606 Mass. Reg. 7.11

Current through Register 1519, April 12, 2024

Section 7.11 - Health and Safety

The following requirements apply to all programs, including family child care, small group and school age and large group and school age child care. Additional requirements for family child care are found at 606 CMR 7.11(17). Additional requirements for small group and school age child care are found at 606 CR 7.11(18). Additional requirements for large group and school age child care are found at 606 CMR 7.11(18) and (19).

(1)Training. All educators must be trained in the program's emergency and evacuation procedures, in standard precautions and in medication administration procedures.

(a)First Aid and CPR.

1. The licensee must ensure that at least one educator currently certified in first aid and age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care.

2. CPR training must be renewed prior to the expiration date listed on the CPR certificate.

3. Only educators who are currently certified in first aid and CPR may provide first aid and CPR.

(b)Medication. Each person who administers prescription or non-prescription medication to a child must be trained to verify and to document that the right child receives the proper dosage of the correct medication designated for that particular child and given at the correct time(s), and by the proper method. Each person who administers medication (other than topical medication) must demonstrate competency in the administration of medication before being authorized by the licensee to administer any medication.

1. The licensee must ensure that at least one educator with training in medication administration is present at any and all times when children are in care.

2. Each person who administers any medication, other than oral or topical medications and epinephrine auto-injectors, must be trained by a licensed health care practitioner and must demonstrate annually to the satisfaction of the trainer, competency in the administration of such medications. An alternative method of training approved by the Massachusetts Department of Public Health (MDPH) can be substituted with approval from MDPH.

3. The licensee must ensure that each educator, including those educators who do not administer medication, receives training in recognizing generic medication side effects and adverse interactions among various medications, and potential side effects of specific medications being administered in the program.

(2)Medication Administration.

(a) The licensee must have a written policy regarding administration of prescription and nonprescription medication. The policy must provide for the administration of medications ordered by a child's health care practitioner.

(b) All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, must be provided by the child's parent, unless noted in 606 CMR 7.11(2)(e) l.

(c) All prescription medications must be in the containers in which they were originally dispensed and with their original labels affixed. Over-the-counter medications must be in the original manufacturer's packaging.

(d) The educator must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child's licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist's descriptive order.

(e) Unless otherwise specified in a child's individual health care plan, the educator must store all medications out of the reach of children and under proper conditions for sanitation, preservation, security and safety during the time the children are in care and during the transportation of children.

1. Those medications found in United States Drug Enforcement Administration (DEA) Schedules II through V must be kept in a secured and locked place at all times when not being accessed by an authorized individual.

2. Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children in a refrigerator maintained at temperatures between 38ºF and 42ºF.

(f) Notwithstanding the provisions of 606 CMR 7.11(2)(e), emergency medications such as epinephrine auto-injectors must be immediately available for use as needed.

(g) Each licensee shall have a written policy on medication disposal.

(h) When possible, all unused, discontinued or outdated prescription medications shall be returned to the parent and such return shall be documented in the child's record. When return to the parent is not possible or practical, such prescription medications must be destroyed and the destruction recorded by a manager or supervisor in accordance with policies of the licensee and the Department of Public Health, Drug Control Program.

(i) No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent.

(j) Each time medication is administered, the educator must document in the child's record the name of the medication, the dosage, the time and the method of administration, and who administered the medication, except as noted in 606 CMR 7.11(2)(k).

(k) The educator must inform the child's parent(s) at the end of each day whenever a topical medication is applied to a diaper rash.

