470-3940 (Rev. 02/24) Page 1 of 15
Iowa Department of Health and Human Services
Licensing Regulation Checklist
Name of Center
License ID No. (Reapplications)
Street
City
Iowa
Zip Code
Date of Inspection
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A D MI N I S T R A T I O N
237A.7
Information regarding a child in a child care center or their relative is confidential. If
this information is released by visual, verbal or written means, written consent from
the parent or guardian is in the file or a court order allowing the release of the
information.
109.4(1)
Written statement of purpose and objectives. Plan and practices consistent with the
written statement.
Required Written Policies
109.4(2)a
Fee policies and financial agreements developed.
109.4(2)b
Written policies on:
• Enrollment and discharge.
• Field trips and non-center activities.
• Transportation if applicable.
• Discipline.
• Nutrition.
• Health and safety policies.
109.4(2)c
Curriculum or program structure developmentally appropriate and activities designed
to the developmental level/needs of children served.
109.4(2)d
Written plan developed for staff orientation regarding center’s policies and licensing
regulations. Orientation is in accordance with center’s staff orientation plan.
109.4(2)e
Written plan for ongoing staff development that complies with 441 IAC 109.7.
109.4(2)f
Copy of the center policies and program to all staff at the time of employment and
each parent at the time a child is admitted to the center.
109.4(2)g
When serving children under the age of 3, develop and implement a policy for
responding to incidents of biting. Include:
(1) Explanation of center philosophy on biting.
(2) How the center will respond to individual and ongoing incidents.
(3) How the center will assess the adequacy of caregiver supervision.
(4) How the center will respond to the child or caregiver who was bitten.
(5) The process of notification of parents.
(6) How the incident will be documented.
(7) How confidentiality will be protected.
(8) First aid procedures that will be used.
109.4(2)h
Develop a policy to ensure that people do not have unauthorized access to children
at the center. Include:
(1) Criteria for allowing people on the property when children are present.
(2) How people will be supervised or monitored.
(3) How responsibility will be delegated to staff.
(4) How the policy will be shared with parents.
109.4(2)i
Develop and implement a policy for protection of child’s confidentiality.
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Required Postings
109.4(3)a
Postings are required for:
• The certificate of license.
• Notice of exposure to communicable disease.
• Notice of decision to deny, suspend, or revoke center license or reduce to
provisional status.
All postings shall be conspicuously placed at main entrance of center.
109.4(3)b
Postings are required for:
• Mandatory reporter requirements.
• Notice of availability of handbook.
• Program activities.
These shall be posted in area frequented by parents or public.
109.4(4)
Requirements and procedures for mandatory reporting of suspected child abuse shall
be posted where they can be read by staff and parents.
109.4(5)
Child Care Centers and Preschool Licensing Standards and Procedures shall be
available in the center and a notice stating a copy is available for review. Contact
information of the child care consultant shall be included in the notice.
109.4(6)
The child care license shall be posted in a conspicuous place and shall state the
particular premises in which child care may be offered and the number of children
who may be cared for at any one time.
P A R E N T A L P A R T I C I P A T I O N
109.5(1)
Written policy notifying parents of unlimited access provisions.
P E R S O N N E L
109.6
Develop policies for hiring and maintaining staff and managers that demonstrate
competence in working with children.
Center Director
109.6(1)
Centers with multiple sites have a qualified director or on-site supervisor at all sites.
Information on the director’s qualifications is submitted to consultant prior to
employment and is sufficient to make a determination.
Center director meets qualifications or is “qualifiable” with a plan established to meet
qualifications.
On-Site Supervisor
109.6(2)
Director or on-site supervisor on-site during the hours of operation or a minimum of
six hours of center’s hours of operation.
Information on on-site supervisor’s qualifications is submitted to the consultant prior
to employment and is sufficient to make a determination.
On-site supervisor meets qualifications or is “qualifiable” with a plan established to
meet qualifications.
109.6(3)
Another responsible adult is clearly designated as the interim on-site supervisor if the
on-site supervisor is temporarily absent from the center.
Volunteers
109.6(5)a
All volunteers shall be at least 16 years of age and shall:
(1) Have signed statements indicating no conviction of any law in any state or
record of founded child or dependent adult abuse.
