(a) Staff-to-child ratio, 20 CAR § 1025-401.

1. (1) The following ratios shall be maintained at all times:

   1. (A) Infant and toddler. One-to-three (1:3), maximum group size = six (6); and
   2. (B) Preschool and school-age. One-to-five (1:5), maximum group size = ten (10).
2. (2) Staff shall be separated in the same manner children are separated to prevent cross-infection.

(b) Director.

1. (1)

   1. (A) If the component is part of a childcare facility, the program director shall be accountable to the facility director.
   2. (B) If the component is an entity unto itself the program director may also be the facility director.

2. (2) The program director shall have completed the following training:

   1. (A) Communicable disease control;
   2. (B) Recognition and care of usual childhood illness;
   3. (C) Cardiopulmonary resuscitation (CPR) certification; and
   4. (D) First aid certification.

(c) Program requirements, 20 CAR § 1025-501.

1. (1) Children shall be provided with quiet activities according to their age and abilities.

2. (2) Caregivers shall:

   1. (A) Administer medicine according to prescribed instructions;
   2. (B) Take temperature frequently or as needed;
   3. (C) Monitor any changes in condition;
   4. (D) Record necessary medical, physiological data, or changes; and
   5. (E) Notify parents immediately if their child’s condition changes significantly for the worse, especially if the condition meets one (1) of the excludable diseases or symptoms.
3. (3) The child shall be removed immediately from sick care when his or her condition meets one (1) of the excludable diseases or symptoms.

4. (4) Children may be returned to regular day care when:

   1. (A) A doctor’s statement has been obtained; or
   2. (B) The child is free of symptoms for twenty-four (24) hours.

(d) Children’s records, 20 CAR § 1025-704.

1. (1) The record shall contain information on the specific condition or illness placing the child in sick care.
2. (2) The record shall contain any recommendations for needed medical treatment and program or environment modifications that the child needs.

(e) Building requirements, 20 CAR § 1025-901.

1. (1) If located in the same facility as day care, sick care shall be separate with a separate entrance and separate ventilation system.

2. (2)

   1. (A) Children with respiratory illnesses shall be cared for in a separate space from children with gastrointestinal illness.
   2. (B) Any child with an undiagnosed condition shall be separated from other children to prevent cross-infection.
   3. (C) A separate area can be defined by curtains, partitions, etc., if airborne transmission is not likely.
3. (3) A hand-washing sink shall be available in each room.
4. (4) To prevent cross-contamination, a designated toilet shall be available to each sick care room.
5. (5) The facility shall be self-contained, i.e., food, water, bedding, toileting (no potty chairs), etc.

(f) Furniture and equipment requirements, 20 CAR § 1025-1101.

1. (1) No furniture, fixtures, equipment, and supplies designated for use in the sick care component shall be used or shared by well children.

2. (2)

   1. (A) All laundry shall be washed each day.
   2. (B) The items shall be placed in a plastic bag and labeled “contaminated” so necessary precautions can be taken.
3. (3) All toys and equipment shall be disinfected after every use.

(g) General health requirements, 20 CAR § 1025-1201.

1. (1) Tables of communicable diseases and symptoms that exclude children from sick care (asterisk denotes reportable diseases):

   	Communicable Diseases: RESPIRATORY ILLNESSChicken Pox	GASTROINTESTINAL ILLNESSGiardia Lamblia*	CONTACTImpetigo
   	German Measles	Hepatitis A*	Lice
   	Hemophilus influenza	Salmonella*	Scabies
   	Measles*	Shigella*
   	Meningococcus*
   	Mumps*
   	Strep throat
   	Tuberculosis*
   	Whooping Cough*

2. (2)

   1. (A) A symptom is a condition that indicates an illness that may not be identifiable by one (1) of the above listed names but presents a situation where the child:

(i) Shall not be admitted to or remain in sick care; and

1. (ii) Should be seen by the family physician.

   1. (B) Symptoms that exclude children from sick care:

      1. (i) Diarrhea:

(b) (b) Accompanied by history of poor fluid intake or marked lethargy;

1. (c) (c) With blood or mucous in the stool unless at least one (1) stool culture shows the absence of:
2. (1) (1) Salmonella;
3. (2) (2) Shigella;
4. (3) (3) Campylobacter; or

5. (4) (4) E. coli;

   1. (d) (d) That exceeds five (5) bowel movements in an eight-hour period or is continued over three (3) or four (4) days unless the child is under the supervision of a physician with written documentation;

      1. (ii) Vomiting for over a six-hour period;
      2. (iii) Difficult or rapid breathing;
      3. (iv) Severe coughing: episodes of coughing which may lead to:

(b) (b) Vomiting; or

1. (c) (c) Difficulty breathing;

   1. (v) Mucous (phlegm) that is foul smelling, yellow, or green, and the child has a fever over one hundred two degrees Fahrenheit (102° F);

      1. (vi) Asthmatics with severe upper respiratory infections:

(b) (b) Whose distress is not controlled by medication;

1. (vii) Sore throat and fever greater than one hundred three degrees Fahrenheit (103° F) or confirmed strep throat until treated with antibiotics for over twenty-four (24) hours;

   1. (viii) Skin conditions that have not been diagnosed as noncontagious by a physician, including but not limited to:

(b) (b) Child in contagious stages of:

1. (1) (1) Chicken pox;
2. (2) (2) Measles;
3. (3) (3) Mumps; or

4. (4) (4) Rubella;

   1. (c) (c) Untreated impetigo;

      1. (d) (d) Untreated scabies or head lice; and

(e) (e) Blood-red rashes and skin conditions with spontaneous bruising;

1. (ix) Children who are in the contagious states of:

(b) (b) Diphtheria; or

1. (c) (c) Tuberculosis;

   1. (x) Pink or red eye or eyes which may be swollen with white or yellow discharge until on antibiotics for over twenty-four (24) hours;

      1. (xi) Abdominal pain that is intermittent or persistent; and
      2. (xii) Fever over one hundred two degrees Fahrenheit (102° F) for more than twenty-four (24) hours, or any fever over one hundred three degrees Fahrenheit (103°F) unless the child: