[29 Pa.B. 3295]
[Continued from previous Web Page] (j) A child has the right to practice the religion or faith of choice, or not to practice any religion or faith.
(k) A child has the right to appropriate medical, behavioral health and dental treatment.
(l) A child has the right to rehabilitation and treatment.
(m) A child has the right to be free from excessive medication.
(n) A child may not be subjected to unusual or extreme methods of discipline which may cause psychological or physical harm to the child.
(o) A child has the right to clean, seasonal clothing that is age and gender appropriate.
§ 3800.33. Prohibition against deprivation of rights.
(a) A child may not be deprived of specific or civil rights.
(b) A child's rights may not be used as a reward or sanction.
(c) A child's visits with family may not be used as a reward or sanction.
STAFFING § 3800.51. Child abuse and criminal history checks.
Child abuse and criminal history checks shall be completed in accordance with 23 Pa.C.S. §§ 6301--6385 (relating to the Child Protective Services Law) and Chapter 3490 (relating to child protective services).
§ 3800.52. Staff hiring, retention and utilization.
Staff hiring retention and utilization shall be in accordance with 23 Pa.C.S. §§ 6301--6385 (relating to the Child Protective Services Law) and Chapter 3490 (relating to child protective services).
§ 3800.53. Director.
(a) There shall be one director responsible for the facility. A director may be responsible for more than one facility.
(b) The director shall be responsible for administration and management of the facility, including the safety and protection of the children, implementation of policies and procedures and compliance with this chapter.
(c) A director of a facility shall have one of the following:
(1) A master's degree from an accredited college or university and 2 years work experience in administration or human services.
(2) A bachelor's degree from an accredited college or university and 4 years work experience in administration or human services.
§ 3800.54. Child care supervisor.
(a) There shall be one child care supervisor available either onsite or by telephone at all times children are at the facility.
(b) For facilities serving 16 or more children, whenever 16 or more children are present at the facility, there shall be at least one child care supervisor present at the facility.
(c) The child care supervisor shall be responsible for developing and implementing the program and schedule for the children and for supervision of child care workers.
(d) The child care supervisor shall have one of the following:
(1) A bachelor's degree from an accredited college or university and 1 year work experience with children.
(2) An associate's degree or 60 credit hours from an accredited college or university and 3 years work experience with children.
§ 3800.55. Child care worker.
(a) There shall be one child care worker present with the children for every eight children who are 6 years of age or older, during awake hours.
(b) There shall be one child care worker present with the children for every 16 children who are 6 years of age and older, during sleeping hours.
(c) There shall be one child care worker present with the children for every four children who are under 6 years of age, during awake hours.
(d) There shall be one child care worker present with the children for every eight children who are under 6 years of age, during sleeping hours.
(e) If there are children who are under 6 years of age and 6 years of age and older in the same group, the ratios specified in subsections (c) and (d) apply.
(f) The child care worker shall be responsible for implementing daily activities and for supervision of the children.
(g) The child care worker shall have a high school diploma or general education development certificate.
(h) A child care worker who is counted in the worker to child ratio shall be 18 years of age or older if all the children served in the facility are under 18 years of age. A child care worker who is counted in the worker to child ratio shall be 21 years of age or older if one or more children served in the facility are 18 years of age or older.
§ 3800.56. Exceptions for staff qualifications.
(a) The staff qualification requirements specified in §§ 3800.53(c), 3800.54(d), 3800.55(g) and 3800.283(1) do not apply to staff persons hired or promoted to the specified positions prior to October 26, 1999.
(b) For facilities previously certified under Chapter 5310 or 6400 (relating to community residential rehabilitation services for the mentally ill; and community homes for individuals with mental retardation), the age requirements specified in § 3800.55(h) (relating to child care worker) do not apply to staff persons hired, or counted in the worker to child ratio, prior to October 26, 1999.
§ 3800.57. Supervision.
(a) While children are at the facility, children shall be supervised during awake and sleeping hours by conducting observational checks of each child at least every hour.
(b) Observational checks of children specified in subsection (a) shall include actual viewing of each child.
(c) Staff persons may not sleep while being counted in the staff to child ratios.
(d) The requirements in subsections (a)--(c) regarding supervision of children during sleeping hours do not apply if the facility serves 12 or fewer children and one of the following conditions is met:
(1) Each of the children has lived at any facility within the legal entity for at least 6 months and each child's health and safety assessment indicates there are no high risk behaviors during sleeping hours.