(2) Signed statements indicating no communicable disease or other health
concerns that poses a threat to children.
109.6(5)b
Signed statement indicating they have been informed of responsibilities as mandatory
reporters.
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109.6(5)c
Undergo record check process if:
(1) It is included in meeting the required child/staff ratio.
(2) Has direct responsibility for a child or children.
(3) Has access to child or children when no other staff is present.
Record Checks
109.6(6)c
Center repeats Iowa record checks at a minimum of every two years or when aware
of additional child abuse or criminal history that occurs.
109.6(6)d
Center repeats national criminal history checks at a minimum of every four years or
when aware of additional history that occurs.
109.6(6)h(2)
No one owns, directs or works in the center who has been prohibited from
involvement with child care.
106.6(7)
Use of controlled substances and medications: All owners, personnel, and
volunteers shall be free of the use of illegal drugs and shall not be under the influence
of alcohol or of any prescription or nonprescription drug that could impair their
ability to function.
P R O F E S S I O N A L G R O W T H A N D D E V E L O P M E N T
109.7(1)
All staff (within first three months of employment):
• Two hours of approved training for the mandatory reporting of child abuse
within three months of employment.
• At least one hour of training regarding universal precautions and infectious
disease control.
• Certification in American Red Cross, American Heart Association, American
Safety and Health Institute or MEDIC First Aid infant, child, and adult
cardiopulmonary resuscitation (CPR) or equivalent certification approved by
the Department. A valid certificate indicating the date of training and
expiration date shall be maintained.
• Certification in infant, child, and adult first aid that uses a nationally recognized
curriculum or is received from a nationally recognized training organization
including the American Red Cross, American Heart Association, American
Safety and Health Institute or MEDIC First Aid or an equivalent certification
approved by the Department. A valid certificate indicating the date of training
and expiration date shall be maintained.
• Minimum health and safety trainings, approved by the Department. If significant
changes occur to content, the Department may require the training be
renewed.
109.7(2)
Center directors and all staff have the required contact hours of training.
Number not in compliance:
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Staff Employed in Centers That Operate Summer Only Programs
109.7(3)
Staff employed in centers that operated a summer-only program receive the following
training within three months of employment:
• Two hours of Iowa’s training for mandatory reporting of child abuse.
• At least one hour of training regarding universal precautions and infectious
disease control.
• Certification in American Red Cross, American Heart Association, American
Safety and Health Institute or MEDIC First Aid infant, child, and adult
cardiopulmonary resuscitation (CPR) or equivalent certification approved by
the Department. A valid certificate indicating the date of training and
expiration date shall be maintained.
• Certification in infant, child, and adult first aid that uses a nationally recognized
curriculum or is received from a nationally recognized training organization
including the American Red Cross, American Heart Association, American
Safety and Health Institute or MEDIC First Aid or an equivalent certification
approved by the Department. A valid certificate indicating the date of training
and expiration date shall be maintained.
• Minimum health and safety trainings, approved by the Department.
109.7(5)
Training plans are developed for staff that supplement educational and experience
requirements and enhance staff’s skill in working with the developmental and cultural
characteristics of children served.
109.7(8)
The director, on-site supervisor, and any person designated a lead in the absence of
supervisory staff shall have all completed all pre-service orientation training outlined
in 109.7(1).
S T A F F R A T I O R E Q U I R E M E N T S
Minimum Staff Requirements
109.8(1)a
All staff in ratio:
• At least sixteen years of age.
• If less than eighteen, may not be sole provider on the premises.
109.8(1)b
All staff in ratio involved with children in programming activities.
109.8(1)c
At least one person on duty in the center when children are present and present on
field trips shall be over the age of 18.
109.8(1)d
Staff person under the age of 18 shall not provide transportation to children in care
109.8(1)e
Staff person under the age of 18 who are not under supervision of an adult shall only
care for school aged children
Ratio
109.8(2)
Ratio maintained in center as required by age.
109.8(2)a
Combinations of age grouping for children four years of age and older determine ratio
on age of majority in group..
109.8(2)b
Combinations of age groupings for children between 3 and 5 years of age may be
allowed with a staff of 1 to every 12 children.