(l) All medications must be administered in accordance with the consent and documentation requirements specified below:

Type of Medication
Written Parental Consent Required
Health Care Practitioner Authorization Required
Logging Required
All Prescription
Yes
Yes, must be in original container with original label containing the name of the child affixed
Yes, name of child, dosage, date, time, staff signature; missed doses must also be noted along with the reason(s) why the dose was missed
Oral Non-Prescription
Yes, renewed weekly with dosage, times, days and purpose
No in FCC.
Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed
Yes, name of child, dosage, date, time, staff signature; missed doses must also be noted along with the reason(s) why the dose was missed
Unanticipated NonPrescription for Mild Symptoms (e.g., acetaminophen, ibuprofen, antihistamines)
Yes, renewed annually
No in FCC.
Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed
Yes, name of child, dosage, date, time, staff signature
Topical, non-Prescription (when applied to open wounds or broken skin)
Yes, renewed annually
No in FCC.
Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed
Yes, name of child, dosage, date, time, staff signature.
Topical, nonPrescription (not applied to open wounds or broken skin)
Yes, renewed annually
No. Items not applied to open wounds or broken skin may be supplied by program with notification to parents of such, or parents may send in preferred brands of such items for their own child(ren)'s use.
No for items used solely for prevention, such as sunscreen, insect repellant and chap stick.

(3)Individual Health Care Plans The licensee must maintain as part of a child's record, an individual health care plan for each child with a chronic medical condition, which has been diagnosed by a licensed health care practitioner. The plan must describe the chronic condition, its symptoms, any medical treatment that may be necessary while the child is in care, the potential side effects of that treatment, and the potential consequences to the child's health if the treatment is not administered.

(a) The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization.

1. Notwithstanding the provisions of 606 CMR 7.11(1)(b)2., the educator must have successfully completed training, given by the child's health care practitioner, or, with his/her written consent, given by the child's parent or the program's health consultant, that specifically addresses the child's medical condition, medication and other treatment needs.

2. In addition to the requirements for the routine, scheduled administration of medication or treatment set forth in 606 CMR 7.11(3)(a), any unanticipated administration of medication or unanticipated treatment for a non-life-threatening condition requires that the educator must make a reasonable attempt to contact the parent(s) prior to administering such unanticipated medication or beginning such unanticipated treatment, or, if the parent(s) cannot be reached in advance, as soon as possible after such medication or treatment is given.

3. The educator must document all medication or treatment administration, whether scheduled or unanticipated, in the child's medication and treatment log.

4. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue.

(b) Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. All educators must be aware of the contents and requirements of the child's individual health care plan specifying how the inhaler or epinephrine auto-injector will be kept secure from access by other children in the program.

(c) Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed.

(4)Abuse and Neglect.

(a) Any form of abuse or neglect of children while in care is strictly prohibited.

(b) The Licensee and all educators must operate the program in ways that protect children from abuse or neglect.

(c) Educators are responsible for abuse and neglect if:

1. the educator admits to causing the abuse or neglect, or

2. the educator is convicted of the abuse or neglect in a criminal proceeding, or

3. the Department of Early Education and Care determines, based upon its own investigation or an investigation conducted by the Department of Children and Families subsequent to a report filed under M.G.L. c. 119, §§ 51A and 51B, that there is reasonable cause to believe that the educator or any other person caused the abuse or neglect while children were in care.

(d) Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted.

(e) The licensee must notify the Department immediately after filing or learning that a 51A report has been filed alleging abuse or neglect of a child while in the care of the program or during a program related activity.

(f) The licensee must notify the Department immediately upon learning that a report has been filed naming an educator or person regularly on the child care premises (including household members in family child care) an alleged perpetrator of abuse or neglect of any child.

(5)Injury Prevention.

(a) Liquids, foods, and appliances that are or become hot enough to burn a child must be kept out of the reach of children.

(b) The use of any substance that may impair the educator's alertness, judgment or ability to care for children during child care hours is prohibited.

(c) Drinking alcoholic beverages and smoking on the child care premises during child care hours are prohibited.

(d) The licensee must ensure that the following are easily and readily available at all times, and accompany the children anytime they leave the facility in the care of staff:

1. a first aid kit;

2. current family contact information;

3. information about allergies and known medical conditions;

4. emergency or life-saving medications, such as asthma inhalers and epinephrine auto-injectors, for any children for whom they have been prescribed;

5. telephone numbers for emergency services;

6. authorizations for emergency care for each child.