(2) There are live-in staff persons at the facility.
§ 3800.58. Staff training.
(a) Prior to working with children, each staff person who will have regular and significant direct contact with children, including part-time and temporary staff persons and volunteers, shall have an orientation to the person's specific duties and responsibilities and the policies and procedures of the facility, including reportable incident reporting, discipline, care and management of children, medication administration and use of restrictive procedures.
(b) Prior to working alone with children and within 120 calendar days after the date of hire, the director and each full-time, part-time and temporary staff person who will have regular and significant direct contact with children, shall have at least 30 hours of training to include at least the following areas:
(1) The requirements of this chapter.
(2) 23 Pa.C.S. §§ 6301--6385 (relating to child protective services law) and Chapter 3490 (relating to child protective services).
(3) Fire safety.
(4) First aid, Heimlich techniques, cardiopulmonary resuscitation and universal precautions.
(5) Crisis intervention, behavior management and suicide prevention.
(6) Health and other special issues affecting the population.
(c) If a staff person has completed the training required in subsection (b) within 12 months prior to the staff person's date of hire, the requirement for training in subsection (b) does not apply.
(d) After initial training, the director and each full-time, part-time and temporary staff person, who will have regular and significant direct contact with children, shall have at least 40 hours of training annually relating to the care and management of children. This requirement for annual training does not apply for the initial year of employment.
(e) Each staff person who will have regular and significant direct contact with children, shall complete training in first aid, Heimlich techniques and cardiopulmonary resuscitation at least every year. If a staff person has a formal certification from a recognized health care organization which is valid for more than 1 year, retraining is not required until expiration of the certification.
(f) Training in first aid, Heimlich techniques and cardiopulmonary resuscitation shall be completed by an individual certified as a trainer by a hospital or other recognized health care organization.
(g) Training in fire safety shall be completed by a fire safety expert or, in facilities serving 20 or fewer children, by a staff person trained by a fire safety expert. Video tapes prepared by a fire safety expert are acceptable for the training if accompanied by an onsite staff person trained by a fire safety expert.
(h) A record of training including the person trained, date, source, content, length of each course and copies of any certificates received, shall be kept.
PHYSICAL SITE § 3800.81. Physical accommodations and equipment.
The facility shall provide or arrange for physical site accommodations and equipment necessary to meet the health and safety needs of a child with a disability.
§ 3800.82. Poisons.
(a) Poisonous materials shall be kept locked and inaccessible to children.
(b) Poisonous materials shall be stored in their original, labeled containers.
(c) Poisonous materials shall be kept separate from food, food preparation surfaces and dining surfaces.
§ 3800.83. Heat sources.
Heat sources, such as hot water pipes, fixed space heaters, hot water heaters and radiators, exceeding 120°F that are accessible to children, shall be equipped with protective guards or insulation to prevent children from coming in contact with the heat source.
§ 3800.84. Sanitation.
(a) Sanitary conditions shall be maintained.
(b) There may be no evidence of infestation of insects or rodents in the facility.
(c) Trash shall be removed from the premises at least once a week.
(d) Trash in kitchens and bathrooms shall be kept in covered trash receptacles that prevent the penetration of insects and rodents.
(e) Trash outside the facility shall be kept in closed receptacles that prevent the penetration of insects and rodents.
§ 3800.85. Ventilation.
Living areas, recreation areas, dining areas, bathrooms, bedrooms and kitchens shall be ventilated by at least one operable window or mechanical ventilation.
§ 3800.86. Lighting.
Rooms, hallways, interior stairs, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to avoid accidents.
§ 3800.87. Surfaces.
(a) Floors, walls, ceilings, windows, doors and other surfaces shall be free of hazards.
(b) If the facility was constructed before 1978 and serves one or more children who are 2 years of age or younger or who are likely to ingest inedible substances, the facility shall test all layers of interior paint in the facility and exterior paint and soil accessible in the play and recreation areas, for lead content. If lead content exceeds .06% in wet paint, .5% in a paint chip sample or 400 ppm in the soil, lead remediation activity is required based on recommendations of the Department of Health. Documentation of lead testing, results and corrections made shall be kept.
(c) The facility may not use asbestos products for any renovations or new construction.