109.8(2)c
Children between 18 months and 3 years of age may be combined, if appropriate to
the developmental needs of the child. If a child under 2 years is combined, the staff
ratio of 1 to 7 shall be maintained, otherwise staff ratio may be determined by the age
of majority of the children in the group.
109.8(2)d
Brief absence of staff person permitted for 5 or less minutes when another staff
person is present
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109.8(2)e
• At least one staff is present in every room where children are resting.
• If ratio reduced to one staff per room during nap time, does not exceed one
hour and ratio in center is still maintained.
• Ratio in infant rooms is always maintained.
109.8(2)f
• Two adults are present when eight or more children are on the premises.
• Two adults are present when eight or more children are being transported in
one vehicle.
• One staff for school transportation; only in center-owned vehicle with parent
authorization.
• One additional staff when the center contracts for transportation for eight or
more children for non-school related purposes.
109.8(2)g
One additional staff when five or more children are involved in a center-sponsored
activity away from the center.
109.8(2)h
If ratio reduced to one staff at the beginning and end of center’s operation, timeframe
does not exceed two hours and occurs only when seven or fewer children are
present with not more than four of the children under two years of age and there are
no more than seven children in the center.
109.8(2)i
Ratio exceeded for school-age children when school classes unexpectedly start late,
are dismissed early, or cancelled. For no more than four hours, care is limited to
children already in the program and licensed capacity is not exceeded.
R E C O RD S
Personnel Records. Number of files reviewed:
109.9(1)a
All files contain statement signed by staff indicating whether they have a criminal
conviction or founded child/dependent adult abuse.
Number not in compliance:
109.9(1)b
All files contain:
(1) A signed copy of the HHS Criminal History Record Check, Form B, that was
submitted prior to employment.
(2) A copy of Request for Child and Dependent Adult Abuse Information.
(3) Copies of the results of Iowa records checks conducted.
(4) Copies of national criminal history check results.
(5) Any Department-issued documents sent to the center related to records
check.
Number not in compliance:
109.9(1)d
All files contain a pre-employment physical exam report completed within six months
prior to hire and at least every three years. Physical exams shall be documented on
form 470-5152, Child Care Provider Physical Examination Report.
Number not in compliance:
109.9(1)e
All files contain documentation to indicate that ongoing staff training requirements are
met, including current certifications in first aid/CPR and mandatory child abuse
training.
Number not in compliance:
109.9(1)f
Files contain a photocopy of a valid driver’s license if the staff will be involved in the
transportation of children.
Number not in compliance:
Children’s Files. Number of files reviewed:
109.9(2)
All files are updated at least annually and when a change occurs.
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109.9(2)a
All files contain sufficient information to allow the center to contact the parent or
emergency contact at any time child is in center’s care.
Number not in compliance:
Information lacking:
109.9(2)b
All files contain sufficient information and authorization to allow the center to secure
emergency medical and dental services at any time child is in center’s care.
Number not in compliance for medical:
Number not in compliance for dental:
Information lacking:
109.9(2)c
All files contain information regarding the specific health and medical needs of a child
including information regarding any prescribed treatment.
For school-age programs in the child’s school, all files include a statement signed by
the parent that the immunization information is available in the school file.
Number not in compliance:
109.9(2)d
All files contain parent authorization of the persons to whom the child may be
released.
Number not in compliance:
109.9(2)e
Files contain documentation of injuries, accidents or other child-related incidents.
Number not in compliance:
109.9(2)f
All files contain parent authorization for attendance at center-sponsored field trips
and non-center activities.
If an inclusive authorization form for activities is used, a copy is kept on file at the
center.
Number not in compliance with center-sponsored trips:
Number not in compliance with non-center activities:
109.9(2)g
Any child with allergies, a written emergency plan. Copy shall accompany child if they
leave the premises.
109.9(3)
Signed and dated Iowa immunization certificates are on file for each child enrolled.
Number missing:
Number invalid:
109.9(4)
Daily written records are maintained for each child under two years of age and
include time periods slept, amount of/time food consumed, time/irregularities of
elimination patterns, general disposition, and general summary of activities.
H E A L T H A N D S A F E T Y P O L I C I E S
109.10
Center shall establish health policies, including criteria for excluding a sick child.