(e) The licensee must maintain adequate first aid supplies, including, but not limited to: adhesive tape, band aids, gauze pads, gauze roller bandage, disposable non-latex gloves, instant cold pack, scissors, tweezers, thermometer, and CPR mouth guard.

(f) The licensee must maintain a record of any unusual or serious incidents including but not limited to behavioral incidents, injuries, property destruction or emergencies. These reports must be reviewed by the licensee or Program Administrator on a monthly basis.

(g) Educators must check children's clothing to ensure that it is free from strings, laces or jewelry that could become entangled or wedged in playground equipment and present a strangulation hazard.

(h) Educators must protect children against cold, heat, and sun injury.

(6)Use of Off-site Facilities.

(a) The educator must confirm the availability and the appropriateness of off-site facilities prior to each use.

(b) The licensee must consider and implement a thoughtful plan for appropriate supervision of children in public spaces.

(c) The licensee must require written parental consent for a child to participate in off-site activities. The program may obtain a general permission from the parent of each child to take the child off the premises of the child care program for common excursions (e.g. library, playground, museums, swimming) if the consent lists the common excursions and the means of transportation. The consent form shall be valid for one year unless withdrawn in writing prior to that time.

(d) Programs must require written parental consent for a child to participate in special activities not listed on the common excursion consent form. The special permission must specify the date of the trip, the destination and duration of the trip and the means of transportation.

(e) Regardless of the general or special written permissions on file, the program must notify parents prior to taking children off the premises.

(f) Each child must carry on his/her person the name, address and telephone number of the educator or child care program whenever s/he is off the premises in the care of the program.

(7)Emergency Preparedness.

(a) The educator must handle all emergency situations in an appropriate manner.

(b) The educator must be able to communicate basic emergency information to emergency personnel.

(c) The licensee must provide to educators a working telephone for the purpose of making and receiving phone calls during all hours of program operation, whether on or off the premises, whenever they are responsible for supervising children.

(d) When considering evacuation or sheltering in place, the educator must follow the directions of the local emergency management authorities.

(e) Exit signs must be posted in rooms that have direct access to the outdoors.

(f) The licensee must have a written plan detailing procedures for meeting potential emergencies including but not limited to missing children, the evacuation of children from the program in the event of a fire, natural disaster, loss of power, heat or hot water or other emergency situation. The plan must include but not be limited to:

1. a method to obtain information from local authorities to determine whether to evacuate or shelter in place in the event of a natural disaster;

2. escape routes from each floor level approved for child care;

3. a designated meeting place outside and away from the child care home or facility;

4. a method of contacting the fire department or other appropriate authorities after the home or facility has been evacuated;

5. a method of communication with parents in the event of an emergency evacuation; and

6. a means to assure that no child is left in the home or facility after evacuation.

(g) The plan must be kept current and must meet the needs of all children in care, including infants, toddlers and any children (including but not limited to those with disabilities) who may need additional assistance during an evacuation.

(h) The educator must hold practice evacuation drills with all groups of children and all educators from each floor level of the approved space at least monthly. Drills must be held during different times of the program day, and must use alternative exits. The educator must document the date, time, exit route used, number of children evacuated and effectiveness of each drill.

(i) Programs that use cribs for evacuation must assure that such cribs are safe for the intended purpose, easily movable and small enough to fit through exit doors to the outside.

(8)Care of Mildly Ill Children. The educator must meet the individual needs of the child for food, drink, rest, play materials, comfort, supervision and appropriate indoor and outdoor activity, as indicated by the health condition of the child.

(9)Management of Infectious Diseases.

(a) The program must follow exclusion policies for serious illnesses, contagious diseases and reportable diseases in conformance with regulations and recommendations set by the Division of Communicable Disease Control, Department of Public Health.

(b) The licensee must notify all parents in accordance with Department of Public Health recommendations when any communicable disease or condition has been introduced into the program.

(c) Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents.

