skills, and to extend their interest in and understanding of the world about them.
    "Regulatory fee" means the amount payable to the department for licensure of a child care center based on the capacity of the center.
    "Requesting entity" means an entity covered by these rules that is requesting an evaluation to determine if the person being evaluated can have involvement with child care. The requesting entity must be a child care facility as defined in Iowa Code chapter 237A.
    "Transgression" means the existence of any of the following in a person’s record:
    1. Conviction of a crime.
    2. A record of having committed founded child or dependent adult abuse.
    3. Listing in the sex offender registry established under Iowa Code chapter 692A.
    4. A record of having committed a public or civil offense.
    5. Department revocation or denial of a child care facility registration or license due to the person’s continued or repeated failure to operate the child care facility in compliance with licensing and registration laws and rules.
    "Unrestricted access" means that a person has contact with a child alone or is directly responsible for child care.
    Related ARC(s): 8650B, 0030C, 1809C, 2169C, 2646C, 3555C441—109.2(237A)  Licensure procedures.    109.2(1)    Application for license.    a.  Any adult or agency has the right to apply for a license. The application for a license shall be made to the department on a department-provided application for a license to operate a child care center.  b.  Requested reports including the fire marshal’s report and other information relevant to the licensing determination shall be furnished to the department upon application and renewal. A building owned or leased by a school district or accredited nonpublic school that complies with rules adopted by the state fire marshal for school buildings is considered appropriate for use by a child care facility.  c.  When a center makes a sufficient application for an initial license, the center may operate for a period of up to 120 calendar days from the date of issuance of the form granting permission to open without a license, pending a final licensing decision. A center has made a sufficient application when it has had an on-site visit and has submitted the following to the department:  (1)  An application for a license.  (2)  An approved fire marshal’s report.  (3)  A floor plan indicating room descriptions and dimensions, including location of windows and doors.  (4)  Information sufficient to determine that the center director meets minimum personnel qualifications.  d.  Applicants shall submit the regulatory fee as specified in subrule 109.2(7) to the department’s division of fiscal management.  e.  Applicants shall be notified of approval or denial of initial applications within 120 days from the date the application is submitted.  (1)  If the applicant has been issued a form granting permission to open without a license, the applicant shall be notified of approval or denial within 120 calendar days of the date of issuance of the form.  (2)  No full or provisional license shall be issued before payment of the applicable regulatory fee as determined pursuant to subrule 109.2(7).  f.  The department shall not act on a licensing application for 12 months after an applicant’s child care center license has been denied or revoked.  g.  When the department has denied or revoked a license, the applicant or person shall be prohibited from involvement with child care unless the department specifically permits involvement through a record check decision.  109.2(2)    License.    a.  An applicant showing compliance with center licensing laws and these rules, including department approval of center plans and procedures and submission of the regulatory fee as specified in subrule 109.2(7) to the department by the date due, shall be issued a license for 24 months. In determining whether or not a center is in compliance with the intent of a licensing standard outlined in this chapter, the department shall make the final decision.  b.  A new license shall be applied for when the center moves, expands, or the facility is remodeled to change licensed capacity.  c.  A new license shall be applied for when another adult or agency assumes ownership or legal responsibility for the center.  109.2(3)    Provisional license.    a.  A provisional license may be issued or a previously issued license may be reduced to a provisional license for a period up to one year when the center does not sufficiently meet standards imposed by law and these rules.  b.  A provisional license shall be renewable when written plans giving specific dates for completion to bring the center up to standards are submitted to and approved by the department. A provisional license shall not be reissued for more than two consecutive years when the lack of compliance with the same standards has not been corrected within two years.  c.  When the center submits documentation or it can otherwise be verified that the center complies with standards imposed by law or these rules, the license shall be upgraded to a full license.  109.2(4)    Denial.  Initial applications or renewals shall be denied when:  a.  The center does not comply with center licensing laws and these rules in order to qualify for a full or provisional license.  b.  The center is operating in a manner which the department determines impairs the safety, health, or well-being of children in care.  c.  A person subject to an evaluation has transgressions that merit prohibition of involvement with child care and of licensure, as determined by the department.  d.  Information provided either orally or in writing to the department or contained in the center’s files is shown to have been falsified by the provider or with the provider’s knowledge.  e.  The center is not able to obtain an approved fire marshal’s certificate as prescribed by the state fire marshal or fails to comply in correcting or repairing any deficiencies in the time determined by the fire marshal or the fire marshal determines the facility is not safe for occupancy.  f.  The regulatory fee as specified in subrule 109.2(7) is not received by the department’s division of fiscal management within 60 calendar days from the due date on the invoice.  109.2(5)    Revocation and suspension.  A license shall be revoked or suspended if corrective action has not been taken when:  a.  The center does not comply with center licensing laws or these rules.  b.  The center is operating in a manner which the department determines impairs the safety, health, or well-being of the children in care.  c.  A person subject to an evaluation has transgressions that merit prohibition of involvement with child care and of licensure, as determined by the department.  d.  Information provided to the department or contained in the center’s files is shown to have been falsified by the provider or with the provider’s knowledge.  e.  The facility is not able to obtain an approved fire marshal’s certificate as prescribed by the state fire marshal or fails to comply in correcting or repairing any deficiencies in the time determined by the fire marshal or the fire marshal determines the facility is not safe for occupancy.  f.  The regulatory fee as specified in subrule 109.2(7) is not paid in full due to insufficient funds to cover a check submitted to the department for the fee.  109.2(6)    Adverse actions.    a.  Notice of adverse actions for a denial, revocation, or suspension and the right to appeal the licensing decision shall be given to applicants and licensees in accordance with 441—Chapter 7 and rule 441—16.3(17A).  b.  An applicant or licensee affected by an adverse action may request a hearing by means of a written request directed to the Department of Human Services, Appeals Section, 1305 E. Walnut Street, Fifth Floor, Des Moines, Iowa 50319-0114. The request shall be submitted within 30 days after the date the department mailed the official notice containing the nature of the denial, revocation, or suspension.  c.  A letter received by an owner or director of a licensed center initiating action to deny, suspend, or revoke the facility’s license shall be conspicuously posted at the main entrance to the facility where it can be read by parents or any member of the public. The letter shall remain posted until resolution of the action to deny, suspend or revoke the license. If the action to deny, suspend, or revoke is upheld, the center shall return the license to the department.  d.  If the center’s license is denied, suspended or revoked, the administrator of the department shall notify the parent, guardian, or legal custodian of each child for whom the facility provides child care. The center shall cooperate with the department in providing the names and address of the parent, guardian, or legal custodian of each child for whom the facility provides child care.  109.2(7)    Regulatory fees.  A fee based upon center capacity is due to the department at the time of issuance of the license in accordance with this subrule.  a.    Fee structure.  The amount of the fee is based on the capacity of the center as indicated below:Center CapacityFee Amount0 to 20 children$5021 to 50 children$7551 to 100 children$100101 to 150 children$125151 or more children$150  b.    Determination of capacity.  The licensing consultant shall determine center capacity by dividing the amount of usable space by the amount of space required per child, as specified in subrule 109.11(1) and subparagraphs 109.11(3)“a”(2) and (3). Upon approval by the department, the final determination of center capacity may include evaluation of other factors that influence capacity, as long as physical space requirements per child as defined in subrule 109.11(1) and subparagraphs 109.11(3)“a”(2) and (3) are maintained.  c.    Notification.  Upon final determination of center capacity by the licensing consultant, the licensing consultant or designee shall sign and provide the child care center licensing fee invoice to the center.  d.    Payment.  The center shall return the child care center licensing fee invoice to the department with the licensing fee payment within 60 calendar days from the date on the invoice. Payment may be in the form of cash, check, money order, or cashier’s check. Regulatory fees are nonrefundable and nontransferable.Related ARC(s): 8650B, 1209C, 2646C, 4752C, 4973C, 6023C441—109.3(237A)  Inspection and evaluation.  The department shall conduct an unannounced on-site visit in order to make a licensing recommendation for all initial and renewal applications for licensure and shall determine compliance with licensing standards imposed by licensing laws and these rules when a complaint is received.  109.3(1)  At least one unannounced on-site visit shall be conducted each calendar year.  109.3(2)  After each visit and complaint, the department shall document whether a center was in compliance with center licensing standards imposed by licensing laws and these rules.  109.3(3)  The written documentation of the department’s conclusion as to whether a center was in compliance with licensing standards for all licensing visits and complaints shall be available to the public. However, the identity of the complainant shall be withheld unless expressly waived by the complainant.Related ARC(s): 4752C441—109.4(237A)  Administration.    109.4(1)    Purpose and objectives.  Incorporated and unincorporated centers shall submit a written statement of purpose and objectives. The plan and practices of operation shall be consistent with this statement.  