Rules for the Licensing of Child Care Facilities 10-148 cmr chapter 32

CHILD GUIDANCE

121. 
     Child guidance
     

1. 
   Positive methods of child guidance. Staff must use positive methods of child guidance which encourage self-control, self-direction, self-esteem and cooperation. Child guidance must meet the individual needs of each child.
   

2. 
   Consistent and reasonable application of rules. Rules, expectations and limits must be applied consistently and carried out in a manner consistent with a child’s developmental ability.
   

3. 
   Constructive methods of guidance. The Child Care Facility must use only constructive methods of guidance. This may include, but is not limited to, interventions such as conflict resolution, encouraging the use of language skills, redirecting, providing choices, using praise or positive reinforcement, recognizing a child’s strengths, and allowing for individual differences.
   

4. 
   Corporal punishment. Corporal punishment as defined in Section 1.6 in these rules is strictly prohibited.
   

5. 
   Shaming. Shaming and embarrassment must not be used.
   

6. 
   Withholding food. The withholding of food, drink, or rest must not be used as punishment or threat of punishment.
   

7. 
   Forced to eat. No child shall be forced to eat or drink against his/her will.
   

8. 
   Soiling, wetting. No child shall be punished for soiling, wetting, or not using the toilet.
   

9. 
   Cruel punishment. No child shall be subjected to cruel or severe punishment, humiliation, verbal abuse or unusual confinement.
   

10. 
    Adaptive equipment. The withholding of any adaptive equipment that would result in loss of a child’s independence must not be used.
    

11. 
    Detrimental practice. No child shall be subjected to an action or practice detrimental to the welfare of children as defined in Section 12.1.5.
    

HEALTH/MEDICAL

122. 
     Immunization
     

1. 
   Certificate of immunization for children. For each child who is not attending public or private school, the facility must require and have on file, within thirty (30) days of the child’s first admission to the facility, and updated annually thereafter, a Certificate of Immunization that clearly illustrates each child’s present immunization status. Each child’s record must reflect an up-to-date status according to the Day Care Immunization Standards, developed by the Maine Center for Disease Control and Prevention.
   

1. 
   Dates of immunization (month/day/year) and vaccine type must be on file for each of the following vaccine-preventable diseases:
   

1. 
   Measles;
   
2. 
   Mumps;
   
3. 
   Rubella;
   
4. 
   Diphtheria;
   
5. 
   Pertussis;
   
6. 
   Polio;
   
7. 
   Tetanus;
   
8. 
   Haemophilus influenzas Type b;
   
9. 
   Varicella;
   
10. 
    Hepatitis B; and
    
11. 
    Pneumococcal conjugate;
    

2. 
   Blood test demonstrating immunity. A blood test demonstrating immunity to measles, mumps, and rubella may be provided as proof of immunity. Evidence of this must be kept on file, and updated in a timely manner.
   

3. 
   Exceptions to proof of immunity. No child shall be required under this rule to have any such immunization if his/her parent(s) states in writing a sincere religious or philosophical belief that it is contrary to the immunization requirements of this rule or if the child’s physician submits documentation that immunization
   

4. 
   Certificate of immunization for staff. For staff born after 1956, the facility must obtain and have available a Certificate of Immunization for measles, mumps, rubella, tetanus and diphtheria. A laboratory blood test proving immunity may also be accepted. Documentation of immunity against measles, mumps and rubella is not required for staff born prior to 1957. No person shall be required to provide such documentation if she/he provides in writing the opposition for sincere religious or philosophical reasons or provides written documentation from a physician that such immunization is medically inadvisable.
   

5. 
   Documenting exemptions to immunization. The facility must maintain a list of children and staff exempted for religious, philosophical or medical reasons.
   

6. 
   Immunization records and reporting requirements. The facility must make immunization records available to the Department of Health and Human Services, Maine Center for Disease Control and Prevention, upon request.
   

123. 
     Medical statement
     

1. 
   Request for physician’s or psychologist’s report. When the department has reasonable cause to believe that the applicant, or a person employed or residing in the facility may have a physical or mental health problem which would have a detrimental impact on the care of children, which may include, but is not limited to substance abuse and/or addiction, or chronic or contagious illness, the department may request the applicant or licensee to provide the department with a physician’s or psychologist’s report. This report must include a diagnosis of any physical or mental conditions and the professional’s assessment of the impact or the effect of the condition and its treatment on the functioning of such individual.
   

2. 
   Exceptions to undergoing evaluations. No person shall be required to undergo a physical examination or other evaluation if he or she states in writing that it is contrary to his or her sincere religious or philosophical teachings and practice, unless there is probable cause to suspect that he or she manifests the symptoms of a disease or illness which may affect the health, safety, or welfare of a child in care.
   

124. 
     Health care consultation
     

1. 
   Health consultation requirements for facilities licensed for thirteen (13) or more children:
   

1. 
   The facility must have a written agreement with a physician, a nurse practitioner, physician's assistant, or nurse with pediatric or childcare experience to serve as a health consultant.
   

2. 
   The facility must have a written plan approved by the health care consultant which must include:
   

1. 
   Evidence of access to emergency medical services;
   

2. 
   Prevention and control of communicable diseases;
   

3. 
   Policy on administration of medication in compliance with Section 17.6, including identification of staff members permitted to dispense medication and procedures for documentation of the administration or dispensing of medication; and
   

4. 
   Provision of training to all facility staff in the facility's health care plan.
   

2. 
   Health consultation requirements for facilities licensed for three (3) to twelve (12) children. The facility licensed for 3-12 children must ensure that a manual of written guidelines for the prevention and control of communicable diseases and other
   

125. 
     Disease surveillance
     

1. 
   Daily observation. The facility must observe the child each day at the time of arrival and throughout the child's stay for obvious signs of illness such as fever, diarrhea, vomiting, or skin rashes.
   

2. 
   Apparent illness of a child. In the event of an apparent illness of a child, the facility must follow appropriate health practices.
   

1. 
   The facility licensed for 3-12 children must comply with Section 17.3.2, above.
   

2. 
   The facility licensed for 13 or more children must follow its written health care policy statement.
   

126. 
     Accidents and sudden illness
     

1. 
   Notification of parent or legal guardian. The facility must immediately notify the child's parent or legal guardian of any illness, serious injury or accident involving their child. An adult designated by the parent or legal guardian shall be notified immediately should the parent or legal guardian be unavailable at the time of emergency.
   

2. 
   Documentation of incidents. The facility must document all accidents, injuries, or emergencies in the child's record on the day of the occurrence and make such reports available to the parent or legal guardian.
   

127. 
     Administration of medication
     

1. 
   Written orders required. The facility shall administer prescription medication only upon written order from a physician or according to the labeled instructions on the original medicine container and with a written, signed and dated request from the parent or legal guardian.
   

2. 
   Recording the administration of medications. The facility must record the administration of all medications, including the amount, time, date and signature of the administrator of the medication.
   

3. 
   Nonprescription medications. The facility must not administer any nonprescription medications to a child without written, signed and dated parental permission naming the medication and dosage. Verbal permission is allowed in emergencies if the provider makes a written note and then gets written permission from the parent as soon as possible.