Policies shall be consistent with the recommendations of the National Health and
Safety Performance Standards.
Children Physical/Immunization Requirements
109.10(1)a
Preschool (for children five years and younger not enrolled in school): Physical exam
report submitted within 30 days of admission, was obtained no more than 12 months
prior to admission, is signed by a licensed MD, DO, Chiropractor, PA, or ARNP, and
contains health history; present health status including allergies, medications, and
acute/chronic conditions; and recommendations for continued care if necessary.
Number not in compliance:
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109.10(1)b
School-age (for children five years and older and enrolled in school): Annual statement
of health status signed by parent is submitted prior to admission, certifies that the
child is free of communicable disease, and lists allergies, medications and
acute/chronic conditions.
Number not in compliance:
109.10(1)c
If a child’s religious affiliation is contrary to medical treatment or immunization
requirements, the file shall contain a notarized statement.
Number not in compliance:
109.10(2)
Medical and dental emergencies: Center shall have sufficient information and
authorization to meet medical and dental emergencies of children. Shall have written
procedures for emergencies and shall ensure that staff are knowledgeable of and able
to implement the procedures
Medications
109.10(3)
The center shall have written procedures for dispensing, storage, and authorization,
and recording of all prescription and non-prescription medications.
109.10(3)a
All medications shall be stored in original containers with physician or pharmacist
directions. Labels should be intact and stored so they are inaccessible to children and
public. Nonprescription medications shall be labeled with the child’s name.
109.10(3)b
For every day an authorization for medication is in effect and child is in attendance,
there shall be a notation of administration including the name of medicine, date, time,
dosage, given or applied, and the initials of the person administering the medication or
the reason the medication was not given.
109.10(3)c
For ongoing, long term medications, authorization shall be obtained for a period not
to exceed the duration of prescription.
109.10(3)d
Staff shall not provide medications to a child if pre-service/orientation training for
medication management has not been completed.
109.10(4)
Daily contact: Each child shall have direct contact with staff person upon arrival.
109.10(5)
Infectious disease control: Centers shall establish policies and procedures related
to infection disease control and use of universal precautions with handling of bodily
fluid. Soiled diapers shall be stored in containers separate from other waste.
109.10(6)
Quiet area: The center shall provide a quiet area under supervision for a child who
appears to be ill or injured. Parents or designated person shall be notified of child’s
status in event of serious illness or emergency.
109.10(7)
Staff hand washing: The center shall ensure staff demonstrate clean personal
hygiene. Staff shall wash hands:
(a) Upon arrival at the center.
(b) Immediately before eating or participating in food service activity.
(c) After diapering a child.
(d) Before leaving the rest room either with a child or by themselves.
(e) Before and after administering nonemergency first aid if gloves are not worn.
(f) After handling animals or cleaning cages.
109.10(8)
Children’s hand washing: Center shall ensure staff assist children in personal
hygiene. For each infant or child with a disability, a separate cloth for washing and one
for rinsing may be used in place of running water. Children’s hands shall be washed:
(a) Immediately before eating or participating in food service activity.
(b) After using the restroom or being diapered.
(c) After handling animals.
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109.10(9)
First aid kit: The center shall ensure that a clearly labeled first aid kit that is
sufficient to address minor injury or trauma is available and accessible to staff at all
times when children are:
• In the center.
• In the outdoor play area.
• On field trips.
109.10(10)
Recording incidents: Parents shall be notified on the day of the incident involving a
child that includes:
• Minor injuries.
• Minor changes in health status.
• Minor behavioral concerns.
• Incidents resulting in injury to a child.
Shall be verbally notified immediately when there is:
• A serious injury to a child.
• An incident resulting in significant change in health status.
• An incident includes child being involved in inappropriate, sexually acting out
behavior.
A WRITTEN report, fully documenting every incident, shall be provided to the parent
or authorized person. This should be completed by staff that witnessed the incident
and retained in child file. Serious injuries and deaths must be reported to the
Department within 24 hours.
109.10(11)
Smoking and use of tobacco products shall be prohibited in the center and every
vehicle used to transport children. Prohibited in outdoor play area during hours of
operation.
Nonsmoking signs shall be posted at every entrance and in every vehicle used to
transport. Signs shall include:
(a) Telephone number for reporting complaints.