109.4(2)    Required written policies.  The child care center owner, board or director shall:  a.  Develop fee policies and financial agreements for the children served.  b.  Develop and implement policies for enrollment and discharge of children, field trips and non-center activities, transportation, discipline, nutrition, and health and safety policies.  c.  Develop a curriculum or program structure that uses developmentally appropriate practices and an activity program appropriate to the developmental level and needs of the children.  d.  Develop and implement a written plan for staff orientation to the center’s policies and to the provisions of 441—Chapter 109 where applicable to staff.  e.  Develop and implement a written plan for ongoing training and staff development in compliance with professional growth and development requirements established by the department in rule 441—109.7(237A).  f.  Make available for review a copy of the center policies and program to all staff at the time of employment and each parent at the time a child is admitted to the center. A copy of the fee policies and financial agreements shall be provided to each parent at the time a child is admitted to the center.  g.  Develop and implement a policy for responding to incidents of biting that includes the following elements.  (1)  An explanation of the center’s perspective on biting.   (2)  A description of how the center will respond to individual biting incidents and episodes of ongoing biting.  (3)  A description of how the center will assess the adequacy of caregiver supervision and the context and the environment in which the biting occurred.  (4)  A description of how the center will respond to the individual child or caregiver who was bitten.  (5)  A description of the process for notification of parents of children involved in the incident.  (6)  A description of how the incident will be documented.  (7)  A description of how confidentiality will be protected.  (8)  A description of first-aid procedures that the center will use in response to biting incidents.  h.  Develop a policy to ensure that people do not have unauthorized access to children at the center. The policy shall be subject to review for minimum safety standards by the licensing consultant. The policy shall include but is not limited to the following:  (1)  The center’s criteria for allowing people to be on the property of the facility when children are present.  (2)  A description of how center staff will supervise and monitor people who are permitted on the property of the center when children are present, but who have not been cleared for involvement with child care through the formal record check process as outlined in subrule 109.6(6). The description shall include definitions of “supervision” and “monitoring.”  (3)  A description of how responsibility for supervision and monitoring of people in the center will be delegated to center staff, which includes provisions that address conflicts of interest.  (4)  A description of how the policy will be shared with parents, guardians, and custodians of all children who are enrolled at the center.  i.  Develop and implement a policy for protection of each child’s confidentiality.  109.4(3)    Required postings.    a.  Postings are required for the certificate of license, notice of exposure of children to a communicable disease, and notice of decision to deny, suspend, or revoke the center’s license or reduce the center’s license to a provisional status. The center’s license, reflecting current regulatory status, and all other required postings shall be conspicuously placed at the main entrance to the center. If the center is located in a building used for additional purposes and shares the main entrance to the building, the required postings shall be conspicuously placed in the center in an area that is frequented daily by parents or the public.  b.  Postings are required for mandatory reporter requirements, the notice of availability of the handbook required in subrule 109.4(5), and the program activities and shall be placed in an area that is frequented daily by parents or the public.  109.4(4)    Mandatory reporters.  Requirements and procedures for mandatory reporting of suspected child abuse as defined in Iowa Code section 232.69 shall be posted where they can be read by staff and parents. Methods of identifying and reporting suspected child abuse and neglect shall be discussed with all staff within 30 days of employment.  109.4(5)    Handbook.  A copy of “Child Care Centers and Preschools Licensing Standards and Procedures” shall be available in the child care center, and a notice stating that a copy is available for review upon request from the center director shall be conspicuously posted. The name, office mailing address and telephone number of the child care consultant shall be included in the notice.  109.4(6)    Certificate of license.  The child care license shall be posted in a conspicuous place and shall state the particular premises in which child care may be offered and the number of children who may be cared for at any one time. Notwithstanding the requirements in rule 441—109.8(237A), no greater number of children than is authorized by the license shall be cared for at any one time.Related ARC(s): 8650B, 1209C, 2646C441—109.5(237A)  Parental participation.    109.5(1)    Unlimited access.  Parents shall be afforded unlimited access to their children and to the provider caring for their children during the center’s hours of operation or whenever their children are in the care of a provider, unless parental contact is prohibited by court order. The provider shall inform all parents of this policy in writing at the time the child is admitted to the center.  109.5(2)    Parental evaluation.  If requested by the department, centers shall assist the department in conducting an annual survey of parents being served by their center. The department shall notify centers of the time frames for distribution and completion of the survey and the procedures for returning the survey to the department. The purpose of the survey shall be to increase parents’ understanding of developmentally appropriate and safe practice, solicit statewide information regarding parental satisfaction with the quality of care being provided to children and obtain the parents’ perspective regarding the center’s compliance with licensing requirements.Related ARC(s): 2646C441—109.6(237A)  Personnel.  The board or director of the center shall develop policies for hiring and maintaining staff that demonstrate competence in working with children and that meet the following minimum requirements:  109.6(1)    Center director requirements.  Centers that have multiple sites shall have a center director or on-site supervisor in each center. The center director is responsible for the overall functions of the center, including supervising staff, designing curriculum and administering programs. The director shall ensure services are provided for the children within the framework of the licensing requirements and the center’s statement of purpose and objectives. The center director shall have overall responsibility for carrying out the program and ensuring the safety and protection of the children. Information shall be submitted in writing to the child care consultant prior to the start of employment. Final determination shall be made by the department. Information shall be submitted sufficient to determine that the director meets the following minimum qualifications:  a.  Is at least 21 years of age.  b.  Has obtained a high school diploma or passed a general education development test.  c.  Has completed at least one course in business administration or 12 contact hours in administrative-related training related to personnel, supervision, record keeping, or budgeting or has one year of administrative-related experience.  d.  Has certification in infant, child, and adult cardiopulmonary resuscitation (CPR), first aid, and Iowa’s training for the mandatory reporting of child abuse.  e.  Has achieved a total of 100 points obtained through a combination of education, experience, and child development-related training as outlined in the following chart:EDUCATIONEXPERIENCE(Points multiplied byyears of experience)CHILD DEVELOPMENT-RELATED TRAININGBachelor’s or higher degree in early childhood, child development, or elementary education75Full-time (20 hours or more per week) in a child care center or preschool setting20One point per contact hour of trainingAssociate’s degree in child development or bachelor’s degree in a child-related field50Part-time (less than 20 hours per week) in a child care center or preschool setting10Child development associate (CDA) or one-year diploma in child development from a community college or technical school40Full-time (20 hours or more per week) child development-related experience10Bachelor’s or higher degree in a non-child-related field40Part-time (less than 20 hours per week) child development-related experience5Associate’s degree in a non-child-related field or completion of at least two years of a four-year degree20Registered child development home provider10Nonregistered family home provider5  (1)  In obtaining the total of 100 points, a minimum of two categories must be used, no more than 75 points may be achieved in any one category, and at least 20 points shall be obtained from the experience category.  (2)  Points obtained in the child development-related training category shall have been taken within the past five years.  (3)  For directors in centers predominantly serving children with special needs, the directors may substitute a disabilities-related or nursing degree for the bachelor’s degree in early childhood, child development or elementary education in determining point totals. In addition, experience in working with children with special needs in an administrative or direct care capacity shall be equivalent to full-time experience in a child care center or preschool in determining point totals.  (4)  For directors in centers serving predominantly school-age children, the directors may substitute a degree in secondary education, physical education, recreation or related fields for the bachelor’s degree in early childhood, child development or elementary education in determining point totals. In addition, child-related experience working with school-age children shall be equivalent to full-time experience in a child care center or preschool in determining point totals.  109.6(2)    On-site supervisor.  The on-site supervisor is responsible for the daily supervision of the center and must be on site daily either during the hours of operation that children are present or a minimum of eight hours of the center’s hours of operation. Information shall be submitted in writing to the child care consultant prior to the start of employment. Final determination shall be made by the department. Information shall be submitted sufficient to determine that the on-site supervisor meets the following minimum qualifications:  a.  Is an adult.  b.  Has obtained a high school diploma or passed a general education development test.  c.  Has certification in infant, child, and adult cardiopulmonary resuscitation (CPR), first aid, and Iowa’s mandatory reporting of child abuse.  d.  