§ 3800.88. Water.
(a) The facility shall have hot and cold water under pressure.
(b) Hot water temperature in areas accessible to children may not exceed 120°F.
(c) A facility that is not connected to a public water system shall have a coliform water test at least every 3 months, by a Department of Environmental Protection-certified laboratory, stating that the water is safe for drinking. Documentation of the certification shall be kept.
§ 3800.89. Temperature.
(a) Indoor temperature shall be at least 65°F during awake hours when children are present in the facility.
(b) Indoor temperature may not be less than 62°F during sleeping hours.
(c) When indoor temperature exceeds 90°F, mechanical ventilation such as fans or air conditioning shall be used.
§ 3800.90. Communication system.
(a) The facility shall have a working, noncoin-operated, telephone with an outside line that is accessible to staff persons in emergencies.
(b) The facility shall have a communication system to allow staff persons to contact other staff persons in the facility for assistance in an emergency.
§ 3800.91. Emergency telephone numbers.
Telephone numbers for the nearest hospital, police department, fire department, ambulance and poison control center shall be posted on or by each telephone with an outside line.
§ 3800.92. Screens.
Windows, including windows in doors, shall be securely screened when doors or windows are open.
§ 3800.93. Handrails and railings.
(a) Each ramp, interior stairway and outside steps exceeding two steps shall have a well secured handrail.
(b) Each porch that has over an 18-inch drop shall have a well-secured railing.
§ 3800.94. Landings and stairs.
(a) There shall be a landing which is at least as wide as the doorway, beyond each interior and exterior door which opens directly into a stairway.
(b) Interior stairs shall have nonskid surfaces.
§ 3800.95. Furniture and equipment.
(a) Furniture and equipment shall be free of hazards.
(b) There shall be enough furniture to accommodate the largest group of children that may routinely congregate in a room at any given time.
(c) Power equipment shall be kept in safe condition.
(d) Power equipment, excluding normal household appliances, shall be stored in a place that is inaccessible to children.
(e) Power equipment excluding normal household appliances, may not be used by children except under supervision of a staff person.
§ 3800.96. First aid supplies.
The facility shall have a first aid manual, nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, tape, scissors and syrup of Ipecac that are stored together.
§ 3800.97. Elevators.
Each elevator shall have a valid certificate of operation from the Department of Labor and Industry.
§ 3800.98. Indoor activity space.
The facility shall have separate indoor activity space for activities such as studying, recreation and group activities.
§ 3800.99. Recreation space.
The facility shall have regular access to outdoor, or large indoor, recreation space and equipment.
§ 3800.100. Exterior conditions.
(a) The exterior of the building and the building grounds or yard shall be free of hazards.
(b) Outside walkways shall be free of ice, snow and obstruction.
§ 3800.101. Firearms and weapons.
Firearms, weapons and ammunition are not permitted in the facility or on the facility grounds, except for those carried by law enforcement personnel.
§ 3800.102. Child bedrooms.
(a) Each single bedroom shall have at least 70 square feet of floor space per child measured wall to wall, including space occupied by furniture.
(b) Each shared bedroom shall have at least 60 square feet of floor space per child measured wall to wall, including space occupied by furniture.
(c) No more than four children may share a bedroom.
(d) Ceiling height in each bedroom shall be at least an average of 7 1/2 feet.
(e) Each bedroom shall have a window with a source of natural light.
(f) Each child shall have the following in the bedroom:
(1) A bed with solid foundation and fire retardant mattress in good repair.
(2) A pillow and bedding appropriate for the temperature in the facility.
(3) A storage area for clothing.
(g) Cots or portable beds are not permitted. This prohibition does not apply for the first 30 days of a child's placement if a facility is given 7 days or less notice of the placement.
(h) Bunk beds shall allow enough space in between each bed and the ceiling to allow the child to sit up in bed.
(i) Bunk beds shall be equipped with securely attached ladders capable of supporting a staff person.
(j) The top bunk of bunk beds shall be equipped with a secure safety rail on each open side and open end of the bunk.
(k) A bedroom may not be used as a means of egress from or access to another part of the facility.
§ 3800.103. Bathrooms.
(a) There shall be at least one flush toilet for every six children.
(b) There shall be at least one sink for every six children.
(c) There shall be at least one bathtub or shower for every six children.
