(b)

1. (1) The parent or legal guardian shall be notified as soon as possible when a participant has any symptom that requires exclusion from the facility.
2. (2) The participant shall be separated from other participants and closely monitored until the parent arrives to pick the participant up.

(c) The caregiver should determine if the illness:

1. (1) Prevents the participant from participating comfortably in activities;
2. (2) Results in a greater need for care than the childcare staff can provide without compromising the health and safety of the other participants; or
3. (3) Poses a risk of spread of harmful diseases to others.

(d) The caregiver shall temporarily exclude the participant from care if the participant has:

1. (1) A sudden change in behavior, such as:

   1. (A) Lethargy or lack of responsiveness;
   2. (B) Unexplained irritability or persistent crying;
   3. (C) Difficult breathing; or
   4. (D) A quickly spreading rash;

2. (2) Fever over one hundred one degrees (101°) oral or one hundred degrees (100°) axillary, or equivalent method, in a participant who also has:

   1. (A) Pain;
   2. (B) Behavior changes; or
   3. (C) Other symptoms of illness;

3. (3)

   1. (A) “Diarrhea” means watery and runny stools, if frequency:

(i) Exceeds two (2) or more stools above normal for that participant; and

1. (ii) Is not related to a change in diet or medication.

   1. (B) Exclusion from the out-of-school time (OST) program is required if diarrhea:

      1. (i) Cannot be contained in the diaper; or
      2. (ii) Is causing soiled clothing in toilet-trained participants;
2. (4) Blood or mucus in stools, unless caused by hard stools;
3. (5) Vomiting illness (two (2) or more episodes of vomiting in the previous twenty-four (24) hours);
4. (6) Abdominal pain that lasts more than two (2) hours;
5. (7) Mouth sores with drooling;
6. (8) Rash with fever or behavior change;

7. (9)

   1. (A) Conjunctivitis or pinkeye, with white, yellow, or green eye discharge and red (bloodshot) eyes.

   2. (B) Exclude only if:

      1. (i) Participant has fever;
      2. (ii) Participant has eye pain;
      3. (iii) Participant has redness or swelling of the skin around the eyes; or
      4. (iv) More than one (1) participant in the program has symptoms;
8. (10) Pediculosis (head lice), until after the first treatment;
9. (11) Active tuberculosis, until a healthcare provider or health official states that the participant is on appropriate therapy and can attend the OST program;
10. (12) Impetigo, until treatment has been started;
11. (13) Strep throat, until twenty-four (24) hours after antibiotic treatment has been started;
12. (14) Chicken pox, until all lesions have crusted, usually six (6) days after the rash appears;
13. (15) Rubella, until six (6) days after onset of rash;
14. (16) Pertussis (whooping cough), until five (5) days of antibiotic treatment;
15. (17) Mumps, until five (5) days after onset of gland swelling;
16. (18) Measles, until four (4) days after onset of rash; and

17. (19) Hepatitis A, until:

    1. (A) One (1) week after onset of illness; or
    2. (B) As directed by the Department of Health.

(e)

1. (1) Any participant who is injured shall have immediate attention.
2. (2) Parents shall be notified of all injuries.
3. (3) Injuries that require the attention of medical personnel shall be reported to the parent immediately and to the Child Care Licensing Unit within one (1) business day.

(h)

1. (1) Medication shall be given to participants only with signed parental permission that includes:

   1. (A) Date;
   2. (B) Type;
   3. (C) Drug name;
   4. (D) Time;
   5. (E) Dosage;
   6. (F) Length of time to give medication; and
   7. (G) What the medication is being given for.

2. (2) It shall:

   1. (A) Be in the original container with a child resistant cap;
   2. (B) Not have an expired date; and
   3. (C) Be labeled with the participant’s name.

3. (3)

   1. (A) Aspirin substitutes, such as ibuprofen and acetaminophen, may be provided by the facility if parental permission has been granted.
   2. (B) These medications shall be in the original container.

4. (4) Staff shall not dispense medications in dosages that exceed the recommendations stated on the medication bottle.

   1. (i)
5. (1) Participants with special healthcare needs (ex. asthma, seizures, diabetes, etc.) who require scheduled daily medications or medications to be given on an emergent basis (Benadryl, EpiPen, rescue asthma medication, etc.) shall have a care plan.
6. (2) Care plans shall have clearly stated parameters, directions, and symptoms for giving the medications.
7. (3) Care plans shall be updated as needed, but at least yearly.

(k) The staff person who administers the medication shall:

1. (1) Initial the permission slip; and

2. (2) Record the date, time, and dosage of the medication administered.