(b) Internet address to DPH.
Transportation
109.10(12)
All children transported in motor vehicle subject to registration, except a bus, shall be
individually secured by a safety belt, seat, or harness.
109.10(12)a
Children under age 6 shall be secured in child restraint system. Child under 1 and
weighing less than 20 lbs. shall be secured during transit in rear facing child restraint
system.
109.10(12)b
Children under 12 shall not be located in front seat.
109.10(12)c
Drivers shall possess a valid driver’s license and shall not operate while under the
influence.
109.10(12)d
Vehicles that are owned or leased by the center shall receive regular maintenance and
inspection according to manufacturer-recommended guidelines for vehicle and tire
maintenance and inspection.
109.10(13)
Field trip emergency numbers: Phone numbers for each child shall be taken by
staff when transporting to and from school, and on field trips and non-center-
sponsored activities away from the premises.
109.10(14)
Pets: Animals kept on site shall be in good health with no evidence of disease, does
not pose a safety threat, and is maintained in clean manner. Documentation of
current vaccinations shall be available for cats and dogs. Pets shall not be allowed in
food prep or kitchen areas.
Animals prohibited from being kept on site: ferrets, reptiles, turtles, birds of the
parrot family.
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Emergency Plans
109.10(15)a
• The center shall have written emergency plans and diagrams for responding to
fire, tornado, flood, and plans responding to intoxicated parents and lost or
abducted children.
• Shall have guidelines for responding or evacuating in case of blizzards, power
failures, bomb threats, chemical spills, or other disasters that could create
structural damage to the center or pose health hazards.
• If center is within 10 miles of nuclear power plant, center shall have evacuation
plan.
• Emergency plans shall include written procedures including plans for:
▪ Evacuation to safely leave the facility.
▪ Relocation to a common, safe location after evacuation.
▪ Shelter in place to take immediate shelter when the current location is
unsafe to leave due to the emergency issue.
▪ Lock down to protect children and providers from an external situation.
▪ Communication and reunification with parents or other adults responsible
for the children, which includes emergency telephone numbers.
▪ Continuity of operations
▪ To address the individual children, including those with functional or
access needs.
109.10(15)b
Emergency instructions, phone numbers, and diagrams for fire, tornado, and flood
shall be visibly posted and documented at least once a month for fire and tornado.
Records shall be maintained for current and previous year.
109.10(15)c
Center shall develop procedures for annual staff and volunteer training on emergency
plans.
109.10(15)d
Daily checks to ensure all exits are unobstructed.
Supervision and Access
109.10(16)a
The center and supervisor shall ensure that staff knows names and number of
children assigned. Staff shall provide careful supervision.
109.10(16)b
Any person who does not have a record check completed shall not have unrestricted
access to children for whom that person is not a parent, guardian, or custodian.
109.10(16)d
A sex offender who has been convicted of an offense against a minor and required to
register with the sex offender registry, shall not be present on the property without
written permission of the director, except for the time reasonably necessary to
transport offender’s own minor child to and from the center.
P H Y S I C A L F A C I L I T I E S
Room Size
109.11(1)
• 35 square feet of usable floor space per child.
• Rooms with cribs have 40 square feet of space per child.
Infant’s Area
109.11(2)
• A safe and properly equipped area is provided for infants that does not allow
for intrusion by children over two years of age.
• Children over age two who remain in the infant area are placed at the
recommendation of a physician or AEA due to a significant developmental
delay. Children are placed for a limited time with HHS approval if doing so
does not pose a threat to the infants.
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Facility Requirements
109.11(3)a
Center shall ensure that:
(1) Facility and premises are sanitary, safe, and hazard free.
(2) Adequate indoor and outdoor space is provided. The outdoor area shall
include safe play equipment and area of shade.
(3) Sufficient space provided for dining.
(4) Sufficient lighting shall be provided.
(5) Sufficient ventilation.
(6) Sufficient heating.
(7) Sufficient cooling.
(8) Sufficient bathroom and diapering facilities.
(9) Equipment, including kitchen appliances, are maintained so as not to result in
burns, shock, or injury to children.
(10) Sanitation and safety procedures for the center are developed and
implemented to reduce risk or injury or harm to children and reduce
transmission of disease.