(d) There shall be slip-resistant surfaces in all bathtubs and showers.
(e) Privacy shall be provided for toilets, showers and bathtubs by partitions or doors.
(f) There shall be at least one wall mirror for every six children.
(g) An individual towel, washcloth, comb, hairbrush and toothbrush shall be provided for each child.
(h) Toiletry items including toothpaste, shampoo, deodorant and soap shall be provided.
(i) Bar soap is not permitted unless there is a separate bar clearly labeled for each child.
§ 3800.104. Kitchen areas.
(a) A facility shall have a kitchen area with a refrigerator, sink, cooking equipment and cabinets for storage.
(b) Utensils for eating, drinking and food serving and preparation shall be washed and rinsed after each use.
(c) Food shall be protected from contamination while being stored, prepared, transported and served.
(d) Uneaten food from a person's dish may not be served again or used in the preparation of other dishes.
(e) Cold food shall be kept at or below 40°F. Hot food shall be kept at or above 140°F. Frozen food shall be kept at or below 0°F.
§ 3800.105. Laundry.
Bed linens, towels, washcloths and clothing shall be laundered at least weekly.
§ 3800.106. Swimming.
(a) Above-ground and in-ground outdoor pools shall be fenced with a gate that is locked when the pool is not in use.
(b) Indoor pools shall be made inaccessible to children when not in use.
(c) A certified lifeguard shall be present with the children at all times while children are swimming.
(d) The certified lifeguard specified in subsection (c) may not be counted in the staff to child ratios specified in §§ 3800.54 and 3800.55 (relating to child care supervisor; and child care worker).
FIRE SAFETY § 3800.121. Unobstructed egress.
(a) Stairways, hallways, doorways, passageways and egress routes from rooms and from the building shall be unlocked and unobstructed, unless the fire safety approval specified in § 3800.14 (relating to fire safety approval) permits locking of certain means of egress. If a fire safety approval is not required in accordance with § 3800.14, means of egress may not be locked.
(b) Doors used for egress routes from rooms and from the building may not be equipped with key-locking devices, electronic card operated systems or other devices which prevent immediate egress of children from the building.
§ 3800.122. Exits.
If more than four children sleep above the ground floor, there shall be a minimum of two interior or exterior exits from each floor. If a fire escape is used as a means of egress, it shall be permanently installed.
§ 3800.123. Evacuation procedures.
There shall be written emergency evacuation procedures that include staff responsibilities, means of transportation and emergency location.
§ 3800.124. Notification of local fire officials.
The facility shall notify local fire officials in writing of the address of the facility, location of bedrooms and assistance needed to evacuate in an emergency. The notification shall be kept current.
§ 3800.125. Flammable and combustible materials.
(a) Combustible materials may not be located near heat sources.
(b) Flammable materials shall be used safely, stored away from heat sources and inaccessible to children.
§ 3800.126. Furnaces.
Furnaces shall be inspected and cleaned at least annually by a professional furnace cleaning company or trained maintenance staff persons. Documentation of the inspection and cleaning shall be kept.
§ 3800.127. Portable space heaters.
Portable space heaters, defined as heaters that are not permanently mounted or installed, are not permitted in the facility.
§ 3800.128. Wood and coal burning stoves.
The use of wood and coal burning stoves is not permitted.
§ 3800.129. Fireplaces.
(a) Fireplaces shall be securely screened or equipped with protective guards while in use.
(b) A staff person shall be present with the children while a fireplace is in use.
(c) A fireplace chimney and flue shall be cleaned when there is an accumulation of creosote. Written documentation of the cleaning shall be kept.
§ 3800.130. Smoke detectors and fire alarms.
(a) A facility shall have a minimum of one operable automatic smoke detector on each floor, including the basement and attic.
(b) There shall be an operable automatic smoke detector located within 15 feet of each bedroom door.
(c) The smoke detectors specified in subsections (a) and (b) shall be located in common areas or hallways.
(d) Smoke detectors and fire alarms shall be of a type approved by the Department of Labor and Industry or listed by Underwriters Laboratories.
(e) If the facility serves four or more children or if the facility has three or more stories including the basement and attic, there shall be at least one smoke detector on each floor interconnected and audible throughout the facility or an automatic fire alarm system that is audible throughout the facility.