Has achieved a total of 75 points obtained through a combination of education, experience, and child development-related training as outlined in the following chart:EDUCATIONEXPERIENCE(Points multiplied byyears of experience)CHILD DEVELOPMENT-RELATED TRAININGBachelor’s or higher degree in early childhood, child development, or elementary education75Full-time (20 hours or more per week) in a child care center or preschool setting20One point per contact hour of trainingAssociate’s degree in child development or bachelor’s degree in a child-related field50Part-time (less than 20 hours per week) in a child care center or preschool setting10Child development associate (CDA) or one-year diploma in child development from a community college or technical school40Full-time (20 hours or more per week) child development-related experience10Bachelor’s or higher degree in a non-child-related field40Part-time (less than 20 hours per week) child development-related experience5Associate’s degree in a non-child-related field or completion of at least two years of a four-year degree20Registered child development home provider10Nonregistered family home provider5  (1)  In obtaining the total of 75 points, a minimum of two categories must be used, no more than 50 points may be achieved in any one category, and at least 10 points shall be obtained from the experience category.  (2)  Points obtained in the child development-related training category shall have been taken within the past five years.  (3)  For on-site supervisors in centers predominantly serving children with special needs, the on-site supervisor may substitute a disabilities-related or nursing degree for the bachelor’s degree in early childhood, child development or elementary education in determining point totals. In addition, experience in working with children with special needs in an administrative or direct care capacity shall be equivalent to full-time experience in a child care center or preschool in determining point totals.  (4)  For on-site supervisors in centers serving predominantly school-age children, the on-site supervisor may substitute a degree in secondary education, physical education, recreation or related fields for the bachelor’s degree in early childhood, child development or elementary education in determining point totals. In addition, child-related experience working with school-age children shall be equivalent to full-time experience in a child care center or preschool in determining point totals.  109.6(3)    Director and on-site supervisor functions combined.  In a center where the functions of the center director and the on-site supervisor are accomplished by the same person, the educational and experience requirements for a center director shall apply. If the center director is serving in the role of the on-site supervisor, the director shall be on site daily either during the hours of operation or a minimum of at least eight hours of the center’s hours of operation. If the staff person designated as the on-site supervisor is temporarily absent from the center, another responsible adult staff shall be designated as the interim on-site supervisor.  109.6(4)    Transition period for staff.  Rescinded IAB 8/3/16, effective 10/1/16.  109.6(5)    Volunteers.  A volunteer shall be at least 16 years of age. All volunteers shall:  a.  Sign a statement indicating whether or not they have one of the following:  (1)  A conviction of any law in any state or any record of founded child abuse or dependent adult abuse in any state.  (2)  A communicable disease or other health concern that could pose a threat to the health, safety, or well-being of the children.  b.  Sign a statement indicating the volunteer has been informed of the volunteer’s responsibilities as a mandatory reporter.  c.  Undergo the record check process when any of the following criteria are met:  (1)  The volunteer is included in meeting the required child-to-staff ratio;  (2)  The volunteer has direct responsibility for a child or children; or  (3)  The volunteer has access to a child or children with no other staff present.  d.  Have on file at the facility a record containing the statements required in paragraphs 109.6(5)“a” and “b” and documentation of any record check process. The record shall be maintained as required in paragraph 109.9(1)“b.”  109.6(6)    Record checks.    a.    Applicability.    (1)  Criminal and child abuse record checks shall be conducted for:
    1. Each owner, director, staff member, volunteer, or subcontracted staff person with direct responsibility for child care or with access to a child when the child is alone;
    2. Anyone living in the child care facility who is 14 years of age or older.
      (2)  Parents, guardians, and custodians are exempt from the record check process in relation to access to their own children or wards.  (3)  Professional staff who hold a current, valid license issued by the educational examiners board are exempt from the record check process in relation to children in the center to whom they provide professional services consistent with Iowa Code chapter 272 and rules adopted by the educational examiners board.      b.    Authorization.  A requesting entity shall request a record check evaluation prior to the employment of a person subject to record checks. The person subject to record checks shall complete the DHS criminal history record check form and any other forms required by the department of public safety to authorize the release of records.  c.    Iowa records checks.  Checks and evaluations of Iowa child abuse and criminal records, including the sex offender registry, shall be completed before the person’s involvement with child care at the center. Iowa records checks shall be repeated at a minimum of every two years and when the department or the center becomes aware of any possible transgressions. The department is not responsible for the cost of conducting the Iowa records check.  (1)  The child care center may access the single-contact repository (SING) as necessary to conduct a criminal and child abuse record check of the person in Iowa. If the results of the check indicate a potential transgression, the center shall send a copy of the results to the department for determination of whether or not the person may be involved with child care, regardless of the person’s status with the center.  (2)  Unless a record check has already been conducted in accordance with subparagraph (1), the department shall conduct a criminal and child abuse record check in Iowa for a person who is subject to a record check. When the department conducts the records check, the fee shall be $35 for each record check. The center shall submit the fee before the department initiates the record check process. Payment must be in the form of cash, check, money order, or cashier’s check. The department may access SING to conduct the records check. The department may also conduct dependent adult abuse, sex offender, and other public or civil offense record checks in Iowa for a person who is subject to a record check.  (3)  Centers that participate in student intern programs may seek a waiver for substitution of the state record check process with a check performed by the student’s educational institution. Requests for a waiver shall be submitted on Form 470-4893, Record Check Waiver, to the address listed on the form.  d.    National criminal history checks.  National criminal history checks based on fingerprints are required for all persons subject to record checks. The national criminal history check shall be repeated for each person every four years and when the department or center becomes aware of any new transgressions committed by that person in another state. The department is not responsible for the cost of conducting the national criminal history check.  (1)  The child care center is responsible for obtaining the fingerprints of all persons subject to record checks. Fingerprints may be taken by law enforcement agencies, by agencies or companies that specialize in taking fingerprints, or by center staff or subcontractors who have received appropriate training in the taking of fingerprints.   (2)  If the results of the Iowa records checks do not warrant prohibition of the person’s involvement with child care or otherwise present protective concerns, the person may be involved with child care on a provisional basis until the national criminal history check and evaluation have been completed.  (3)  The child care center shall provide fingerprints to the department of public safety prior to a person’s involvement with child care at the center. The center shall submit the fingerprints on forms or in a manner allowed by the department of public safety.  (4)  Centers that are required to submit fingerprint-based checks of the FBI national criminal database to comply with federal regulations may seek a waiver to substitute that record check for the procedure required in this subrule. Requests for a waiver shall be submitted on Form 470-4893, Record Check Waiver, to the address listed on the form.  (5)  Centers that participate in student intern programs may seek a waiver to substitute the fingerprint-based check of the FBI national criminal database performed by the student’s educational institution for the procedure required in this subrule. Requests for a waiver shall be submitted on Form 470-4893, Record Check Waiver, to the address listed on the form.  (6)  A center considering involvement of a person who has had a national criminal history check at another center may request information from that center. That center may provide the following information in writing upon a center’s request, using Form 470-4896, National Criminal History Check Confirmation:
    1. Date of most recent national criminal history check conducted by the center on the person in question, and
    2. Whether or not the national check process resulted in clearance of the person for involvement with child care.
      (7)  If the results of the national criminal history check indicate that the person has committed a transgression, the center, if interested in continuing the person’s involvement in child care, shall send a copy of the results to the department for evaluation. The department shall determine whether or not the person may be involved with child care.  (8)  A center shall submit all required fingerprints to the department of public safety before the issuance or renewal of the center’s license.      e.    Mandatory prohibition.  A person with any of the following convictions or founded abuse reports is prohibited from involvement with child care:  (1)  Founded child or dependent adult abuse that was determined to be sexual abuse.  (2)  A requirement to be listed on any state sex offender registry or the national sex offender registry.  (3)  Any of the following felony convictions:  1.  Child endangerment or neglect or abandonment of a dependent person.  2.  Domestic abuse.  3.  Crime against a child including, but not limited to, sexual exploitation of a minor.  4.  Forcible felony.  5.  Arson.  (4)  A record of a misdemeanor conviction of a crime against a child that constitutes one of the following offenses:  1.  Child abuse.  2.  Child endangerment.  3.  Sexual assault.  4.  Child pornography.  (5)  If a person subject to a record check refuses to consent to a record check, the person shall be prohibited from involvement with child care.  (6)  If a person has been convicted of a crime and makes what the person knows to be a false statement of material fact in connection with the conviction or record check, the person shall be prohibited from involvement with child care.  f.    Mandatory time-limited prohibition.    (1)  A person with the following convictions or founded abuse reports is prohibited from involvement with child care for five years from the date of the conviction or founded abuse report:
