151 HEALTH, SAFETY AND WELFARE INCLUSION, EXCLUSION, AND DISMISSAL OF CHILDREN AND STAFF DUE TO ILLNESS

100151.1 A Licensee shall take the following actions under the following circumstances:- (a) A child who exhibits one (1) or more symptoms of an illness identified in Subsection 151.2, upon arrival, shall not attend the Facility that day;

- (b) If, during the time a child is at the Facility, the Facility staff observes one (1) or more symptoms of an illness identified in Subsection 151.2, the Licensee shall notify the child's parent(s) or guardian(s) immediately. A Licensee shall require that the parent(s) or guardian(s) remove the child from the Facility within two (2) hours after the notification was provided;

- (c) A Licensee shall isolate a child who exhibits one (1) or more symptoms of an illness identified in Subsection 151.2. The child shall remain within sight and hearing of a staff member; and

- (d) A Licensee shall ensure that a child who exhibits one (1) or more symptoms of an illness identified in Subsection 151.2 does not share any personal hygiene, grooming items, or food.100151.2 A Licensee shall exclude a child from a Facility while exhibiting symptoms of illness including, but not limited to, the following:- (a) Diarrhea (loose, watery, or bloody stools);

- (b) Vomiting two (2) or more times in a twenty-four (24) hour period;

- (c) Body rash with any fever;

- (d) Sore throat with any fever or swollen glands;

- (e) Abnormal discoloration of the skin;

- (f) Any fever accompanied by a rash, vomiting, diarrhea, earache, irritability, or confusion;

- (g) Any other symptom indicative of a reportable communicable disease, as such is defined in 22-B DCMR Chapter 2, or in any superseding document.100151.3 A Licensee shall observe each child for the presence of the following symptoms

of illness, that may indicate a medical problem, which may require exclusion from the Facility, isolation from other children, and consultation with the child's parent(s), guardian(s), or licensed health care practitioner(s):

1. (a) Fever;
2. (b) Lethargy or inability to walk;
3. (c) Respiratory problems, including increased respiratory rate, retractions in the chest, excessive nasal flaring, audible persistent wheezing, persistent coughing, either productive or nonproductive, severe coughing causing redness or blueness in the face, or difficulty in breathing;
4. (d) Abdominal and urinary system problems, including intestinal parasites, dark urine, white spots in the stool, increased urgency or frequency of urination, or no urination for an entire day;
5. (e) Cardiac problems, including choking, change in color of the skin, chest pain, or persistent sweating;
6. (f) Ear problems, including discharge from the ear and/or ear pain;
7. (g) Throat and mouth problems, including sores on the lips or in the mouth, white patches in the mouth, throat pain, or a dental problem that needs immediate attention; and
8. (h) Injuries, including persistent bleeding, oozing wounds, apparent fracture, complaint of persistent bone pain or stiffness, or difficulty with the movement of any extremity.

100151.4 A child who exhibits one (1) or more symptoms of an illness identified in Subsection 151.2, and who has been treated for the symptom(s) by a licensed health care practitioner, may be readmitted to the Facility only with written permission, and written instructions for continuing care if needed, from a licensed health care practitioner.

100151.5 If a child exhibits mild symptoms of illness and/or discomfort, the Center Director, or his/her designee, or the Caregiver, in consultation with the child's parent(s) or guardian(s), shall decide whether the child should be immediately discharged from the Facility or discharged at the end of the day. This decision shall consider the following:

(a) Whether the illness prevents the child from participating comfortably in activities;

(b) Whether the illness results in a need for care that is greater than the staff can provide without compromising the health and safety of other children; and

(c) Whether the illness poses a risk of spread of harmful diseases to others.

100151.6 Staff members who exhibit one (1) or more symptoms of an illness identified in Subsection 151.2, and who have been treated for the symptom(s) by a licensed health care practitioner, may return to work with written permission from a licensed health care practitioner.

100151.7 Staff members who, after having experienced conditions that affect the ability to perform required duties, have been treated for said condition(s) by a licensed health care practitioner, may return to work with written permission from a licensed health care practitioner.

100151.8 Staff members who after serious or prolonged illness, have been treated for said illness by a licensed health care practitioner, may return to work with written permission from that licensed health care practitioner.

SOURCE: Final Rulemaking at 63 DCR 14640 (December 2, 2016).