(f) If one or more children or staff persons are not able to hear the smoke detector or fire alarm system, all smoke detectors and fire alarms shall be equipped so that each person with a hearing impairment will be alerted in the event of a fire.
(g) If a smoke detector or fire alarm becomes inoperative, repair shall be completed within 48 hours of the time the detector or alarm was found to be inoperative.
(h) There shall be a written procedure for fire safety monitoring if the smoke detector or fire alarm becomes inoperative.
§ 3800.131. Fire extinguishers.
(a) There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic.
(b) If the indoor floor area on a floor including the basement or attic is more than 3,000 square feet, there shall be an additional fire extinguisher with a minimum 2-A rating for each additional 3,000 square feet of indoor floor space.
(c) A fire extinguisher with a minimum 2A-10BC rating shall be located in each kitchen. The kitchen extinguisher meets the requirements for one floor as required in subsection (a).
(d) Fire extinguishers shall be listed by Underwriters Laboratories or approved by Factory Mutual Systems.
(e) Fire extinguishers shall be accessible to staff persons. Fire extinguishers may be kept locked if access to the extinguisher by a child may cause a safety risk to the child. If fire extinguishers are kept locked, each staff person shall be able to immediately unlock the fire extinguisher in the event of a fire emergency.
(f) Fire extinguishers shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher.
§ 3800.132. Fire drills.
(a) An unannounced fire drill shall be held at least once a month.
(b) Fire drills shall be held during normal staffing conditions and not when additional staff persons are present.
(c) A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, the number of children in the facility at the time of the drill, problems encountered and whether the fire alarm or smoke detector was operative.
(d) Children shall be able to evacuate the entire building into a public thoroughfare, or to a fire-safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employe of the facility.
(e) A fire drill shall be held during sleeping hours at least every 6 months.
(f) Alternate exit routes shall be used during fire drills.
(g) Fire drills shall be held on different days of the week, at different times of the day and night and on different staffing shifts.
(h) Children shall evacuate to a designated meeting place outside the building or within the fire-safe area during each fire drill.
(i) A fire alarm or smoke detector shall be set off during each fire drill.
(j) Elevators may not be used during a fire drill or a fire.
CHILD HEALTH § 3800.141. Child health and safety assessment.
(a) A child shall have a written health and safety assessment within 24 hours of admission.
(b) The assessment shall be completed or coordinated, signed and dated by medical personnel or staff persons trained by medical personnel.
(c) The assessment shall include the following:
(1) Medical information and health concerns such as allergies; medications; immunization history; hospitalizations; medical diagnoses; medical problems that run in the family; issues experienced by the child's mother during pregnancy; special dietary needs; illnesses; injuries; dental, mental or emotional problems; body positioning and movement stimulation for children with disabilities, if applicable; and ongoing medical care needs.
(2) Known or suspected suicide or self-injury attempts or gestures and emotional history which may indicate a predisposition for self-injury or suicide.
(3) Known incidents of aggressive or violent behavior.
(4) Substance abuse history.
(5) Sexual history or behavior patterns that may place the child or other children at a health or safety risk.
(d) A copy of the assessment shall be kept in the child's record.
§ 3800.142. Health and safety plan.
If the health and safety assessment in § 3800.141 (relating to health and safety assessment) identifies a health or safety risk, a written plan to protect the child shall be developed and implemented within 24 hours after the assessment is completed.
§ 3800.143. Child health examination.
(a) A child shall have a health examination within 15 days after admission and annually thereafter, or more frequently as specified at specific ages in the periodicity schedule recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision,'' available from 141 Northwest Point Boulevard, Post Office Box 927, Elk Grove Village, Illinois, 60009-0927.
(b) If the child had a health examination prior to admission that meets the requirements of subsection (e) within the periodicity schedule specified in subsection (a), and there is written documentation of the examination, an initial examination within 15 days after admission is not required. The next examination shall be required within the periodicity schedule specified in subsection (a).
(c) If the child will participate in a program that requires significant physical exertion, a health examination shall be completed before the child participates in the physical exertion portion of the program.
(d) The health examination shall be completed, signed and dated by a licensed physician, certified registered nurse practitioner or licensed physician's assistant. Written verification of completion of each health examination, date and results of the examination, the name and address of the examining practitioner and follow-up recommendations made, including each component, shall be kept in the child's record.
(e) The health examination shall include:
(1) A comprehensive health and developmental history, including both physical and behavioral health development.
