Title of Regulation: 22VAC40-111. Standards for Licensed Family Day Homes (amending 22VAC40-111-10, 22VAC40-111-30, 22VAC40-111-50, 22VAC40-111-60, 22VAC40-111-90, 22VAC40-111-100, 22VAC40-111-130, 22VAC40-111-140, 22VAC40-111-150, 22VAC40-111-200, 22VAC40-111-210, 22VAC40-111-230, 22VAC40-111-650, 22VAC40-111-760, 22VAC40-111-800, 22VAC40-111-810, 22VAC40-111-820, 22VAC40-111-830, 22VAC40-111-850, 22VAC40-111-870, 22VAC40-111-990).

Statutory Authority: §§ 63.2-217 and 63.2-1734 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: February 24, 2017.

Agency Contact: Sharon Smith-Basey, Program Consultant, Department of Social Services, 801 East Main Street, Richmond, VA 23219, telephone (804) 726-7037, FAX (804) 726-7132, or email sharon.basey@dss.virginia.gov.

Basis: Sections 63.2-100, 63.2-203, 63.2-217, and 63.2-1734 of the Code of Virginia provide the legal authority for the State Board of Social Services to adopt regulations and requirements for licensed family day homes. The Code of Virginia mandates "promulgation of regulations for the activities, services, and facilities to be employed by persons and agencies required to be licensed…which shall be designed to ensure that such activities, services and facilities are conducive to the welfare of the children under the custody or control of such persons or agencies." Section 63.2-1734 further mandates that: "Such regulations shall be developed in consultation with representatives of the affected entities and shall include, but need not be limited to, matters relating to the sex, age, and number of children and other persons to be maintained, cared for, or placed out as the case may be, and to the buildings and premises to be used, and reasonable standards for the activities, services and facilities to be employed. Such regulations shall not require the adopting of a specific teaching approach or doctrine or require the membership, affiliation, or accreditation services of any single private accreditation or certification agency."

Purpose: The proposed amendments update the regulation and align it with new federal requirements described in the Child Care and Development Block Grant Act of 2014. Adding these federal health and safety requirements is essential to protect the health, safety, or welfare of citizens.

The goals of this proposed action are to (i) update regulations to comply with new federal requirements for child care providers; (ii) update current licensing regulations to ensure consistency with requirements for Child Care and Development Fund recipients; and (iii) present a clearly written regulation that reflects current federal guidelines and practices in child care. Amendment of the existing regulation was determined by the State Board of Social Services as the most efficient and effective way to make the necessary changes to achieve clarity and consistency and to protect children.

Substance: Provisions included in the amended standards to be considered include revisions to address federal law changes that necessitate the development of new standards in current areas as well as areas not previously considered to address ever-changing national health and safety guidelines and practices. Substantive proposed amendments to the regulations include the following areas:

1. Grace period for immunization requirements for homeless children or foster care children.

2. Prevention of and response to emergencies due to food and allergic reactions.

3. Prevention of shaken baby syndrome and abusive head trauma.

4. Revised emergency preparedness plan requirements.

5. Orientation training for all caregivers with content including health and safety requirements.

6. Updated annual training requirements to include health and safety topics.

7. Revised cardiopulmonary resuscitation and first aid training requirements.

Issues: The primary advantages of the proposed regulatory action are to ensure that parents have sufficient information to make informed decisions when choosing to place their child in licensed family day homes that incorporate new standards that reflect federal health and safety requirements. The new regulations ensure consistent requirements for Child Care and Development Fund recipients.

The proposed regulatory action requires all child care providers to have current certification in cardiopulmonary resuscitation and first aid, which increases the health and safety of all children in care. The total number of orientation and annual training hours will increase for all providers to strengthen their professional development.

The advantage to the Commonwealth is that the proposed action increases protections of the health, safety, and welfare of children receiving care in licensed family day homes. Additionally, the proposed changes promote consistency with other child care regulations. There are no disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The State Board of Social Services (Board) proposes several amendments to the Standards for Licensed Family Day Homes in order to align the regulation with federal requirements and the Code of Virginia, and to improve clarity.

Result of Analysis. Some proposed amendments do increase costs for licensed family day homes. Given the likely benefits for the health and safety of children, and the necessity of the amendments to maintain federal funding, the benefits of the proposed changes likely exceed the costs.

Estimated Economic Impact. The federal Child Care and Development Block Grant Act of 2014 requires specific health and safety topics to be addressed for providers receiving Child Care and Development Funds. Currently Virginia receives about $110 million from this program per fiscal year. In order to continue to receive federal funding under the Child Care and Development Fund, the federal requirements must be adopted under Virginia rules. Licensed family day homes (FDHs) are eligible to apply for subsidies under the program. According to the Virginia Department of Social Services (DSS), 37% of licensed family day homes in the Commonwealth are approved subsidy vendors.

Consequently the Board proposes amendments such as adding: 1) a requirement for FDH licensees to post with parental approval a current list of allergies, sensitivities and dietary restriction, 2) a new requirement that while transporting children, the driver will have the allergy care plan and emergency contact information to prevent an allergic reaction, be aware of food allergies and sensitivities when preparing food and not serve prohibited food to a child, 3) a new provision allowing providers to keep attendance records as hard copy or electronically, 4) a new requirement for FDH licensees to keep a written record of a child in attendance as arrival and departure occurs, 5) exceptions for homeless children without documentation of immunizations or physical examination to attend FDHs during a grace period of 90 days, 6) 4 additional required hours of annual training for caregivers, 7) a new requirement for all caregivers to have current certification in CPR and first aid, and 8) a requirement that caregivers complete a DSS-sponsored orientation course within 90 days of employment.

Allergies: The proposals to add requirements for providers to post with parental approval a current list of allergies, sensitivities and dietary restriction, and for drivers transporting children to have the allergy care plan and emergency contact information to prevent an allergic reaction and be aware of food allergies, etc., would require a small additional amount of staff time and materials for licensed FDHs. The proposed requirements would likely increase awareness of health risks for children under care and decrease the probability that children's health is put at risk due to ignorance or carelessness.

Attendance Records: Under the current regulation FDHs must keep a written record of children in attendance each day. The proposal to allow providers to keep attendance records as hard copy or electronically reduces storage and potentially time costs for those FDHs that prefer to keep records electronically. The proposal to require licensees to keep the written record of each child in attendance as arrival and departure occurs would produce a small cost in that staff will have less flexibility as to when to record attendance. It would also be beneficial in that emergency responders will be better equipped in the event of an emergency to identify children in attendance. 

Homeless Children: Under the current regulation before any child may attend an FDH, the licensee must obtain documentation that the child has been immunized according to the requirements of § 32.1-46 A of the Code of Virginia and applicable State Board of Health regulations. Additionally, the provider must have documentation of a physical examination by or under direction of a physician within 30 days after the first day of attendance of the child.

The proposal to permit providers to accept homeless children without immunization or physical examination documentation for up to 90 days would be beneficial in that it would reduce barriers for homeless children to attend licensed child care while their families are taking necessary actions to comply with health and safety requirements. Enabling children's attendance at FDHs helps enable parents and guardians in homeless families to work or seek work and potentially gain homes.

Training: Under the current regulation FDH caregivers must have 16 clock hours of annual training. The Board proposes to increase the annual requirement to 20 clock hours. Childcare workers earn on average $10.79 per hour in Virginia.¹ Assuming the value of a childcare workers' time is their wage, the time cost of requiring 4 additional hours of training is $43.16² annually per FDH caregiver. DSS offers online child care courses as part of an agreement with Virginia's Community College Workforce; these classes currently cost $20 for 4 clock hours of training.³ Thus the total cost for 4 additional hours of required training per year can be estimated to be about $63 annually per FDH caregiver.

The current regulation requires the person issued the FDH license and assistants who are left alone with the children in care to have current certification in first aid and CPR appropriate to the age of children in care. The proposed regulation requires that all caregivers have such certification. The American Red Cross website lists the fee for a class that includes pediatric first aid and CPR as $110. The course takes approximately 7 hours of caregivers' time.⁴ Childcare workers earn on average $10.79 per hour in Virginia.⁵ Assuming the value of a childcare workers' time is their wage, the time cost of the requirement is $75.53.⁶ Thus the cost of the proposed CPR and first aid requirement for each child care worker in a licensed FDH would be $185.53 per two year certification, or $92.77 per year. Caregivers, such as the licensee, who already have current certification in CPR and first aid and would have continued to have done so without the new requirement would not incur this cost. Additionally, the CPR and first aid class can count toward the required 20 hours of training a year.

According to DSS, the proposed required DSS-sponsored orientation course takes 10 hours and is provided without a fee. Assuming the value of a childcare workers' time is their wage, the time cost of the requirement is $107.90. The 10 hours can count toward the required 20 hours of training during the first year of employment.