(d) The program must follow all applicable Department policies and requirements pertaining to the prevention of serious illnesses, contagious diseases, and reportable diseases.

(10)Infection Control.

(a) All educators must be trained in infection control procedures.

(b) Educators must educate children about and promote hand washing procedures and health precautions.

(c) The licensee must ensure that educators and children wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands must be dried with individual or disposable towels or automatic hand blow-dryers. The use of common towels is prohibited. Educators and children must wash their hands at least at the following times:

1. before and after water play;

2. before and after eating or handling food;

3. after toileting or diapering;

4. after coming into contact with bodily fluids or discharges (including sneezes, coughing);

5. after handling animals or their equipment, and

(d) In addition, educators must wash their hands:

1. before and after administration of medication;

2. after performing cleaning tasks, handling trash or using cleaning products.

(e) Facilities used for hand washing after diapering or toileting must be separate from facilities and areas used for food preparation and food service.

(f) The licensee must ensure that equipment, materials, items or surfaces (including floors, walls and clothing used for dramatic play) are washed with soap and water and disinfected as needed to maintain a sanitary environment.

(g) All floors used by children must be swept and/or vacuumed daily.

(h) All eating surfaces must be washed and disinfected before and after each use.

(i) Where applicable, the following items, equipment and surfaces must be washed and disinfected after each use:

1. toilet training chairs which have first been emptied into a toilet;

2. sinks and faucets used for hand washing after the sink is used for rinsing a toilet training chair;

3. diapering surfaces;

4. mops used for cleaning body fluids;

5. bibs (when used only for one child, good judgment should be used in deciding whether it can be reused before washing);

6. thermometers; and

7. water tables and water play equipment.

(j) Toys mouthed by children must be set aside and stored after each use and may not be used by another child until they are washed and disinfected.

(k) Personal items intended for individual use by children, including but not limited to bottles, pacifiers, toothbrushes and sleeping materials, must be labeled with the name of the child for whom they are intended.

(l) The following items must be monitored for cleanliness and washed and disinfected at least daily:

1. toilets and toilet seats;

2. containers, including lids, used to hold soiled diapers;

3. sinks and sink faucets;

4. drinking fountains;

5. play tables; and

6. washcloths and towels.

(m) The following must be washed and disinfected at least weekly:

1. cribs, cots, mats and other approved sleeping equipment;

2. sheets, blankets or other coverings;

3. machine washable fabric toys;

4. smooth surfaced, non-porous floors; and

5. mops used for cleaning.

(n) The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer's directions.

(o) All disinfectant solutions must be stored in accordance with manufacturer's instructions and in a secure place out of the reach of children.

(p) The licensee must provide disposable non-latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child's name and returned to the parent at the end of the day.

(q) The licensee must ensure that when individual towels or washcloths are used for any purpose they are stored open to the air and not touching each other.

(11)Personal Hygiene.

(a) The educator must model and follow good personal hygiene practices at all times.

(b) The educator must ensure that when each child is washed, an individual, labeled washcloth or disposable material is used.

(c) The licensee must have available sufficient clean and dry indoor and outdoor clothing to change a child's clothing or for a child to change his/her own clothing when wet or soiled and to ensure that children are dressed appropriately for the weather and for indoor and outdoor program activities. Clothing must be washed after each use.

(d) Educators must assist children in brushing their teeth whenever they are in care for more than four hours or whenever they consume a meal while in care.

(e) Children must use individual, labeled toothbrushes which must be stored in a safe and sanitary manner open to the air without touching each other.

(12)Diapering and Toileting. In programs serving children who are under two years and nine months of age and/or not toilet trained, the educator must ensure that:

(a) a change of clothing is available for each child;

(b) diapering areas are separate from facilities and areas used for food preparation and food service;

(c) a supply of clean, dry diapers adequate to meet the needs of the children is maintained;

(d) a common changing table or diapering surface is not used for any other purpose;

(e) the changing surface is smooth, intact, impervious to water and easily cleaned.