(2) A comprehensive, unclothed physical examination.
(3) Immunizations, screening tests and laboratory tests as recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision.''
(4) Blood lead level assessments for children 5 years of age or younger, unless the examining practitioner determines that the testing is unnecessary, after reviewing the results of previously conducted blood lead testing, which review and conclusion is documented in the child's medical record.
(5) Sickle cell screening for children who are African-American unless the examining practitioner determines that the testing is unnecessary, after reviewing the results of previously conducted sickle cell testing, which review and conclusion is documented in the child's medical record.
(6) A gynecological examination including a breast examination and a Pap test if recommended by medical personnel.
(7) Communicable disease detection if recommended by medical personnel based on the child's health status and with required written consent in accordance with applicable laws.
(8) Specific precautions to be taken if the child has a communicable disease, to prevent spread of the disease to other children.
(9) An assessment of the child's health maintenance needs, medication regimen and the need for blood work at recommended intervals.
(10) Special health or dietary needs of the child.
(11) Allergies or contraindicated medications.
(12) Medical information pertinent to diagnosis and treatment in case of an emergency.
(13) Physical or mental disabilities of the child, if any.
(14) Health education, including anticipatory guidance.
(15) Recommendations for follow-up physical and behavioral health services, examinations and treatment.
(f) Immunization records, screening tests and laboratory tests may be completed, signed and dated by a registered nurse or licensed practical nurse instead of a licensed physician, certified registered nurse practitioner or licensed physician's assistant.
§ 3800.144. Dental care.
(a) Each child shall receive dental care, at as early an age as necessary, needed for relief of pain and infections, restoration of teeth and maintenance of dental health.
(b) A child who is 3 years of age or older shall have a dental examination performed by a licensed dentist and teeth cleaning performed by a licensed dentist or dental technician at least semiannually. If a child has not had a dental examination and teeth cleaning within 6 months prior to admission, a dental examination and teeth cleaning shall be performed within 30 days after admission.
(c) A written record of completion of each dental examination, including the preadmission examination permitted in subsection (b), specifying the date of the examination, the dentist's name and address, procedures completed and follow-up treatment recommended and dates provided, shall be kept in the child's record.
(d) Follow-up dental work indicated by the examination, such as treatment of cavities and the application of protective sealants, shall be provided in accordance with recommendations by the licensed dentist.
§ 3800.145. Vision care.
(a) Each child shall receive vision screening and services to include diagnosis and treatment including eyeglasses, for defects in vision.
(b) Each child who is 3 years of age or older shall receive vision screening within 30 days after admission in accordance with the periodicity schedule recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision,'' and ''Eye Examination and Vision Screening in Infants, Children and Young Adults (RE9625).''
(c) If the child had a vision screening prior to admission that meets the requirements of subsection (a) within the periodicity schedule specified in subsection (b), an initial examination within 30 days after admission is not required. The next screening shall be required within the periodicity schedule specified in subsection (b).
(d) Follow-up treatment and services, such as provision of eyeglasses, shall be provided as recommended by the treating practitioner.
(e) A written record of completion of each vision screening, including the preadmission screening permitted in subsection (c), specifying the date of the screening, the treating practitioner's name and address, results of the screening, follow-up recommendations made, and the dates and provision of follow-up services and treatment, shall be kept in the child's record.
§ 3800.146. Hearing care.
(a) Each child shall receive a hearing screening and services to include diagnosis and treatment including hearing aids, for defects in hearing.
(b) Each child who is 3 years of age or older shall receive a hearing screening within 30 days after admission in accordance with the periodicity schedule recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision.''
(c) If the child had a hearing screening prior to admission that meets the requirements of subsection (a) within the periodicity schedule specified in subsection (b), an initial examination within 30 days after admission is not required. The next screening shall be required within the periodicity schedule specified in subsection (b).
(d) Follow-up treatment and services, such as provision of hearing aids, shall be provided as recommended by the treating practitioner.
(e) A written record of completion of each hearing screening, including the preadmission screening permitted in subsection (c), specifying the date of the screening, the treating practitioner's name and address, the results of the screening, follow-up recommendations made, and the dates and provision of follow-up services and treatment, shall be kept in the child's record.
§ 3800.147. Use of tobacco.