Overall: Several of the proposed amendments introduce some additional costs in terms of time, materials and/or fees. All of the proposed changes likely will have some positive impact on health and safety. The extent of the impact on health and safety is not known. Thus a definitive comparison of the likely benefits with the more easily estimated costs cannot be made. Taking into consideration the need to make these amendments in order to maintain federal funding, which contributes to FDH subsidies, the benefits of the proposed regulation likely exceed the costs.

Businesses and Entities Affected.  The proposed amendments affect the 1,279 licensed family day homes in the Commonwealth, their staff, and their clients.⁷ All licensed family day homes are small businesses.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments are unlikely to have a large impact on employment. The proposal to require that all caregivers have current certification in first aid and CPR appropriate to the age of children in care may moderately increase employment for providers of such certification.

Effects on the Use and Value of Private Property. The proposed amendments are unlikely to have a large impact on the use and value of private property.

Real Estate Development Costs. The proposed amendments do not affect real estate development costs.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. As described in the Estimated Economic Impact section, the proposals to add 1) a requirement for FDH licensees to post with parental approval a current list of allergies, sensitivities and dietary restriction, 2) a new requirement that while transporting children, the driver will have the allergy care plan and emergency contact information to prevent an allergic reaction, be aware of food allergies and sensitivities when preparing food and not serve prohibited food to a child, 3) a new requirement for FDH licensees to keep a written record of a child in attendance as arrival and departure occurs, 4) 4 additional required hours of annual training for caregivers, 5) a new requirement for all caregivers to have current certification in CPR and first aid, and 6) a requirement that caregivers complete a DSS-sponsored orientation course within 90 days of employment, all increase costs for licensed family day homes. The proposal to allow providers to keep attendance records as hard copy or electronically reduces costs for some FDH licensees.

Alternative Method that Minimizes Adverse Impact. In order to comply with the federal Child Care and Development Block Grant Act, the Board is proposing amendments that will increase costs for some family day homes, all of which are small businesses. There is no clear alternative that will both satisfy federal law and reduce the adverse impact on these small businesses.

Adverse Impacts:

Businesses. As discussed above, some proposed amendments will increase costs for businesses.

Localities. The proposed amendments are unlikely to adversely affect localities.

Other Entities. The proposed amendments are unlikely to adversely affect other entities.

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¹ Source: U.S. Bureau of Labor Statistics' May 2015 State Occupational Employment and Wage Estimates (the most recent available data). See: http://www.bls.gov/oes/current/oes_va.htm

² $10.79 x 4 = $43.16

³ Source: Department of Social Services

⁴ The American Red Cross class is listed as taking six hours and twenty minutes. Assuming 40 minutes roundtrip travel time, the caregiver would spend 7 hours to satisfy this requirement.

⁵ See note 1, supra

⁶ $10.79 x 7 = $75.53

⁷ Data source: Department of Social Services

Agency's Response to Economic Impact Analysis: The Department of Social Services reviewed the economic impact analysis prepared by the Department of Planning and Budget and concurs.

Summary:

The proposed amendments align requirements of licensed programs with specific federal health and safety standards for providers receiving funds from the Child Care and Development Fund under the federal Child Care and Development Block Grant Act of 2014. Proposed amendments include (i) a requirement for family day home licensees to post with parental approval a current list of allergies, sensitivities, and dietary restrictions; (ii) requirements that while transporting children a driver will have the allergy care plan and emergency contact information and that the family day home be aware of food allergies and sensitivities when preparing food and not serve prohibited food to a child; (iii) a provision allowing providers to keep attendance records as hard copy or electronically; (iv) a requirement for family day home licensees to keep a written record of a child in attendance as arrival and departure occurs; (v) exceptions for homeless children without documentation of immunizations or physical examination to attend family day homes during a grace period of 90 days; (vi) four additional required hours of annual training for caregivers and a requirement that prevention of shaken baby syndrome and abusive head trauma be part of initial orientation; (vii) a requirement for all caregivers to have current certification in CPR and first aid; (viii) a requirement that caregivers complete a Department of Social Services-sponsored orientation course within 90 days of employment; and (ix) provisions adding lockdown to the family day home's emergency preparedness plan.

22VAC40-111-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Accessible" means capable of being entered, reached, or used.

"Adult" means any individual 18 years of age or older.