   1. (l) Medication shall be returned to the parent or disposed of properly when:
3. (1) A participant withdraws from the program; or

4. (2) The medication is out of date.

   1. (m) Medicine shall be stored at the proper temperature, separately from food at all times.

(n)

1. (1) A first-aid supply shall be kept out of reach of the participant.
2. (2) A first-aid kit containing medications shall be locked.

3. (3) This kit shall include the following:

   1. (A) Adhesive Band-Aids, various sizes;
   2. (B) Sterile gauze squares;
   3. (C) Adhesive tape;
   4. (D) Roll of gauze bandages;
   5. (E) Antiseptic;
   6. (F) Thermometer;
   7. (G) Scissors;
   8. (H) Disposable gloves; and
   9. (I) Tweezers.

(o) Medicine shall be:

1. (1) Kept out of the reach of the participants when dispensing; and
2. (2) Stored in a locked area at all other times.

(p)

1. (1) Facilities shall comply with the Arkansas Clean Indoor Air Act of 2006, Arkansas Code § 20-27-1801 et seq.
2. (2) Smoking in an OST program is prohibited at all times.

3. (3) This includes:

   1. (A)

      1. (i) All areas of the facility, regardless of whether participants are in care.
      2. (ii) Includes time periods such as nights, weekends, holidays, etc.
      3. (iii) Also includes office areas or other areas of the facility that share the same ventilation systems;
   2. (B) Outdoor play area or areas;
   3. (C) Other outdoor areas when participants are present; and
   4. (D) In any vehicle used to transport participants, whether participants are present in the vehicle or not.

(q) The facility shall follow any health or medical care plans or medical documentation as provided by the participant’s:

1. (1) Physician;
2. (2) Parent; or
3. (3) Guardian.

(r)

1. (1) Universal precautions shall be used when handling items contaminated by blood.
2. (2) These items shall be disposed of separately and by using rubber gloves that shall be properly disposed of after each use.
3. (3) Note. Hands must be washed even after gloves are used.
4. (4) It is recommended that universal precautions be used when handling and disposing of materials containing bodily secretions such as wet or soiled diapers, fecal matter, etc.

(s)

1. (1) Garbage shall be kept in closed containers.

2. (2) Garbage and trash shall be removed from the:

   1. (A) Program daily; and
   2. (B) Grounds at least once a week.

(t) The facility shall be free of:

1. (1) Insects;
2. (2) Rodents; and
3. (3) Pests.

(u)

1. (1) There shall be no pets or animals allowed that present a health and safety threat.

2. (2) Certification from a licensed veterinarian shall be maintained on-site verifying that dogs and cats have a current vaccination against rabies.

   1. (v)

3. (1) The communicable diseases listed in Appendix A, whether suspected in a participant or an adult, shall be reported within twenty-four (24) hours to either the:

   1. (A) Local county health unit; or
   2. (B) Toll-free reporting system (800-482-8888).

4. (2) Immediate notification is recommended for the following:

   1. (A) Hepatitis;
   2. (B) Rash illness, including measles and rubella;
   3. (C) Whooping cough (pertussis);
   4. (D) Meningitis;
   5. (E) Mumps;
   6. (F) Tuberculosis;
   7. (G) Salmonellas, including typhoid; and
   8. (H) E. coli.

(w) Reporting data should include:

1. (1) The reporter’s:

   1. (A) Name;
   2. (B) Location; and
   3. (C) Phone number;
2. (2) The name of the disease reported and the date of onset;

3. (3)

   1. (A) The patient’s:

      1. (i) Name;
      2. (ii) Address;
      3. (iii) Phone number;
      4. (iv) Age;
      5. (v) Sex; and
      6. (vi) Race.
   2. (B) Please spell the patient’s name;

4. (4) The attending physician’s:

   1. (A) Name;
   2. (B) Location; and
   3. (C) Phone number;

5. (5)

   1. (A) Any pertinent clinical and laboratory information used in the diagnosis.
   2. (B) Please give the laboratory name; and

6. (6) Any treatment information, if known.

   1. (x) It is recommended that all staff members who have direct contact with participants receive annual influenza (flu) immunizations.

(aa)

1. (1) Participants shall be protected from overexposure to the sun.
2. (2) Sunscreen shall be used if needed and as directed by the parent.
3. (3) OST participants may apply sunscreen to themselves with supervision.
4. (4) A blanket permission may be obtained annually.

(bb) It is recommended that the facility have:

1. (1) An automated external defibrillator on-site; and
2. (2) A staff member or members on-site who are trained in the proper use of this device.