(a) Use or possession of tobacco products by children is prohibited.
(b) Use or possession of tobacco products by staff persons is prohibited in the facility and during transportation provided by the facility.
(c) If staff persons use tobacco products outside but on the premises of the facility, the following apply:
(1) The facility shall have written fire safety procedures. Procedures shall include extinguishing procedures and requirements that smoking shall occur only a safe distance from the facility and from flammable or combustible materials or structures.
(2) Written safety procedures shall be followed.
(3) Use of tobacco products shall be out of the sight of the children.
§ 3800.148. Health and behavioral health services.
(a) The facility shall identify acute and chronic conditions of a child and shall arrange for or provide appropriate medical treatment.
(b) Medically necessary physical and behavioral health services, diagnostic services, follow-up examinations and treatment, such as medical, nursing, pharmaceutical, dental, dietary, hearing, vision, blood lead level, psychiatric and psychological services that are planned or prescribed for the child, shall be arranged for or provided.
§ 3800.149. Emergency medical plan.
(a) The facility shall have a written emergency medical plan listing the following:
(1) The hospital or source of health care that will be used in an emergency.
(2) The method of transportation to be used.
(3) An emergency staffing plan.
(4) Medical and behavior health conditions or situations under which emergency medical care and treatment are warranted.
(b) The child's parent and, if applicable, the child's guardian or custodian, shall be given a copy of the emergency medical plan upon admission.
(c) The child's parent and, if applicable, the child's guardian or custodian, shall be notified immediately if the emergency plan is implemented for the child.
STAFF HEALTH § 3800.151. Staff health statement.
A staff person or volunteer who comes into direct contact with the children or who prepares or serves food, shall have a statement signed and dated by a licensed physician, certified registered nurse practitioner or licensed physician's assistant, within 12 months prior to working with children or food service and every 2 years thereafter, stating that the person is free of serious communicable disease that may be spread through casual contact or that the staff person has a serious communicable disease that may be spread through casual contact but is able to work in the facility if specific precautions are taken that will prevent the spread of the disease to children.
§ 3800.152. Serious communicable diseases.
(a) If a staff person or volunteer has a serious communicable disease that may be spread through casual contact, written authorization from a licensed physician, certified nurse practitioner or licensed physician's assistant is required for the person to be present at the facility.
(b) Written authorization from a licensed physician, certified nurse practitioner or licensed physician's assistant shall include a statement that the person will not pose a serious threat to the health of the children and specific instructions and precautions to be taken for the protection of the children.
(c) The written instructions and precautions specified in subsection (b) shall be followed.
NUTRITION § 3800.161. Three meals a day.
At least three meals and one snack a day shall be provided to the children.
§ 3800.162. Quantity of food.
(a) The quantity of food served shall meet minimum daily requirements as recommended by the United States Department of Agriculture, unless otherwise recommended in writing by a licensed physician, certified nurse practitioner or licensed physician's assistant for a specific child.
(b) Additional portions of meals shall be available for the children.
§ 3800.163. Food groups and alternative diets.
(a) Each meal shall contain at least one item from the dairy, protein, fruits and vegetables and grain food groups, unless otherwise recommended in writing by a licensed physician, certified nurse practitioner or licensed physician's assistant for a specific child.
(b) Dietary alternatives shall be available for a child who has special health needs, religious beliefs regarding dietary restrictions or vegetarian preferences.
§ 3800.164. Withholding or forcing of food prohibited.
(a) A facility may not withhold meals or drink as punishment.
(b) A child may not be forced to eat food.
TRANSPORTATION § 3800.171. Safe transportation.
The following requirements apply whenever the facility, facility staff persons or facility volunteers provide transportation for the children. These requirements do not apply if transportation is provided by a source other than the facility.
(1) The child care worker to child ratios specified in § 3800.55 (relating to child care worker) apply.
(2) Each child shall be in an individual, age and size appropriate, safety restraint at all times the vehicle is in motion.
(3) The restrictive procedures specified in §§ 3800.201--3800.213 (relating to restrictive procedures) apply.
(4) The driver of a vehicle shall be 21 years of age or older.
MEDICATIONS § 3800.181. Storage of medications.
(a) Prescription and over-the-counter medications shall be kept in their original containers.
(b) Prescription and potentially poisonous over-the-counter medications shall be kept in an area or container that is locked.