"Age-appropriate" means suitable to the chronological age and individual needs of a child.

"Assistant" means an individual who helps the provider or substitute provider in the care, protection, supervision, and guidance to children in the home.

"Body fluids" means urine, feces, vomit, blood, saliva, nasal discharge, and tissue discharge.

"Caregiver" means an individual who provides care, protection, supervision, and guidance to children in the home and includes the provider, substitute provider, and assistant.

"Child" means an individual under 18 years of age.

"Child day program" means a regularly operating service arrangement for children where, during the absence of a parent or guardian, a person or organization has agreed to assume responsibility for the supervision, protection, and well-being of a child under the age of 13 for less than a 24-hour period.

"Child with special needs" means a child with developmental disabilities, intellectual disabilities, emotional disturbance, sensory or motor impairment, or significant chronic illness who requires special health surveillance or specialized programs, interventions, technologies, or facilities.

"Cleaned" means treated in such a way as to remove dirt and debris by scrubbing and washing with soap and water or detergent solution and rinsing with water.

"Commissioner" means the Commissioner of the Virginia Department of Social Services.

"Department" means the Virginia Department of Social Services.

"Department's representative" means an employee or designee of the Virginia Department of Social Services, acting as the authorized agent of the commissioner.

"Evacuation" means movement of occupants out of the building to a safe area near the building.

"Family day home" means a child day program offered in the residence of the provider or the home of any of the children in care for one through 12 children under the age of 13, exclusive of the provider's own children and any children who reside in the home, when at least one child receives care for compensation. A family day home serving five through 12 children, exclusive of the provider's own children and any children who reside in the home, shall be licensed. A family day home caring for more than four children under the age of two years, including the provider's own children and any children who reside in the home, shall be licensed or voluntarily registered. A family day home where the children in care are all related to the provider by blood or marriage shall not be required to be licensed.

"Good character and reputation" means knowledgeable and objective people agree that the individual (i) maintains business, professional, family, and community relationships that are characterized by honesty, fairness, and truthfulness; and (ii) demonstrates a concern for the well-being of others to the extent that the individual is considered suitable to be entrusted with the care, guidance, and protection of children. Relatives by blood or marriage, and people who are not knowledgeable of the individual, such as recent acquaintances, shall not be considered objective references.

"High school program completion or the equivalent" means an individual has earned a high school diploma or General Education Development (G.E.D.) certificate, passed a high school equivalency examination approved by the Board of Education in accordance with §§ 22.1-223, 22.1-224, and 22.1-225  of the Code of Virginia, or has completed a program of home instruction in accordance with § 22.1-254.1 of the Code of Virginia equivalent to high school completion.

"Homeless child" means a child who lacks a fixed, regular, and adequate nighttime residence and who is:

1. Living in a car, park, public space, abandoned building, substandard housing, bus or train station, or similar setting;

2. Sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; sometimes referred to as doubled-up;

3. Living in motels, hotels, trailer parks, or camping grounds due to lack of alternative adequate accommodations;

4. Living in congregate, temporary, emergency, or transitional shelters;

5. Awaiting or in foster care placement;

6. A migratory child who qualifies as homeless because he is living in circumstances described in the federal Elementary and Secondary Education Act of 1965, P.L. 89-10 (20 USC § 6399); and

7. Living in a primary nighttime residence that is a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.

"Inaccessible" means not capable of being entered, reached, or used.

"Infant" means a child from birth up to 16 months of age.

"Lockdown" means a situation where children are isolated from a security threat and access within and to the home is restricted.

"Nighttime care" means care provided between 7 p.m. and 6 a.m.

"Parent" means the biological, foster or adoptive parent, legal guardian, or any individual with responsibility for, or custody of a child enrolled in or in the process of being enrolled in a family day home.

"Physician" means an individual licensed to practice medicine in any of the 50 states or the District of Columbia.

"Preschool" means children from two years up to the age of eligibility to attend public school, age five by September 30 of that same year.

"Programmatic experience" means time spent working directly with children in a group that is located away from the child's home. Work time shall be computed on the basis of full-time work experience during the period prescribed or equivalent work time over a longer period. Experience settings may include [ , but not be limited to, ] a child day program, family day home, child day center, boys and girls club, field placement, elementary school, or a faith-based organization.

"Provider" means an individual who is issued the family day home license by the Department of Social Services and who has primary responsibility in providing care, protection, supervision, and guidance of children in the family home.