    1. Conviction of a controlled substance offense under Iowa Code chapter 124.
    2. Founded child abuse that was determined to be physical abuse.
      (2)  After the five-year prohibition period imposed pursuant to 109.6(6)“f”(1), the person may request the department to perform an evaluation under paragraph 109.6(6)“g” to determine whether prohibition of the person’s involvement with child care continues to be warranted.      g.    Evaluation required.  For all other transgressions, and as requested under subparagraph 109.6(6)“f”(2), the department shall notify the requesting entity that an evaluation shall be conducted to determine whether prohibition of the person’s involvement with child care is warranted.  (1)  The person with the transgression shall complete the record check evaluation form. The requesting entity shall provide the form and any other documents to the department within ten calendar days of the date on the form. The department shall use the information the person with the transgression provides on this form to assist in the evaluation. Failure of the person with the transgression to complete and the requesting entity to return this form by the specified date shall result in denial or revocation of the license or denial of employment. The department shall not process evaluations that are not signed by the person subject to an evaluation.  (2)  The department may use information from the department’s case records in performing the evaluation.  (3)  The requesting entity may provide, or the department may request from the person subject to an evaluation or from the requesting entity, information to assist in performance of the evaluation that includes, but is not limited to, the following:
    1. Documentation of criminal justice proceedings.
    2. Documentation of rehabilitation.
    3. Written employment references or applications.
    4. Documentation of substance abuse education or treatment.
    5. Criminal history records, child abuse information, and dependent adult abuse information from other states.
    6. Documentation of the person’s prior residences.
      (4)  Any person or agency that might have pertinent information regarding criminal or abuse history and rehabilitation of the prospective employee may be contacted.  (5)  In an evaluation, the department shall consider all of the following factors:
    1. The nature and seriousness of the transgression in relation to the position sought or held.
    2. The time elapsed since the commission of the transgression.
    3. The circumstances under which the transgression was committed.
    4. The degree of rehabilitation.
    5. The likelihood that the person will commit the transgression again.
    6. The number of transgressions committed by the person.
      (6)  When a person subject to a record check has a transgression that has been determined in a previous evaluation not to warrant prohibition of the person’s involvement with child care and has no subsequent transgressions, an exemption from reevaluation of the latest record check is authorized. The person may commence employment with another child care facility in accordance with the department’s previous evaluation. The exemption is subject to all of the following conditions:
    1. The person’s position with the subsequent employer is substantially the same or has the same job responsibilities as the position for which the previous evaluation was performed.
    2. Any restrictions placed on the person’s employment by the department in the previous evaluation shall remain applicable in the person’s subsequent employment.
    3. The person subject to the record check has maintained a copy of the previous evaluation and provides the evaluation to the subsequent employer, or the previous employer provides to the subsequent employer the previous evaluation from the person’s personnel file pursuant to the person’s authorization. If a physical copy of the previous evaluation is not provided to the subsequent employer, the record check shall be reevaluated.
    4. The subsequent employer may request a reevaluation of the record check and may employ the person while the reevaluation is being performed.
      h.    Evaluation decision.  Within 30 days of receipt of a completed record check evaluation, the department shall make a decision on the person’s involvement with child care. The department has final authority in determining whether prohibition of the person’s involvement with child care is warranted and in developing any conditional requirements and corrective action plan under this paragraph.  (1)  The department shall mail to the requesting entity and the person on whom the evaluation was completed the record check decision that explains the decision reached regarding the evaluation of the transgression.  (2)  If the department determines through an evaluation of a person’s transgressions that the person’s prohibition of involvement with child care is warranted, the person shall be prohibited from involvement with child care. The department may identify a period of time after which the person may request that another record check and evaluation be performed.  (3)  The department may permit a person who is evaluated to maintain involvement with child care if the person complies with the department’s conditions and corrective action plan relating to the person’s involvement with child care.  (4)  The department shall send a letter to the employer that informs the employer whether the person subject to an evaluation has been approved or denied involvement with child care. If the person has been approved, the letter shall inform the employer of any conditions and corrective action plan relating to the person’s involvement with child care.  (5)  The department shall reevaluate any transgressions where a state or federal law change requires different considerations of the transgression than had been previously applied.  i.    Notice to parents.  The administrator of the department shall notify the parents, guardians, and legal custodians of each child for whom the person provides child care if there has been founded child abuse committed by an owner, director, or staff member of the child care center. The center shall cooperate with the department in providing the names and addresses of the parents, guardians, and legal custodians of each child for whom the facility provides child care.      109.6(7)    Use of controlled substances and medications.  All owners, personnel, and volunteers shall be free of the use of illegal drugs and shall not be under the influence of alcohol or of any prescription or nonprescription drug that could impair their ability to function.    Related ARC(s): 8650B, 9441B, 0418C, 1209C, 1809C, 2646C, 4114C, 6023C441—109.7(237A)  Professional growth and development.  The center director, on-site supervisor, and staff counted as part of the staff ratio shall meet the following minimum staff training requirements:  109.7(1)    Required training within the first three months of employment.  During their first three months of employment, all staff shall receive the following training:  a.  Two hours of Iowa’s training for mandatory reporting of child abuse.  b.  At least one hour of training regarding universal precautions and infectious disease control.  c.  Certification in American Red Cross, American Heart Association, American Safety and Health Institute, or MEDIC First Aid infant, child, and adult cardiopulmonary resuscitation (CPR) or equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.  d.  Certification in infant, child, and adult first aid that uses a nationally recognized curriculum or is received from a nationally recognized training organization, including the American Red Cross, American Heart Association, the National Safety Council, the American Safety and Health Institute, or MEDIC First Aid or an equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.  e.  Minimum health and safety trainings, approved by the department, in the following areas:  (1)  Prevention and control of infectious disease, including immunizations.  (2)  Prevention of sudden infant death syndrome and use of safe sleep practices.  (3)  Administration of medication, consistent with standards for parental consent.  (4)  Prevention of and response to emergencies due to food and allergic reactions.  (5)  Building and physical-premises safety, including identification of and protection from hazards that can cause bodily injury, such as electrical hazards, bodies of water, and vehicular traffic.  (6)  Prevention of shaken baby syndrome and abusive head trauma.  (7)  Emergency preparedness and response planning for emergencies resulting from a natural disaster or a human-caused event.  (8)  Handling and storage of hazardous materials and the appropriate disposal of biocontaminants.  (9)  Precautions in transporting children.  (10)  Child development.Minimum health and safety training may be required if content has significant changes which warrant that the training be renewed.  109.7(2)    Center directors and all staff.    a.  During their first year of employment, all center directors and all staff shall receive the following training:  (1)  Ten contact hours of training from one or more of the following content areas:
    1. Planning a safe, healthy learning environment (includes nutrition).
    2. Steps to advance children’s physical and intellectual development.
    3. Positive ways to support children’s social and emotional development (includes guidance and discipline).
    4. Strategies to establish productive relationships with families (includes communication skills and cross-cultural competence).
    5. Strategies to manage an effective program operation (includes business practices).
    6. Maintaining a commitment to professionalism.
    7. Observing and recording children’s behavior.
    8. Principles of child growth and development.
      (2)  Training received for cardiopulmonary resuscitation (CPR), first aid, mandatory reporting of child abuse, and universal precautions shall not count toward the ten contact hours. A provider shall not use a specific training or class to meet minimum continuing education requirements more than one time every three years.  (3)  Staff who have completed a comprehensive training package of at least ten contact hours offered through a child care resource and referral agency or community college within six months prior to initial employment shall have the first year’s ten contact hours of training waived.      b.  Following their first year of employment, all center directors and all staff shall:  (1)  Maintain current certification for Iowa’s training for the mandatory reporting of child abuse; infant, child and adult CPR; and infant, child and adult first aid.  (2)  Receive six contact hours of training annually from one or more of the content areas listed in subparagraph 109.7(2)“a”(1). A provider shall not use a specific training or class to meet minimum continuing education requirements more than one time every five years.  (3)  Center directors and on-site supervisors shall receive eight contact hours of training annually from one or more of the content areas listed in subparagraph 109.7(2)“a”(1).  c.  Initial training obtained as identified in paragraph 109.7(1)“e” may be counted toward annual training hours during the year of employment in which the training is taken.      109.7(3)    Staff employed in centers that operate summer-only programs.  During their first three months of employment, all staff shall receive the following training:  a.  Two hours of Iowa’s training for mandatory reporting of child abuse.  b.  At least one hour of training regarding universal precautions and infectious disease control.  c.  Certification in American Red Cross, American Heart Association, American Safety and Health Institute, or MEDIC First Aid infant, child, and adult cardiopulmonary resuscitation (CPR) or equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.  d.   Certification in infant, child, and adult first aid that uses a nationally recognized curriculum or is received from a nationally recognized training organization, including the American Red Cross, American Heart Association, the National Safety Council, the American Safety and Health Institute, or MEDIC First Aid or an equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.  e.  Minimum health and safety trainings, approved by the department, in the following areas:  (1)  Prevention and control of infectious disease, including immunizations.  (2)  Prevention of sudden infant death syndrome and use of safe sleep practices.  (3)  Administration of medication, consistent with standards for parental consent.  (4)  Prevention of and response to emergencies due to food and allergic reactions.  (5)  Building and physical-premises safety, including identification of and protection from hazards that can cause bodily injury, such as electrical hazards, bodies of water, and vehicular traffic.  (6)  Prevention of shaken baby syndrome and abusive head trauma.  (7)  Emergency preparedness and response planning for emergencies resulting from a natural disaster or a human-caused event.  (8)  Handling and storage of hazardous materials and the appropriate disposal of biocontaminants.  (9)  Precautions in transporting children.  (10)  Child development.  109.7(4)    Training plans.  Training shall supplement the educational and experience requirements in rule 441—109.6(237A) and shall enhance the staff’s skill in working with the developmental and cultural characteristics of the children served.  109.7(5)    Substitution.  A provider who submits documentation from a child care resource and referral agency that the provider has completed the Iowa Program for Infant/Toddler Care (IA PITC), ChildNet, or Beyond Business Basics training series may use those hours to fulfill a maximum of two years’ training requirements, not including first-aid and mandatory reporter training.  109.7(6)    Approved training.    a.  The training must be conducted by a trainer who is employed by or under contract with one of the following entities or who uses curriculum or training materials developed or obtained with the written permission of one of the following entities:  (1)  An accredited university or college.  (2)  A community college.  (3)  Iowa State University Extension.  (4)  A child care resource and referral agency.  (5)  An area education agency.  (6)  The regents’ center for early developmental education at the University of Northern Iowa.  (7)  A hospital (for health and safety, first-aid, and CPR training).  (8)  The American Red Cross, the American Heart Association, the National Safety Council, or Medic First Aid (for first-aid and CPR training).  (9)  An Iowa professional association, including the Iowa Association for the Education of Young Children (Iowa AEYC), the Iowa Family Child Care Association (IFCCA), the Iowa After School Alliance, and the Iowa Head Start Association.  (10)  A national professional association, including the National Association for the Education of Young Children (NAEYC), the National Child Care Association (NCCA), the National Association for Family Child Care (NAFCC), the National After School Association, and the American Academy of Pediatrics.  (11)  The Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).  (12)  The Iowa department of public health, department of education, or department of human services.  (13)  Head Start agencies or the Head Start technical assistance system.  (14)  Organizations that are certified by the International Association for Continuing Education and Training (IACET).  b.  The department will not approve more than eight hours of training delivered in a single day.  c.  The department may randomly monitor any state-approved training for quality control purposes.  d.  Training conducted with staff during the hours of operation of the facility, during staff lunch hours, or while children are resting must not diminish the required staff ratio coverage. Staff shall not be actively engaged in care and supervision and simultaneously participate in training.  e.  A training organization not approved by the department may submit for review to the department a request for child care training approval. All approvals, unless otherwise specified, shall be valid for five years. The department shall issue its decision within 30 business days of receipt of a complete request.  109.7(7)    Elements of training.  Training provided to Iowa child care providers shall offer:  a.  Instruction that is consistent with:  (1)  Iowa child care regulatory standards;  (2)  The Iowa early learning standards; and  (3)  The philosophy of developmentally appropriate practice as defined by the National Association for the Education of Young Children, the Program for Infant/Toddler Care, and the National Health and Safety Performance Standards.  b.  Content equal to at least one contact hour of training.  c.  An opportunity for ongoing interaction and timely feedback, including questions and answers within the contact hours.  d.  A certificate of training for each participant that includes:  (1)  The name of the participant.  (2)  The title of the training.  (3)  The dates of training.  (4)  The content area addressed.  (5)  The name of the training organization.  (6)  The name of the instructor.  (7)  The number of contact hours.  109.7(8)    Training for supervisors and designees.  The director, on-site supervisor, and any person designated a lead in the absence of supervisory staff shall have completed all preservice/orientation training outlined in subrule 109.7(1).    Related ARC(s): 8650B, 2646C, 3095C, 4753C, 5361C, 6023C441—109.8(237A)  Staff ratio requirements.    109.8(1)    Staff requirements.  Persons counted as part of the staff ratio shall meet the following requirements:  a.  Be at least 16 years of age. However, a staff person under the age of 18 may not be the sole provider on the premises of a child care facility.  b.  Be involved with children in programming activities.  c.  At least one staff person on duty in the center when children are present and present on field trips shall be over the age of 18.  d.  Staff persons under the age of 18 shall not provide transportation to children in care.  e.  If staff persons under the age of 18 are providing child care services without an adult, they shall only provide care to school-aged children.  109.8(2)    Staff ratio.  The staff-to-child ratio shall be as follows:Age of childrenMinimum ratio of staff to childrenTwo weeks to two yearsOne to every four childrenTwo yearsOne to every seven childrenThree yearsOne to every ten childrenFour yearsOne to every twelve childrenFive years to ten yearsOne to every fifteen childrenTen years and overOne to every twenty children  a.  Combinations of age groupings for children four years of age and older may be allowed and may have staff ratio determined on the age of the majority of the children in the group.   b.  Combinations of age groupings for children between three years of age and five years of age may be allowed with a ratio of one staff member to every 12 children.  c.  Children between 18 months and three years of age may be combined, if appropriate to the developmental needs of the child. If a child under two years is in a combined age group, the staff ratio of one to seven shall be maintained. Otherwise, staff ratio may be determined by the age of the majority of the children in the group.  d.  Every child-occupied program room shall have supervision present in the room. Brief absences of a staff member may be allowed for no more than five minutes when another staff person is present.  e.  During nap time, at least one staff shall be present in every room where children are resting. Staff ratio requirements may be reduced to one staff per room where children are resting and staff ratio coverage can be maintained in the center. The staff ratio shall always be maintained for children under two years of age.  f.  When more than eight children are present on the licensed premises or are being transported in one vehicle, at least two adult staff shall be present. Only one adult is required when a center is transporting children in a center-owned vehicle with parent authorization for the sole purpose of transporting children to and from school. When a center contracts with another entity to provide transportation other than for the purpose of transporting school-age children to or from school, at least one adult staff in addition to the driver shall be present if at least eight children provided care by the center are transported.  g.  Any child care center-sponsored program activity involving five or more children conducted away from the licensed facility shall provide a minimum of one additional staff over the required staff ratio for the protection of the children.  h.  For a period of two hours or less at the beginning and end of the center’s hours of operation, one staff may care for seven or fewer children, provided no more than four of the children are under the age of two years and there are no more than seven children in the center.  i.  For centers or preschools serving school-age children, the ratio for school-age children may be exceeded for a period of no more than four hours during a day when school classes start late or are dismissed early or canceled due to inclement weather or structural damage provided the children are already enrolled at the center and the center does not exceed the licensed capacity.Related ARC(s): 2646C, 6564C441—109.9(237A)  Records.    109.9(1)    Personnel records.  