109.11(3)d
Record of monthly inspections of outdoor recreation area and equipment shall be
kept.
109.11(4)
Restroom facilities:
• One toilet and sink for each 15 children over two years of age in room with
ventilation.
• Built after 11/1/95 – at least one sink in same area as toilet.
• Adequate training seats or chairs for children under two years if used in lieu of
plumbed toilet.
109.11(5)
Telephone: Working non-pay phone with posting adjacent for emergency numbers
for police, fire, and poison control center. Center street address and phone included
in posting.
List of emergency numbers for children kept near phone.
109.11(6)
Kitchen appliance or microwaves:
• Gas or electric ovens are not in program area.
• Area housing kitchen appliances in program area is sectioned off and not
counted in useable floor space.
• Formula or food warmed for infants in microwaves is not served immediately
and is shaken or stirred prior to serving.
• Breast milk is not warmed in the microwave.
Environmental Hazards
109.11(7)a
Centers built before 1978: Assessment and plan for remedy of lead paint hazard is
conducted.
109.11(7)b
Centers at ground level that use basement area as program space, or have a
basement beneath program space: Testing and plan for remedy of radon is conducted.
109.11(7)c
All centers: Annual inspection prior to heating season of all fuel-burning appliances to
reduce risk of carbon monoxide poisoning and shall install one carbon monoxide
detector on each floor that conforms to UL Standard 2034.
109.11(7)d
A before and after school program or summer-only program that serves only school
age children in a public school building is exempt from lead and carbon monoxide
assessments.
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A C T I V I T Y P R O G R A M R E Q U I R E M E N T S
Program/Activities
109.12(1)
• Program structure that uses developmentally appropriate practices and
written program of activities planned to the developmental needs of children
served.
• Program complements but does not duplicate school curriculum.
• Schedule of program is posted in a place visible to parents.
109.12(1)a
Program provides a curriculum or program of activities that promotes self-esteem
and positive self-image, social interaction, self-expression and communication, creative
expression, and problem-solving skills.
109.12(1)b
Program provides for a balance of active and quiet, individual and group, indoor and
outdoor, and staff-initiated and child-initiated activities.
109.12(1)c
Program provides activities that promote fine and gross motor activities.
109.12(1)d
Program provides experiences in harmony with ethnic and cultural backgrounds.
109.12(1)e
Program provides a nap or quiet time for all children under the age of six not
enrolled in school who are present five or more hours.
Discipline
109.12(2)
Center shall have written policy on discipline of children which provides for positive
guidance, with direction for resolving conflict and setting of limits.
109.12(2)a
Center does not use corporal punishment including spanking, shaking, or slapping.
109.12(2)b
Punishment which is humiliating or frightening or causes pain or discomfort is not
allowed. Mechanical restrains shall never be used. If part of a treatment plan for a
child with a disability, staff shall receive training.
109.12(2)c
Punishment or threat of punishment associated with illness, toilet training, or food or
rest is not be used.
109.12(2)d
No child is subject to verbal abuse, threats, derogatory remarks about child or child’s
family.
Child Requiring Accommodations
109.12(3)
• Reasonable accommodations are made for children with disabilities.
• Required files contain documentation of reasonable accommodations made in
providing care to a child with a disability.
Play Equipment and Materials
109.12(4)
• Sufficient toilet articles are provided for handwashing.
• Sufficient and safe indoor play equipment, materials, and furniture that
conforms with CPSC or ASTM.
• Play equipment, materials, and furniture meet the developmental, activity, and
special needs of the children.
• Room’s arrangement does not obstruct the direct observation of children.
• Individual covered mats, beds, or cots, and appropriate bedding is provided for
all children who nap.
• Procedures are developed and implemented to maintain equipment and
materials in a sanitary manner.
• Sufficient spacing is maintained between equipment to reduce transmission of
disease and allow ease of movement by children and staff to respond to
activities and care needs.
• Sanitary procedures are followed for use and storage of personal hygiene
articles.
If insufficient, list concerns:
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Infant Environment
109.12(5)
Environment for children under age two protects from harm but does not unduly
restrict development.
109.12(5)a
Stimulation provided to infants throughout the day. Same caretaker for infants as
possible.
