(a) Staff-to-participant ratio, 20 CAR § 1027-301.

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

   1. (A) Out-of-school time participant, one to five (1:5); and
   2. (B) Maximum group size ten (10).
2. (2) Staff shall be separated in the same manner participants are separated to prevent cross-infection.

(b) Director, 20 CAR § 1027-302.

1. (1)

   1. (A) If the component is part of an out-of-school time 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 certification; and
   4. (D) First aid certification.

(c) Program requirements, 20 CAR § 1027-401.

1. (1) Participants shall be provided with quiet activities according to their ages 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 or 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 participant shall be removed immediately from sick care when his or her condition meets one (1) of the excludable diseases or symptoms.

4. (4) Participants may be returned to the regular out-of-school time program when:

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

(d) Participants’ records, 20 CAR § 1027-603.

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

(e) Building requirements, 20 CAR § 1027-801.

1. (1) If located in the same facility as an out-of-school time program, sick care shall be separate with a separate entrance and separate ventilation system.

2. (2)

   1. (A) Participants with respiratory illnesses shall be cared for in a separate space from participants with gastrointestinal illness.
   2. (B) Any participant with an undiagnosed condition shall be separated from other participants 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 § 1027-1001.

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

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 § 1027-1101.

1. (1)

   1. (A) Tables of communicable diseases and symptoms that exclude children from sick care.
   2. (B) Asterisk denotes reportable diseases.
2. (2) Communicable diseases.

   RESPIRATORY ILLNESS	GASTROINTESTINAL ILLNESS	CONTACT
   Chicken pox	Giardia lamblia*	Impetigo
   German measles	Hepatitis A*	Lice
   Hemophilus influenzae	Salmonella*	Scabies
   Measles*	Shigella*
   Meningococcus*
   Mumps*
   Strep throat
   Tuberculosis*
   Whooping cough*

3. (3) Symptoms that exclude participants from sick care.

   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 participant:

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

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

   1. (B) Diarrhea:

      1. (i) Accompanied by evidence of dehydration for excessive fluid loss;
      2. (ii) Accompanied by history of poor fluid intake or marked lethargy;
      3. (iii) With blood or mucus in the stool unless at least one (1) stool culture shows the absence of Salmonella, Shigella, Campylobacter, or E. coli; and
      4. (iv) That exceeds five (5) bowel movements in an eight-hour period or is continued over three (3) or four (4) days unless the participant is under the supervision of a physician with written documentation.
   2. (C) Vomiting for over a six-hour period.
   3. (D) Difficult or rapid breathing.

   4. (E)

      1. (i) Severe coughing.
      2. (ii) Episodes of coughing that may lead to:

(b) (b) Vomiting; or

1. (c) (c) Difficulty breathing.

   1. (F) Mucus (phlegm) that is foul-smelling, yellow, or green, and the participant has a fever over one hundred two degrees (102°).

   2. (G) Asthmatics with severe upper respiratory infections:

      1. (i) Who have not been seen by a physician; or
      2. (ii) Whose distress is not controlled by medication.
   3. (H) Sore throat and fever greater than one hundred three degrees (103°) or confirmed strep throat until treated with antibiotics for over twenty-four (24) hours.

   4. (I) Skin conditions that have not been diagnosed as noncontiguous by a physician, including but not limited to:

      1. (i) Yellow (jaundiced) eyes or skin;
      2. (ii) Child in contagious stages of:

(b) (b) Measles;

1. (c) (c) Mumps; or

   1. (d) (d) Rubella;

      1. (iii) Untreated impetigo;
      2. (iv) Untreated scabies or head lice; and
      3. (v) Blood-red rashes and skin conditions with spontaneous bruising.

   2. (J) Participants who are in the contagious states of:

      1. (i) Pertussis;
      2. (ii) Diphtheria; or
      3. (iii) Tuberculosis.
   3. (K) Pink or red eye or eyes that may be swollen with white or yellow discharge until on antibiotics for over twenty-four (24) hours.
   4. (L) Abdominal pain that is intermittent or persistent.

   5. (M) Fever over one hundred two degrees (102°) for greater than twenty-four (24) hours, or any fever over one hundred three degrees (103°) unless the participant:

      1. (i) Has been evaluated and treated by a physician; and
      2. (ii) Does not have other exclusion criteria.