(f) each child's diaper is changed on a regular basis throughout the day and when wet or soiled;

(g) the changing surface is protected with a covering that is of adequate size to prevent the child from coming in contact with the changing surface;

(h) educators wash their hands with liquid soap and running water using friction and dry their hands with individual or disposable towels after diapering a child;

(i) educators keep at least one hand on the child at all times when the child is being changed on an elevated surface;

(j) each child is washed and dried with individual washing materials during each diaper change. After changing, the child's hands must be washed with liquid soap and water, and dried with individual or disposable towels;

(k) soiled disposable diapers are placed in a closed container that is lined with a leak-proof disposable lining. Soiled diapers must be removed from the program daily, or more frequently as necessary;

(l) soiled non-disposable diapers are placed in a sealed plastic container labeled with the child's name and returned to the child's parents at the end of the day.

(m) children are toilet-trained in accordance with the requests of their parents and consistent with the child's physical, emotional, and developmental abilities.

(13)Sleep, Rest and Quiet Activity.

(a) The licensee must provide an opportunity for children to rest or engage in quiet activities in a program where children are in care for less than four hours.

(b) During sleep, rest or quiet activities educators must ensure that children are easily accessible during an emergency.

(c) Restraints may not be used on sleeping children under any circumstances.

(d) The licensee must include, as part of the daily schedule, an extended period of sleep, rest or quiet activities for children in care for longer than four hours.

1. The length of the sleep, rest or quiet activity period must be appropriate to the needs of the children.

2. When children choose not to sleep or awaken early, they must be offered quiet activities for the remainder of the sleep or quiet activity period.

3. The licensee must:

a. minimize noise and disturbance;

b. provide a separate mat, cot, sofa, portacrib, playpen, bassinet or bed, and blanket for each child present at any time during the day;

c. provide sleeping materials that are individually marked and in good repair and clean; and

d. ensure safe and sanitary storage of blankets and bed linens.

4. Educators must ensure that:

a. there is a distance of at least two feet between each crib or cot, or there is a distance of at least three feet between children's faces while resting or napping;

b. there is appropriate space and adequate lighting for quiet activities for children who do not sleep;

c. there is adequate lighting to allow proper supervision.

(e) Programs serving infants must:

1. place infants on their backs for sleeping, unless the child's health care professional orders otherwise in writing;

2. nap infants in an individual crib, portacrib, playpen or bassinet;

3. ensure that cribs have firm, properly fitted mattresses with clean coverings, and do not contain any potential head entrapment areas.

4. ensure that slats on cribs are no more than 2% inches apart.

5. ensure that cribs, portacribs, playpens or bassinets used for sleeping infants younger than 12 months of age do not contain pillows, comforters, stuffed animals or other soft, padded materials.

(14)Requirements for Evening Care. Educators providing evening care must comply with all applicable regulations regarding daytime care, including, but not limited to, staffing ratios, supervision of children, curriculum, nutrition, ventilation and lighting, and naptime regulations.

(15)Requirements for Overnight Care. Educators providing overnight care must comply with all applicable regulations for day time care, in addition to the following:

(a)Occasional Overnight Care.

1. The educator must remain on the same floor level as child care children during the overnight shift.

2. Each child must have an individual bed, crib, or cot, with bedding appropriate to the season and the child's age, that is maintained in a safe and sanitary condition.

3. The educator must remain awake until all the children, including all household members and/or visitors below the age of 12 years old, are asleep.

4. The educator must be readily available to respond to childhood issues at night, such as illness, night fears, toileting accidents, and requests for drinks.

(b)Regular Overnight Care.

1. The educator must comply with all of the requirements for occasional overnight care, and;

2. The educator must submit a written plan for approval to EEC and must receive EEC written approval prior to providing any regular overnight care. The written plan must include the following information:

a. plans to assist children with disabilities, including but not limited to cognitive or physical, who might require additional assistance in an evacuation;

b. the maximum overnight capacity being requested and the age range of children expected to be in care;

c. a floor plan, with designated exit routes, for the entire building where children are located, and the rooms used by children for sleeping;

d. a specific description of how an evacuation would occur when the maximum capacity of children and educators is present; and

e. Any additional information as requested by the Department to determine the safety of children in care.

