(a) It is the intent of the Legislature that the department develop modified staffing levels and requirements for crisis nurseries, provided that the health, safety, and well-being of the children in care are protected and maintained.

1. (1) All caregivers shall be certified in pediatric cardiopulmonary resuscitation (CPR) and pediatric first aid. Certification shall be demonstrated by current and valid pediatric CPR and pediatric first aid cards issued by the American Red Cross, the American Heart Association, by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191, or from an accredited college or university.
2. (2) The licensee shall develop, maintain, and implement a written staff training plan for the orientation, continuing education, on-the-job training and development, supervision, and evaluation of all lead caregivers, caregivers, and volunteers. The licensee shall incorporate the training plan in the crisis nursery plan of operation.

3. (3) The licensee shall designate at least one lead caregiver to be present at the crisis nursery at all times when children are present. The lead caregiver shall have one of the following education and experience qualifications:

   1. (A) Completion of 12 postsecondary semester units or equivalent quarter units, with a passing grade, as determined by the institution, in classes with a focus on early childhood education, child development, or child health at an accredited college or university, as determined by the department, and six months of work experience in a licensed group home, licensed infant care center, or comparable group child care program or family day care. At least three semester units, or equivalent quarter units, or equivalent experience shall include coursework or experience in the care of infants.
   2. (B) A current and valid Child Development Associate (CDA) credential, with the appropriate age level endorsement issued by the CDA National Credentialing Program, and at least six months of on-the-job training or work experience in a licensed child care center or comparable group child care program.
   3. (C) A current and valid Child Development Associate Teacher Permit issued by the California Commission on Teacher Credentialing pursuant to Sections 80105 to 80116, inclusive, of Title 5 of the California Code of Regulations.
4. (4) Lead caregivers shall have a minimum of 24 hours of training and orientation before working with children. One year experience in a supervisory position in a child care or group care facility may substitute for 16 hours of training and orientation. The written staff training plan shall require the lead caregiver to receive and document a minimum of 20 hours of annual training directly related to the functions of his or her position.
5. (5) Caregiver staff shall complete a minimum of 24 hours of initial training within the first 90 days of employment. Eight hours of training shall be completed before the caregiver staff are responsible for children, left alone with children, and counted in the staff-to-child ratios described in subdivision (c). A maximum of four hours of training may be satisfied by job shadowing.

(b) The department shall allow the use of fully trained and qualified volunteers as caregivers in a crisis nursery, subject to the following conditions:

1. (1) Volunteers shall be fingerprinted for the purpose of conducting a criminal record review as specified in subdivision (b) of Section 1522.
2. (2) Volunteers shall complete a child abuse central index check as specified in Section 1522.1.
3. (3) Volunteers shall be in good physical health and be tested for tuberculosis not more than one year prior to, or seven days after, initial presence in the facility.
4. (4) Volunteers shall complete a minimum of 16 hours of training as specified in paragraphs (5) and (6).

5. (5) Prior to assuming the duties and responsibilities of a crisis caregiver or being counted in the staff-to-child ratio, volunteers shall complete at least five hours of initial training divided as follows:

   1. (A) Two hours of crisis nursery job shadowing.
   2. (B) One hour of review of community care licensing regulations.
   3. (C) Two hours of review of the crisis nursery program, including the facility mission statement, goals and objectives, child guidance techniques, and special needs of the client population they serve.

6. (6) Within 90 days, volunteers who are included in the staff-to-child ratios shall do both of the following:

   1. (A) Acquire a certification in pediatric first aid and pediatric cardiopulmonary resuscitation.
   2. (B) Complete at least 11 hours of training covering child care health and safety issues, trauma informed care, the importance of family and sibling relationships, temperaments of children, self-regulation skills and techniques, and program child guidance techniques.
7. (7) Volunteers who meet the requirements of paragraphs (1), (2), and (3), but who have not completed the training specified in paragraph (4), (5), or (6) may assist a fully trained and qualified staff person in performing child care duties. However, these volunteers shall not be left alone with children, shall always be under the direct supervision and observation of a fully trained and qualified staff person, and shall not be counted in meeting the minimum staff-to-child ratio requirements.

(c) The department shall allow the use of fully trained and qualified volunteers to be counted in the staff-to-child ratio in a crisis nursery subject to the following conditions:

1. (1) The volunteers have fulfilled the requirements in paragraphs (1) to (6), inclusive, of subdivision (b).
2. (2) There shall be at least one fully qualified and employed staff person on site at all times.

3. (3)

   1. (A) There shall be at least one employed staff person or volunteer caregiver for each group of six children, or fraction thereof, who are 18 months of age or older, and one employed staff person or volunteer caregiver for each group of three children, or fraction thereof, who are under 18 months of age from 7 a.m. to 7 p.m.
   2. (B) There shall be at least one employed staff person or volunteer caregiver for each group of six children, or fraction thereof, who are 18 months of age or older, and one employed staff person or volunteer caregiver for each group of four children, or fraction thereof, who are under 18 months of age from 7 p.m. to 7 a.m.
   3. (C) There shall be at least one employed staff person present for every volunteer caregiver used by the crisis nursery for the purpose of meeting the minimum caregiver staffing requirements.
   4. (D) The crisis nursery’s plan of operation shall address how it will deal with unexpected circumstances related to staffing and ensure that additional caregivers are available when needed.

(e)

1. (1) When a child has a health condition that requires prescription medication, the licensee shall ensure that the caregiver does all of the following:

   1. (A) Assists children with the taking of the medication as needed.
   2. (B) Ensures that instructions are followed as outlined by the appropriate medical professional.
   3. (C) Stores the medication in accordance with the label instructions in the original container with the original unaltered label in a locked and safe area that is not accessible to children.

   4. (D) Administers the medication as directed on the label and prescribed by the physician in writing.

      1. (i) The licensee shall obtain, in writing, approval and instructions from the child’s authorized representative for administration of the prescription medication for the child. This documentation shall be kept in the child’s record.
      2. (ii) The licensee shall not administer prescription medication to a child in accordance with instructions from the child’s authorized representative if the authorized representative’s instructions conflict with the physician’s written instructions or the label directions as prescribed by the child’s physician.

2. (2) Nonprescription medications may be administered without approval or instructions from the child’s physician if all of the following conditions are met:

   1. (A) Nonprescription medications shall be administered in accordance with the product label directions on the nonprescription medication container or containers.

   2. (B)

      1. (i) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child’s authorized representative for administration of the nonprescription medication to the child. This documentation shall be kept in the child’s record.
      2. (ii) The licensee shall not administer nonprescription medication to a child in accordance with instructions from the child’s authorized representative if the authorized representative’s instructions conflict with the product label directions on the nonprescription medication container or containers.
3. (3) The licensee shall develop and implement a written plan to record the administration of the prescription and nonprescription medications and to inform the child’s authorized representative daily, for crisis day services, and upon discharge for overnight care, when the medications have been given.
4. (4) When no longer needed by the child, or when the child is removed or discharged from the crisis nursery, all medications shall be returned to the child’s authorized representative or disposed of after an attempt to reach the authorized representative.