(c) Prescription and potentially poisonous over-the-counter medications stored in a refrigerator shall be kept in a separate locked container.
(d) Prescription and over-the-counter medications shall be stored separately.
(e) Prescription and over-the-counter medications shall be stored under proper conditions of sanitation, temperature, moisture and light.
(f) Discontinued and expired medications, and prescription medications for children who are no longer served at the facility, shall be disposed of in a safe manner.
§ 3800.182. Labeling of medications.
(a) The original container for prescription medications shall be labeled with a pharmacy label that includes the child's name, the name of the medication, the date the prescription was issued, the prescribed dosage and the name of the prescribing physician.
(b) Over-the-counter medications shall be labeled with the original label.
§ 3800.183. Use of prescription medications.
Prescription medications shall be used only by the child for whom the medication was prescribed.
§ 3800.184. Medication log.
(a) A medication log shall be kept to include the following for each child:
(1) A list of prescription medications.
(2) The prescribed dosage.
(3) Possible side effects.
(4) Contraindicated medications.
(5) Specific administration instructions, if applicable.
(6) The name of the prescribing physician.
(b) For each prescription and over-the-counter medication including insulin administered or self-administered, documentation in the log shall include the medication that was administered, dosage, date, time and the name of the person who administered or self-administered the medication.
(c) The information in subsection (b) shall be logged at the same time each dosage of medication is administered or self-administered.
§ 3800.185. Medication errors.
(a) Documentation of medication errors shall be kept in the medication log. Medication errors include the failure to administer medication, administering the incorrect medication, administering the correct medication in an incorrect dosage or administering the correct medication at the incorrect time.
(b) After each medication error, follow-up action to prevent future medication errors shall be taken and documented.
§ 3800.186. Adverse reaction.
If a child has a suspected adverse reaction to a medication, the facility shall notify the prescribing physician, the child's parent and, if applicable, the child's guardian or custodian, immediately. Documentation of adverse reactions and the physician's response shall be kept in the child's record.
§ 3800.187. Administration.
(a) Prescription medications and injections of any substance shall be administered by one of the following:
(1) A licensed physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic.
(2) A graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the facility.
(3) A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the facility.
(4) A staff person who meets the criterion in § 3800.188 (relating to medications administration training) for the administration of oral, topical and eye and ear drop prescriptions, insulin injections and epinephrine injections for insect bites.
(5) A child who meets the requirements in § 3800.189 (relating to self-administration of medications).
(b) Prescription medications and injections shall be administered according to the directions specified by a licensed physician, certified registered nurse practitioner or licensed physician's assistant.
§ 3800.188. Medications administration training.
(a) A staff person who has completed and passed a Department-approved medications administration course within the past 2 years is permitted to administer oral, topical and eye and ear drop prescription medications and epinephrine injections for insect bites.
(b) A staff person who has completed and passed a Department-approved medications administration course and who has completed and passed a diabetes patient education program within the past 12 months that meets the Standards for Diabetes Patient Education Programs of the Pennsylvania Department of Health is permitted to administer insulin injections.
(c) A record of the training shall be kept including the person trained, the date, source, name of trainer, content and length of training.
§ 3800.189. Self-administration of medications.
A child is permitted to self-administer medications, insulin injections and epinephrine injections for insect bites, if the following requirements are met:
(1) A person who meets the qualifications of § 3800.187(a)(1)--(4) (relating to administration) is physically present observing the administration and immediately records the administration in accordance with § 3800.184 (relating to medication log).
(2) The child recognizes and distinguishes the medication and knows the condition or illness for which the medication is prescribed, the correct dosage and when the medication is to be taken.
RESTRICTIVE PROCEDURES § 3800.201. Restrictive procedure.
A restrictive procedure includes chemical restraint, exclusion and manual restraint and for secure care, mechanical restraint and seclusion.
§ 3800.202. Appropriate use of restrictive procedures.
(a) A restrictive procedure may not be used in a punitive manner, for the convenience of staff persons or as a program substitution.
(b) With the exception of exclusion as specified in § 3800.212 (relating to exclusion), a restrictive procedure may be used only to prevent a child from injuring himself or others.
(c) For each incident in which use of a restrictive procedure is considered:
(1) Every attempt shall be made to anticipate and de-escalate the behavior using methods of intervention less intrusive than restrictive procedures.
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