109.12(5)b
• Infants diapered in a sanitary manner as needed in central diapering area.
• One changing table for every 15 infants/toddlers needing diaper changes.
• Diapering, sanitation, and handwashing procedures posted and implemented in
central diapering area.
If insufficient, list concerns:
109.12(5)c
Highchairs or hook-on seats equipped with safety strap and designed not to topple.
Safety strap engaged when child in seat.
109.12(5)d
Toys provided are safe, washable, too large to swallow, and with no removable parts.
Hard surface toys sanitized daily.
109.12(5)e
The provider shall follow safe sleep practices recommended by AAP for infants under
one year of age:
• Infants shall always be placed on their back for sleep.
• Infants shall be placed on a firm mattress with a tight fitted sheet that meets
Consumer Product Safety Commission federal standards.
• Infants shall not be allowed to sleep on a bed, sofa, air mattress or other soft
surface. No child will be allowed to sleep in any items not designed for
sleeping including, but not limited to, an infant seat, car seat, swing, bouncy
seat.
• No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose
bedding shall be allowed in the sleeping area with the infant.
• No co-sleeping shall be allowed.
• Sleeping infants shall be actively observed by sight and sound.
• If an alternate sleeping position is needed, a signed physician or physician
assistant authorization with statement of medical reason is required.
109.12(5)f
Crib or crib-like furniture, waterproof mattress covering, and sufficient bedding that
meets CPSC or ASTM standards is provided for each child under two years of age.
109.12(5)g
Infant walkers are not used.
109.12(5)h
Centers operating five hours or less on a daily basis: Sufficient number of cribs or
crib-like furniture for children who may nap that provide a waterproof mattress,
sufficient bedding, meet CPSC or ASTM standards, maintained in a sanitary manner,
and used only by one child at a time.
If insufficient, list concerns:
109.12(5)i
All items used for sleeping are in compliance with manufacturer standards for age and
weight of child.
E X T E N D E D E V E N I N G C A R E
Facility Requirements
109.13(1)a
Sufficient and age-appropriate cribs, beds, cots, and bedding are provided. Sufficient
furniture, lighting, and activity material provided. Equipment and materials maintained
in a safe and sanitary manner.
If insufficient, list concerns:
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109.13(1)b
• Separate, private space for school-age boys and girls for restroom and bedtime
activities.
• Restroom doors nonlockable.
109.13(1)c
• Center supplements those personal effect items not provided by parents for
personal hygiene and sleep.
• Written information obtained regarding child’s snacking, toileting, personal
hygiene, and bedtime routines.
Activities
109.13(2)a
Evening activities self-selected by child.
109.13(2)b
• Child-occupied rooms have adult supervision present – except those used by
school-age children for sleep.
• All staff in ratio are present and awake.
• If visual monitoring equipment used for rooms where school-age children are
sleeping, monitor allows for all children to be visible.
• If visual monitoring equipment used for rooms where school-age children are
sleeping, staff are present at all times in room with monitor and conduct
checks in the sleeping room every 15 minutes.
G E T W E L L C E N T E R
109.14(1)a
Medical advisor for health policy is an MD or DO in pediatrics or family practice.
109.14(1)b
• Licensed LPN or RN on duty at all times children are present.
• If nurse on duty is LPN, arrangements exist for medical advisor or RN in
proximate area to provide consultation.
Health Policies
109.14(2)a
Written health policy consistent with NHSPS and approved and signed by the owner
or board and medical advisor prior to start of business and shall address procedures
in the following areas:
(1) Policy addresses medical consultation, emergencies, triage policies, storage and
administration of medications, dietary considerations, sanitation and infection
control, categorization of illness, length of enrollment periods, exclusion
policy, employee health policy.
(2) Reportable disease policy.
Any change in health policy was approved by medical advisor and submitted to HHS.
Written summary of health policy given to parents when child enrolled.
109.14(2)b
All children receive a brief evaluation by LPN or RN upon arrival.
109.14(2)c
Summary of health status provided to parent at end of day that includes:
(1) Admitting symptoms.
(2) Medications and time administered.
(3) Nutritional intake.
(4) Rest periods.
(5) Output.
(6) Temperature.