The center shall maintain personnel information sufficient to ensure that persons employed in the center meet minimum staff and training requirements and do not pose any threat to the health, safety, or well-being of the children. Each employee’s file shall contain, at a minimum, the following:  a.  A statement signed by each individual indicating whether or not the individual has any conviction of violating any law in any state or has any record of founded child abuse or dependent adult abuse in any state.  b.  Copies of all records checks kept in accordance with state and federal law regarding confidentiality of records checks. These records shall include:  (1)  A copy of a DHS criminal history record check form or any other permission form approved by the department of public safety for conducting an Iowa or national criminal history record check.  (2)  A copy of a request for child abuse information form, when applicable.  (3)  Copies of the results of Iowa records checks conducted through the SING for review by the department upon request.  (4)  Copies of national criminal history check results.  (5)  Any department-issued documents sent to the center related to a records check, regardless of findings.  c.  Reserved.  d.  A physical examination report. Personnel shall have good health as evidenced by a preemployment physical examination. Acceptable physical examinations shall be documented on Form 470-5152, Child Care Provider Physical Examination Report. The examination shall be performed within six months prior to beginning employment and shall be repeated at least every three years.  e.  Documentation showing the minimum staff training requirements as outlined at rule 441—109.7(237A) are met, including current certifications in first aid and cardiopulmonary resuscitation (CPR) and Iowa’s training for the mandatory reporting of child abuse.  f.  A photocopy of a valid driver’s license if the staff will be involved in the transportation of children.  109.9(2)    Child’s file.  Centers shall maintain sufficient information in a file for each child, which shall be updated at least annually or when the parent notifies the center of a change or the center becomes aware of a change, to ensure that:  a.  A parent or an emergency contact authorized by the parent can be contacted at any time the child is in the care of the center.  b.  Appropriate emergency medical and dental services can be secured for the child while in the center’s care.  c.  Information is available in the center regarding the specific health and medical needs of a child, including information regarding any professionally prescribed treatment. Information shall include a physical examination report as required at subrule 109.10(1). For a center serving school-age children that operates in the same school facility in which the child attends school, documentation shall include a statement signed by the parent that the immunization information is available in the school file.  d.  A child is released only to authorized persons.  e.  Documentation of injuries, accidents, or other incidents involving the child is maintained.  f.  Parent authorization is obtained for a child to attend center-sponsored field trips and non-center activities. If parental authorization is obtained on an authorization form inclusive of all children participating in the activity, the authorization form shall be kept on file at the center.  g.  For any child with allergies, a written emergency plan is available in case of an allergic reaction. A copy of this information shall accompany the child if the child leaves the premises.   109.9(3)    Immunization certificates.  Signed and dated Iowa immunization certificates, provided by the state department of public health, shall be on file for each child enrolled as prescribed by the department of public health at 641—Chapter 7.  109.9(4)    Daily activities.  For each child under two years of age, the center shall make a daily written record. At the end of the child’s day at the center, the daily written record shall be provided verbally or in writing to the parent or the person who removes the child from the center. The record shall contain information on each of these areas:  a.  The time periods in which the child has slept.  b.  The amount of food consumed and the times at which the child has eaten.  c.  The time of and any irregularities in the child’s elimination patterns.  d.  The general disposition of the child.  e.  A general summary of the activities in which the child participated.Related ARC(s): 8650B, 0996C, 2646C, 3095C, 6023C441—109.10(237A)  Health and safety policies.  The child care center shall establish definite health policies, including the criteria for excluding a sick child from the center. The policies shall be consistent with the recommendations of the National Health and Safety Performance Standards and shall include, but are not limited to:  109.10(1)    Physical examination report.    a.    Preschool-age children.  For each child five years of age and younger not enrolled in kindergarten, the child care center shall require an admission physical examination report, submitted within 30 days from the date of admission, signed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner. The date of the physical examination shall be no more than 12 months prior to the first day of attendance at the center. The written report shall include past health history, status of present health including allergies, medications, and acute or chronic conditions, and recommendations for continued care when necessary. Annually thereafter, a statement of health condition, signed by a licensed medical doctor, doctor of osteopathy, physician assistant or advanced registered nurse practitioner, shall be submitted that includes any change in functioning, allergies, medications, or acute or chronic conditions.  b.    School-age children.  For each child five years of age and older and enrolled in school, the child care center shall require, prior to admission, a statement of health status signed by the parent or legal guardian that certifies that the child is free of communicable disease and that specifies any allergies, medications, or acute or chronic conditions. The statement from the parent shall be submitted annually thereafter.  c.    Religious exemption.  Nothing in this rule shall be construed to require medical treatment or immunization for staff or the child of any person who is a member of a church or religious organization which has guidelines governing medical treatment for disease that are contrary to these rules. In these instances, an official statement from the organization shall be incorporated in the personnel or child’s file.  109.10(2)    Medical and dental emergencies.  The center shall have sufficient information and authorization to meet the medical and dental emergencies of children. The center shall have written procedures for medical and dental emergencies and shall ensure, through orientation and training, that all staff are knowledgeable of and able to implement the procedures.  109.10(3)    Medications.  The center shall have written procedures for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications, including the following:  a.  All medications shall be stored in their original containers, with accompanying physician or pharmacist’s directions and label intact and stored so they are inaccessible to children and the public. Nonprescription medications shall be labeled with the child’s name.  b.  For every day an authorization for medication is in effect and the child is in attendance, there shall be a notation of administration including the name of the medicine, date, time, dosage given or applied, and the initials of the person administering the medication or the reason the medication was not given.  c.  In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.  d.  A child care staff member shall not provide medications to a child if the staff member has not completed preservice/orientation training that includes medication administration.  109.10(4)    Daily contact.  Each child shall have direct contact with a staff person upon arrival for early detection of apparent illness, communicable disease, or unusual condition or behavior which may adversely affect the child or the group. The center shall post notice at the main entrance to the center where it is visible to parents and the public of exposure of a child receiving care by the center to a communicable disease, the symptoms, and the period of communicability. If the center is located in a building used for other purposes and shares the main entrance to the building, the notice shall be conspicuously posted in the center in an area that is frequented daily by parents or the public.  109.10(5)    Infectious disease control.  Centers shall establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge or blood. Soiled diapers shall be stored in containers separate from other waste.  109.10(6)    Quiet area for ill or injured.  The center shall provide a quiet area under supervision for a child who appears to be ill or injured. The parents or a designated person shall be notified of the child’s status in the event of a serious illness or emergency.  109.10(7)    Staff hand washing.  The center shall ensure that staff demonstrate clean personal hygiene sufficient to prevent or minimize the transmission of illness or disease. All staff shall wash their hands at the following times:  a.  Upon arrival at the center.  b.  Immediately before eating or participating in any food service activity.  c.  After diapering a child.  d.  Before leaving the rest room either with a child or by themselves.  e.  Before and after administering nonemergency first aid to a child if gloves are not worn.  f.  After handling animals and cleaning cages.  109.10(8)    Children’s hand washing.  The center shall ensure that staff assist children in personal hygiene sufficient to prevent or minimize the transmission of illness or disease. For each infant or child with a disability, a separate cloth for washing and one for rinsing may be used in place of running water. Children’s hands shall be washed at the following times:  a.  Immediately before eating or participating in any food service activity.  b.  After using the rest room or being diapered.  c.  After handling animals.  109.10(9)    First-aid kit.  The center shall ensure that a clearly labeled first-aid kit is available and easily accessible to staff at all times whenever children are in the center, in the outdoor play area, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children.  109.10(10)    Recording incidents.    a.  Incidents involving a child, including minor injuries, minor changes in health status, or other minor behavioral concerns, shall be reported to the parents, guardians, and legal custodians on the day of the incident. Incidents resulting in an injury to a child shall be reported to the parent on the day of the incident.   b.  Incidents resulting in a serious injury, as defined in Iowa Code section 702.18, to a child in the child care facility or in the care of child care facility staff or incidents resulting in a significant change in the health status of a child shall be verbally reported to the parents, guardians, and legal custodians immediately.   (1)  Serious injuries shall be reported to the department within 24 hours of the incident.  (2)  Serious injuries shall be documented and information maintained in the child’s file as required by subrule 109.9(2).  c.  The parents, guardians, and legal custodians of any child included in incidents involving inappropriate, sexually acting-out behavior shall be notified immediately after the incident. A written report fully documenting every incident shall be provided to the parent or person authorized to remove the child from the center. The written report shall be prepared by the staff member who observed the incident, and a copy shall be retained in the child’s file.  109.10(11)    Smoking.  Smoking and the use of tobacco products shall be prohibited at all times in the center and in every vehicle used to transport children. Smoking and the use of tobacco products shall be prohibited in the outdoor play area during hours of operation of the center. Nonsmoking signs shall be posted at every entrance of the child care center and in every vehicle used to transport children. All signs shall include:  a.  