(16)Requirements for Pets.

(a) If the licensee has pets in the program, they must be appropriate for the children in care. Before introducing a pet to the program, the licensee must consider the effect on the children's health and safety, including possible allergies, and notify parents in advance, or prior to the child's enrollment.

(b) Educators must closely supervise all interactions between children and animals and instruct children on safe behavior when in close proximity to animals.

(c) If pets are kept in the program, the educator must:

1. ensure that animals, regardless of ownership, are free from disease and parasites and are licensed and/or vaccinated as prescribed by law;

2. not allow children to take part in the cleaning of the animal's cage;

3. keep litter boxes inaccessible to children;

4. ensure that pets are kept in a safe and sanitary manner.

(d) Children must not come into physical contact with reptiles. Reptiles in the program must be kept in accordance with Department of Public Health Guidelines.

(17)Additional Requirements for Family Child Care.

(a)Firearms. The licensee must keep firearms unloaded and either stored in a locked cabinet or equipped with a trigger lock and stored in a safe, secured place out of the reach of children. The licensee must store ammunition separately from firearms, either in a locked cabinet or a safe, secured place out of the reach of children.

(b)Plan for Potential Emergencies. In addition to the information required by 606 CMR 7.11(7)(f), the plan for potential emergencies must include the name and telephone number of a potential emergency caregiver who will be available to arrive at the child care home within ten minutes of being summoned to provide temporary child care in case of a medical emergency.

(c)Diaper Changing Surfaces. Diaper changing surfaces must be covered by either a disposable covering, a covering that is washed and disinfected after every use, or a covering designated for an individual child.

(d)Overnight Care.

1. In addition to the provisions of the written plan for regular overnight care specified at 606 CMR 7.11(15)(b)2, family child care licensees must include:

a. the number and names of the adults in the household who would be available to assist in an evacuation, including the educator;

b. the number and names of household members and/or visitors who would need assistance in an emergency evacuation, including children, elderly, and disabled individuals;

c. a clear and specific description of the location of bedrooms used by household members, visitors, and the educator.

2. The educator must have adequate sleep to ensure alertness while caring for children. As provided at 606 CMR 7.09(7), no educator may regularly care for child care children more than 12 hours in any 24-hour period.

3. Whenever regular overnight care is provided for seven to ten child care children two educators must remain on the premises, one of whom must remain awake during the entire overnight shift.

4. Children in care shall not sleep in the same room with children of the opposite sex, without written parental permission.

(18)Additional Requirements for Small Group and School Age and Large Group and School Age Child Care.

(a)Abuse or Neglect. The licensee must ensure that any educator accused of the abuse or neglect of a child in a report to the Department of Children and Families, filed pursuant to M.G.L. c. 119, § 51A does not work directly with children until the Department of Children and Families investigation is completed and for such further time as the Department of Early Education and Care requires.

(b)Escape Routes. A diagram of escape routes must be posted conspicuously at each means of egress in rooms that do not have direct access to the outdoors.

(c)Diapering.

1. A written plan for diapering and toilet training and for the disposal or cleaning of soiled clothing, linen, blankets and diapers must be developed, implemented and posted in diapering areas.

2. The diaper changing surface must be covered by a disposable cover that is changed after each child has been diapered and that is disposed of in a closed container.

3. The diaper changing surface must be washed and disinfected after each child has been diapered.

(d)First Aid Training. The licensee must document that each educator is certified in first aid within six months of employment.

(e)Overnight Care.

1. In addition to the provisions of the written plan for regular overnight care specified at 606 CMR 7.11(15)(b)2., the licensee must include:

a. the staff schedule and qualifications of the educators available to assist in an emergency evacuation;

b. a statement showing the location of all awake staff and any asleep staff during the overnight shift.