Exceptions to Licensing Requirements
109.14(3)a
Minimum ratio: 1:4 for infants and 1:5 for children over age two.
109.14(3)b
All staff that have contact with children: Minimum of 17 clock hours of special training
in caring for mildly ill children. Current certifications in file.
(1) Within one month of employment: Training includes four hours in infant and
child CPR and four hours in pediatric first aid; one hour in infection control.
(2) Within 6 months of employment: Training includes six hours of care of ill
children and two hours in child abuse identification and reporting.
109.14(3)c
40 square feet of program space per child.
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109.14(3)d
Sink in every child-occupied room.
109.14(3)e
Outdoor space waived by HHS if adjacent to pediatrics unit.
109.14(3)f
Grouping of children allowed by categorization of illness without regard to age and in
separate rooms with full walls and doors.
F O O D S E R V I C E S
109.15(1)
• Center shall serve each child a full, nutritionally balanced meal as defined by
CACFP guidelines.
• Staff shall provide supervision at table during snacks and meals.
• Children at center two hours or longer shall be offered food of not less than
two hours and no more than three hours apart unless child is asleep.
109.15(2)
• Center shall follow minimum CACFP menu patterns for meals and snacks.
• Menus planned one week in advance, made available to parents, and kept on
file with substitutions noted.
• Avoid foods with high incident rate of causing choking.
Feeding of Children Under Two Years of Age
109.15(3)a
• Children under 12 months fed on demand, unless other written instructions
from parent.
• Infant CACFP menu patterns followed and appropriate to the infant’s
nutritional requirements and eating abilities.
• Menu patterns modified only upon written instruction of parent, physician, or
health care provider.
• Special formulas given to child with feeding problem if prescribed by physician.
109.15(3)b
• Children under six months held or fed in sitting-up position.
• Bottles not propped for any child, given to a child in a crib or left sleeping with
a bottle.
• Spoon feeding is adapted to developmental capabilities of child.
109.15(3)c
Children 12 months of age or younger fed single-serve, ready-to-feed formulas,
concentrated or powdered formula following manufacturer’s instructions or breast
milk unless otherwise ordered by parent or physician.
109.15(3)d
Children under age two not on formula or breast milk are fed whole milk.
109.15(3)e
Clean and sanitized bottles and nipples used for on-site formula preparation and kept
refrigerated.
Food Brought From Home
109.15(4)a
• Written policies developed for food brought from home for children under
five years of age not enrolled in school and is provided to parent at admission.
• Food brought from home for children under five years of age not enrolled in
school is monitored and supplemented if necessary to ensure CACFP
guidelines maintained.
109.15(4)b
Center does not restrict parent from providing meals brought from home for school
aged children or apply nutritional standards.
109.15(4)c
Perishable foods brought from home are maintained to avoid contamination or
spoilage.
109.15(4)d
Snacks that may not meet CACFP guidelines are allowed by parents for special
occasions.
Food Preparation/Sanitation
109.15(5)
Food preparation and storage procedures are consistent with NHSPS.
109.15(5)a
Sufficient refrigeration is provided appropriate to perishable food.
If insufficient, list concerns:
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109.15(5)b
• Sanitary and safe methods in food preparation, serving, and storage sufficient
to prevent transmission of disease, infestation, and spoilage are followed.
• Staff preparing food that have injuries on hands wear protective gloves.
• Staff serving food use clean serving utensils and have clean hands/wear
protective gloves.
If insufficient, list concerns:
109.15(5)c
Sanitary methods are used for dishwashing sufficient to prevent transmission of
disease.
If insufficient, list concerns:
109.15(5)d
Sanitary methods are used for garbage disposal sufficient to prevent transmission of
disease and infestation.
If insufficient, list concerns:
Water
109.15(6)
• Suitable water and sanitary drinking facilities are available and accessible.
• Centers serving infants and toddlers provide, at a minimum, individual cups.
If insufficient, list concerns:
109.15(6)a
Private water supplies are of satisfactory bacteriological quality as shown by an annual
water analysis drawn between May 1 and June 30 of each year.
If children under age two are served, private water analysis included nitrate analysis.
109.15(6)b
If public or private water supply was determined unsuitable for drinking, commercially
bottled water certified as chemically and bacteriologically potable or other approved
water was used.