The telephone number for reporting complaints, and  b.  The Internet address of the department of public health (smokefreeair.iowa.gov).  109.10(12)    Transportation.  As outlined in Iowa Code section 321.446, all children transported in a motor vehicle subject to registration, except a bus, shall be individually secured by a safety belt, safety seat, or harness in accordance with federal motor vehicle safety standards and the manufacturer’s instructions.  a.  Children under the age of 6 shall be secured during transit in a federally approved child restraint system. Children under 1 year of age and weighing less than 20 pounds shall be secured during transit in a rear-facing child restraint system.  b.  Children under the age of 12 shall not be located in the front seating section of the vehicle.  c.  Drivers of vehicles shall possess a valid driver’s license and shall not operate a vehicle while under the influence of alcohol, illegal drugs, prescription or nonprescription drugs that could impair the drivers’ ability to operate a motor vehicle.  d.  Vehicles that are owned or leased by the center shall receive regular maintenance and inspection according to manufacturer-recommended guidelines for vehicle and tire maintenance and inspection.  109.10(13)    Field trip emergency numbers.  Emergency telephone numbers for each child shall be taken by staff when transporting children to and from school and on field trips and non-center-sponsored activities away from the premises.  109.10(14)    Pets.  Animals kept on site shall be in good health with no evidence of disease, be of such disposition as to not pose a safety threat to children, and be maintained in a clean and sanitary manner. Documentation of current vaccinations shall be available for all cats and dogs. No ferrets, reptiles, including turtles, or birds of the parrot family shall be kept on site. Pets shall not be allowed in kitchen or food preparation areas.  109.10(15)    Emergency plans.    a.  The center shall have written emergency plans and diagrams for responding to fire, tornado, and flood (if area is susceptible to flood), and plans for responding to intruders within the center, intoxicated parents, and lost or abducted children. In addition, the center shall have guidelines for responding or evacuating in case of blizzards, power failures, bomb threats, chemical spills, earthquakes, or other disasters that could create structural damage to the center or pose health hazards. If the center is located within a ten-mile radius of a nuclear power plant or research facility, the center shall also have plans for nuclear evacuations. Emergency plans shall include written procedures including plans for the following:  (1)  Evacuation to safely leave the facility.  (2)  Relocation to a common, safe location after evacuation.  (3)  Shelter-in-place to take immediate shelter when the current location is unsafe to leave due to the emergency issue.  (4)  Lockdown to protect children and providers from an external situation.  (5)  Communication and reunification with parents or other adults responsible for the children which shall include emergency telephone numbers.  (6)  Continuity of operations.  (7)  To address the needs of individual children, including those with functional or access needs.  b.  Emergency instructions, telephone numbers, and diagrams for fire, tornado, and flood (if area is susceptible to floods) shall be visibly posted by all program and outdoor exits. Emergency plan procedures shall be practiced and documented at least once a month for fire and for tornado. Records on the practice of fire and tornado drills shall be maintained for the current and previous year.  c.  The center shall develop procedures for annual staff and volunteer training on these emergency plans and shall include information on responding to fire, tornadoes, intruders, intoxicated parents, and lost or abducted children in the orientation provided to new employees and volunteers.  d.  The center shall conduct a daily check to ensure that all exits are unobstructed.  109.10(16)    Supervision and access.    a.  The center director and on-site supervisor shall ensure that each staff member or volunteer knows the number and names of children assigned to that staff member or volunteer for care. Assigned staff and volunteers shall provide careful supervision.   b.  Any person in the center who is not an owner, staff member, or volunteer who has a record check and department approval to be involved with child care shall not have unrestricted access to children for whom that person is not the parent, guardian, or custodian.  c.  Persons who are exempt from the record check process are granted access in accordance with 109.6(6)“a”(2) unless the provisions of paragraph 109.10(16)“d” apply.  d.  A sex offender who has been convicted of a sex offense against a minor and who is required to register with the Iowa sex offender registry under the provisions contained in Iowa Code chapter 692A shall not operate, manage, be employed by, or act as a contractor or volunteer at a child care center. The sex offender also shall not be present upon the property of a child care center without the written permission of the center director, except for the time reasonably necessary to transport the offender’s own minor child or ward to and from the center.  (1)  Written permission shall include the conditions under which the sex offender may be present, including:
    1. The precise location in the center where the sex offender may be present;
    2. The reason for the sex offender’s presence at the facility;
    3. The duration of the sex offender’s presence;
    4. Description of the supervision that the center staff will provide the sex offender to ensure that no child is alone with the sex offender.
      (2)  Before giving written permission, the center director shall consult with the center licensing consultant. The written permission shall be signed and dated by the center director and the sex offender and kept on file for review by the center licensing consultant.    Related ARC(s): 8650B, 1209C, 2646C, 3095C, 3096C, 6023C441—109.11(237A)  Physical facilities.    109.11(1)    Room size.  The program room size shall be a minimum of 80 square feet of useable floor space or sufficient floor space to provide 35 square feet of useable floor space per child. In rooms where floor space occupied by cribs is counted as useable floor space, there shall be 40 square feet of floor space per child. Kitchens, bathrooms, halls, lobby areas, storage areas and other areas of the center not designed as activity space for children shall not be used as regular program space or counted as useable floor space.  109.11(2)    Infants’ area.  An area shall be provided properly and safely equipped for the use of infants and free from the intrusion of children two years of age and older. Upon the recommendation of a child’s physician or the area education agency serving the child, a child who is two years of age or older with a disability that results in significant developmental delays in physical and cognitive functioning who does not pose a threat to the safety of the infants may, if appropriate and for a limited time approved by the department, remain in the infant area.  109.11(3)    Facility requirements.    a.  The center shall ensure that:  (1)  The facility and premises are sanitary, safe and hazard-free.  (2)  Adequate indoor and outdoor program space that is adjacent to the center is provided. Centers shall have a safe outdoor program area with at least sufficient square footage to accommodate 30 percent of the enrollment capacity at any one time at 75 square feet per child. The outdoor area shall include safe play equipment and an area of shade.  (3)  Sufficient program space is provided for dining to allow ease of movement and participation by children and to allow staff sufficient space to attend to the needs of the children during routine care and emergency procedures.  (4)  Sufficient lighting shall be provided to allow children to adequately perform developmental tasks without eye strain.  (5)  Sufficient ventilation is provided to maintain adequate indoor air quality.  (6)  Sufficient heating is provided to allow children to perform tasks comfortably without excessive clothing.  (7)  Sufficient cooling is provided to allow children to perform tasks without being excessively warm or subject to heat exposure.  (8)  Sufficient bathroom and diapering facilities are provided to attend immediately to children’s toileting needs and maintained to reduce the transmission of disease.  (9)  Equipment, including kitchen appliances, placed in a program area is maintained so as not to result in burns, shock or injury to children.  (10)  Sanitation and safety procedures for the center are developed and implemented to reduce the risk of injury or harm to children and reduce the transmission of disease.  b.  Approval may be given by the department to waive the outdoor space requirement for programs of three hours or less, provided there is suitable substitute space and equipment available.  c.  Approval may be given by the department for centers operating in a densely developed area to use alternative outdoor play areas in lieu of adjacent outdoor play areas.  d.  The director or designated person shall complete and keep a record of at least monthly inspections of the outdoor recreation area and equipment for the purpose of assessing and rectifying potential safety hazards. If the outdoor play area is not used for a period of time due to inclement weather conditions, the center shall document the reasons why the monthly inspection did not occur and shall complete and document an inspection prior to resuming use of the area.  e.  Centers that operate in a public school building, including before and after school programs and summer programs serving school-age children, may receive limited exemption from a facility requirement at subrule 109.11(3), particularly relating to ventilation and bathroom facilities, if complying with the requirement would require a structural or mechanical change to the school building. Centers shall ensure that the space occupied by the center is sanitary, safe, and hazard-free and shall conduct monthly playground inspections or provide documentation that one has been completed by the public school personnel.  109.11(4)    Bathroom facilities.  At least one functioning toilet and one sink for each 15 children shall be provided in a room with natural or artificial ventilation. Training seats or chairs may be used for children under two years of age. New construction after November 1, 1995, shall provide for at least one sink in the same area as the toilet and, for centers serving children two weeks to two years of age, shall provide for at least one sink in the central diapering area. At least one sink shall be provided in program rooms for infants and toddlers or in an adjacent area other than the kitchen. New construction after April 1, 1998, shall have at least one sink provided in the program rooms for infants and toddlers.  109.11(5)    Telephone.  A working nonpay telephone shall be available in the center with emergency telephone numbers for police or 911, fire, ambulance, and poison information center posted adjacent to the telephone. The street address and telephone number of the center shall be included in the posting. A separate file or listing of emergency telephone numbers for each child shall be maintained near the telephone.  109.11(6)    Kitchen appliances and microwaves.  Gas or electric ranges or ovens shall not be placed in the program area. If kitchen appliances are maintained in the program area for food preparation activities, the area shall be sectioned off and shall not be counted as useable floor space for room size. Centers using microwave ovens for warming infant bottles or infant food shall ensure that the formula or food item is not served immediately to the child after being removed from the microwave. The infant bottle shall be shaken or food stirred and the formula or food item tested by the caregiver before being fed to the infant. Breast milk shall not be warmed in a microwave.  