2. All educators required by the ratios must be awake at all times while overnight care is being provided. Notwithstanding the required staff to child ratios, there must always be at least two educators on the premises at all times when overnight care is provided.

(19)Additional Requirements for Large Group and School Age Child Care.

(a)Health Care Policy. The licensee must have a written health care policy that includes:

1. the name, address and telephone number of the health care consultant and local health care authority; the telephone number of the fire department, police, ambulance, nearest emergency health care facility, and the Poison Control Center; the name and telephone number of the emergency back-up person, if applicable; and the telephone number and address of the program, including, where applicable, the location of the program in the facility;

2. the procedures to be followed in case of illness, injury or emergency, method of transportation, notification of parents, and procedures when parent(s) cannot be reached including procedures to be followed when on field trips;

3. a list defining mild symptoms with which ill children may remain in care, and more severe symptoms that require notification of the parents or back-up contact to pick up the child;

4. a plan for caring for mildly ill children who remain in care;

5. a plan for administering medication, including:

a. annual evaluation of the ability of any staff authorized to administer medication to follow the medication administration procedures specified at 606 CMR 7.11(2);

b. a requirement that parents provide written authorization by a licensed health care practitioner for administration of any non-topical, non-prescription medication to their child. Such authorization shall be valid for one year unless earlier revoked;

6. a plan for meeting individual children's specific health care needs, including the procedure for identifying children with allergies and protecting children from that to which they are allergic;

7. a plan to allow parents, with the written permission of their child's health care practitioner, to train staff in implementation of their child's individual health care plan;

8. a plan to ensure that all appropriate specific measures will be taken to ensure that the health requirements of children with disabilities are met, when children with disabilities are enrolled;

9. a plan to ensure that all children 12 months of age or younger are placed on their backs for sleeping, unless the child's health care professional orders otherwise in writing;

10. notification to parents that educators are mandated reporters and must, by law, report suspected child abuse or neglect to the Department of Children and Families.

(b)Health Care Consultant. Each program must have access to a Health Care Consultant who will:

1. be available to the program for consultation, as needed;

2. approve the program's health care plan at initial licensure and at each license renewal;

3. approve first aid training and training in medication administration for staff.

(c)Infection Control. Notwithstanding the requirements of 606 CMR 7.11(10)(m), smooth surfaced, non-porous floors and mops used for cleaning must be washed and disinfected at least daily.

606 CMR 7.11

Amended by Mass Register Issue 1452, eff. 9/1/2021.

Amended by Mass Register Issue 1459, eff. 9/1/2021.

Type of Medication	Written Parental Consent Required	Health Care Practitioner Authorization Required	Logging Required
All Prescription	Yes	Yes, must be in original container with original label containing the name of the child affixed	Yes, name of child, dosage, date, time, staff signature; missed doses must also be noted along with the reason(s) why the dose was missed
Oral Non-Prescription	Yes, renewed weekly with dosage, times, days and purpose	No in FCC. Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed	Yes, name of child, dosage, date, time, staff signature; missed doses must also be noted along with the reason(s) why the dose was missed
Unanticipated NonPrescription for Mild Symptoms (e.g., acetaminophen, ibuprofen, antihistamines)	Yes, renewed annually	No in FCC. Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed	Yes, name of child, dosage, date, time, staff signature
Topical, non-Prescription (when applied to open wounds or broken skin)	Yes, renewed annually	No in FCC. Yes in Large and Small Group. Must be in original container with original label containing the name of the child affixed	Yes, name of child, dosage, date, time, staff signature.
Topical, nonPrescription (not applied to open wounds or broken skin)	Yes, renewed annually	No. Items not applied to open wounds or broken skin may be supplied by program with notification to parents of such, or parents may send in preferred brands of such items for their own child(ren)'s use.	No for items used solely for prevention, such as sunscreen, insect repellant and chap stick.