109.11(7)    Environmental hazards.    a.  Within one year of being issued an initial or renewal license, centers operating in facilities built prior to 1978 shall conduct a visual assessment for lead hazards that exist in the form of peeling, cracking or chipping paint or painted surfaces in need of repair. If these lead hazards are found, it shall be assumed that lead-based paint is present on the surfaces, and the surfaces shall be repaired by an Iowa certified lead-safe renovator before a full license will be issued.   b.  Within one year of being issued an initial or renewal license, centers operating in facilities that are at ground level, use a basement area as program space, or have a basement beneath the program area shall have radon testing performed as prescribed by the state department of public health at 641—Chapter 43. Retesting shall be accomplished at least every two years from the date of the initial measurement. If testing determines confirmed radon gas levels in excess of 4.0 picocurie per liter, a plan using radon mitigation procedures established by the state department of public health shall be developed with and approved by the state department of public health prior to a full license being issued.  c.  To reduce the risk of carbon monoxide poisoning, all centers shall, on an annual basis prior to the heating season, have a professional inspect all fuel-burning appliances, including oil and gas furnaces, gas water heaters, gas ranges and ovens, and gas dryers, to ensure the appliances are in good working order with proper ventilation. All centers shall install one carbon monoxide detector on each floor of the center that is listed with Underwriters Laboratory (UL) as conforming to UL Standard 2034.  d.  Centers that operate before and after school programs and summer-only programs that serve only school-age children and that operate in a public school building are exempted from testing for lead, radon, and carbon monoxide.Related ARC(s): 6023C, 6564C441—109.12(237A)  Activity program requirements.    109.12(1)    Activities.  The center shall have a written curriculum or program structure that uses developmentally appropriate practices and a written program of activities planned according to the developmental level of the children. The center shall post a schedule of the program in a visible place. The child care program shall complement but not duplicate the school curriculum. The program shall be designed to provide children with:  a.  A curriculum or program of activities that promotes self-esteem and positive self-image; social interaction; self-expression and communication skills; creative expression; and problem-solving skills.  b.  A balance of active and quiet activities; individual and group activities; indoor and outdoor activities; and staff-initiated and child-initiated activities.  c.  Activities which promote both gross and fine motor development.  d.  Experiences in harmony with the ethnic and cultural backgrounds of the children.  e.  A supervised nap or quiet time for all children under the age of six not enrolled in school who are present at the center for five or more hours.  109.12(2)    Discipline.  The center shall have a written policy on the discipline of children which provides for positive guidance, with direction for resolving conflict and the setting of well-defined limits. The written policy shall be provided to staff at the start of employment and to parents at time of admission. The center shall not use as a form of discipline:  a.  Corporal punishment including spanking, shaking, and slapping.  b.  Punishment which is humiliating or frightening or which causes pain or discomfort to the child. Children shall never be locked in a room, closet, box or other device. Mechanical restraints shall never be used as a form of discipline. When restraints are part of a treatment plan for a child with a disability authorized by the parent and a psychologist or psychiatrist, staff shall receive training on the safe and appropriate use of the restraint.  c.  Punishment or threat of punishment associated with a child’s illness, lack of progress in toilet training, or in connection with food or rest.  d.  No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child’s family.  109.12(3)    Policies for children requiring special accommodations.  Reasonable accommodations, based on the special needs of the child, shall be made in providing care to a child with a disability. Accommodation can be a specific treatment prescribed by a professional or a parent, or a modification of equipment, or removal of physical barriers. The accommodation shall be recorded in the child’s file.  109.12(4)    Play equipment, materials and furniture.  The center shall provide sufficient and safe indoor play equipment, materials, and furniture that conform with the standards or recommendations of the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products. Play equipment, materials, and furniture shall meet the developmental, activity, and special needs of the children.Rooms shall be arranged so as not to obstruct the direct observation of children by staff. Individual covered mats, beds, or cots and appropriate bedding shall be provided for all children who nap. The center shall develop procedures to ensure that all equipment and materials are maintained in a sanitary manner. Sufficient spacing shall be maintained between equipment to reduce the transmission of disease, to allow ease of movement and participation by children and to allow staff sufficient space to attend to the needs of the children during routine care and emergency procedures. The center shall provide sufficient toilet articles for each child for hand washing. Parents may provide items for oral hygiene (if appropriate to the developmental age and needs of the child). The center shall ensure that sanitary procedures are followed for use and storage of the articles.  109.12(5)    Infant environment.  A child care center serving children two weeks to two years old must provide an environment which protects the children from physical harm, but is not so restrictive as to inhibit physical, intellectual, emotional, and social development.  a.  Stimulation shall be provided to each child through being held, rocked, played with and talked with throughout the time care is provided. Insofar as possible, the same adult should provide complete care for the same child.  b.  Each infant and toddler shall be diapered in a sanitary manner as frequently as needed at a central diapering area. Diapering, sanitation, and hand-washing procedures shall be posted and implemented in every diapering area. There shall be at least one changing table for every 15 infants.  c.  Highchairs or hook-on seats shall be equipped with a safety strap which shall be engaged when the chair is in use and shall be constructed so the chair will not topple.  d.  Safe, washable toys, large enough so they cannot be swallowed and with no removable parts, shall be provided. All hard-surface toys used by children shall be sanitized daily.  e.   The provider shall follow safe sleep practices as recommended by the American Academy of Pediatrics for infants under the age of one. Requirements are as follows:   (1)  Infants shall always be placed on their backs for sleep.  (2)  Infants shall be placed on a firm mattress with a tight fitted sheet that meets U.S. Consumer Product Safety Commission federal standards.  (3)  Infants shall not be allowed to sleep on a bed, sofa, air mattress or other soft surface. No child shall be allowed to sleep in any item not designed for sleeping including, but not limited to, an infant seat, car seat, swing, or bouncy seat.  (4)  No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose bedding shall be allowed in the sleeping area with the infant.  (5)  No co-sleeping shall be allowed.  (6)  Sleeping infants shall be actively observed by sight and sound.  (7)  If an alternate sleeping position is needed, a signed physician or physician assistant authorization with statement of medical reason is required.  f.  A crib or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards or recommendations from the Consumer Product Safety Commission or ASTM International for juvenile products shall be provided for each child under two years of age if developmentally appropriate. Crib railings shall be fully raised and secured when the child is in the crib. A crib or criblike furniture shall be provided for the number of children present at any one time. The center shall develop procedures for maintaining all cribs or criblike furniture and bedding in a clean and sanitary manner. There shall be no restraining devices of any type used in cribs.  g.  Infant walkers shall not be used.  h.  For programs operating five hours or less on a daily basis, the center shall have a sufficient number of cribs or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards from the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products for children who may nap during the time in attendance. Cribs or criblike furniture shall be used by only one child at a time and shall be maintained in a clean and sanitary manner.  i.  All items used for sleeping must be used in compliance with manufacturer standards for age and weight of the child.Related ARC(s): 2646C, 3556C441—109.13(237A)  Extended evening care.  A center providing extended evening care shall comply with the licensing requirements for centers contained in Iowa Code chapter 237A and this chapter, with the additional requirements set forth below.  109.13(1)    Facility requirements.    a.  The center shall ensure that sufficient cribs, beds, cots and bedding are provided appropriate to the child’s age and that sufficient furniture, lighting, and activity materials are available for the children. Equipment and materials shall be maintained in a safe and sanitary manner.  b.  The center shall ensure that a separate space is maintained for school-age boys and girls to provide privacy during bathroom and bedtime activities. Bathroom doors used by children shall be nonlockable.  c.  The center shall ensure that parents have provided the personal effects needed to meet their child’s personal hygiene and prepare for sleep. The center shall supplement those items needed for personal hygiene which the parent does not provide. The center shall obtain written information from the parent regarding the child’s snacking, toileting, personal hygiene and bedtime routines.  109.13(2)    Activities.    a.  Evening activities shall be primarily self-selected by the child.  b.  Every child-occupied room except those rooms used only by school-age children for sleeping shall have adult supervision present in the room. Staff counted for purposes of meeting child-to-staff ratios shall be present and awake at all times. In rooms where only school-age children are sleeping, visual monitoring equipment may be used. If a visual monitor is used, the monitoring must allow for all children to be visible at all times. Staff shall be present in the room with the monitor and shall enter the room used for sleeping to conduct a check of the children every 15 minutes.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; two hours’ training in child abuse identification and reporting, as required by Iowa Code section 232.69, within the first six months of employment and every three years thereafter; and maintenance of a valid certificate indicating expiration date.  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.Related ARC(s): 5361C441—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.These rules are intended to implement Iowa Code section 232.69 and chapter 237A.    Related ARC(s): 8650B, 9441B, 0030C, 0418C, 0996C, 1209C, 1809C, 2169C, 2646C, 3095C, 3096C, 3555C, 3556C, 4114C, 4752C, 4753C, 4973C, 5361C, 6023C, 6564C