"Relocation" means movement of occupants of the building to a safe location away from the vicinity of the building.

"Residence" means principal legal dwelling or abode that is occupied for living purposes by the provider and contains the facilities necessary for sleeping, eating, cooking, and family living.

"Sanitized" means treated in such a way as to remove bacteria and viruses from inanimate surfaces through first cleaning and secondly using a solution of one tablespoon of bleach mixed with one gallon of water and prepared fresh daily or using a sanitizing solution approved by the U.S. Environmental Protection Agency. The surface of the item is sprayed or dipped into the sanitizing solution and then allowed to air dry for a minimum of two minutes or according to the sanitizing solution instructions.

"School age" means eligible to attend public school, age five or older by September 30 of that same year.

"Serious injury" means a wound or other specific damage to the body such as, but not limited to, unconsciousness; broken bones; dislocation; deep cut requiring stitches; poisoning; concussion; and a foreign object lodged in eye, nose, ear, or other body orifice.

"Shaken baby syndrome" or "abusive head trauma" means a traumatic injury that is inflicted upon the brain of an infant or young child. The injury can occur during violent shaking, causing the child's head to whip back and forth, the brain to move about, and blood vessels in the skull to stretch and tear.

"Shelter-in-place" means movement of occupants of the building to designated protected spaces within the building.

"Substitute provider" means an individual who meets the qualifications of a provider; is designated by the provider; and who provides care, protection, supervision, and guidance for children in the family day home when the provider is absent from the home for more than two hours.

"Time out" means a discipline technique in which a child is moved for a brief time away from the stimulation and reinforcement of ongoing activities and other children in the group to allow the child who is losing self-control to regain composure.

"Toddler" means a child from 16 months of age up to 24 months of age.

22VAC40-111-30. Operational responsibilities.

A. The provider shall ensure compliance with these standards and the terms of the current license issued by the department and with relevant federal, state or local laws, and other relevant regulations.

B. The provider will ensure compliance with the home's policies that have been disclosed to the parents as required by 22VAC-40-111-70.

C. The provider shall be of good character and reputation. Character and reputation investigation includes, but is not limited to, background checks as required by §§ 63.2-1702 and 63.2-1721 of the Code of Virginia.

D. The provider shall meet the requirements specified in 22VAC40-191, Background Checks for Child Welfare Agencies.

E. The provider shall ensure that the home's activities, services, and facilities are conducive to the welfare of children in care.

F. The provider shall be responsible for the home's day-to-day operation.

G. The provider shall post with parental approval, a current list of all children's allergies, sensitivities, and dietary restrictions.

G. H. The provider shall ensure that any advertising is not misleading or deceptive as required by § 63.2-1713 of the Code of Virginia.

H. I. The provider shall meet the requirements specified in 22VAC40-80, General Procedures and Information for Licensure.

22VAC40-111-50. General recordkeeping.

A. The family day home shall keep a written record of children in attendance each day.

B. The provider's records A. Records required by this regulation may be kept as hard copy or electronically and shall be maintained in the home and made accessible to the department's representative.

B. The family day home shall maintain a written record of daily attendance that documents the arrival and departure of each child in care as it occurs.

C. Information contained in a child's record shall be privileged and confidential. The provider shall not distribute or release information in a child's record to any unauthorized person without the written consent of the child's parent.

D. Children's records shall be made available to a child's parent upon request, unless otherwise ordered by the court.

E. Records and reports on children, caregivers, and household members required by this chapter shall be maintained and made accessible to the department's representative for two years from the date of termination of services for a child, date of separation from employment for caregivers, or date of termination of residence for a household member, or unless specified otherwise.

22VAC40-111-60. Children's records.

A. The provider shall maintain an up-to-date record at the family day home for each enrolled child.

B. A child's record shall contain the following information:

1. Child's full name, nickname (if any), sex, address, and birth date;

2. Emergency contact care information including:

a. Name, home address, and telephone number of each parent who has custody;

b. Name, address, and telephone number of each custodial parent's place of employment;

c. Name, office address, and telephone number of the child's physician;

d. Name, address, and telephone number of two designated persons to contact in case of an emergency if the parent cannot be reached;

e. Information on allergies and intolerance to food, medication, or any other substances, and actions to take in an emergency situation;

f. A written care plan for each child with a diagnosed food allergy, to include instructions from a physician regarding the food to which the child is allergic and the steps to be taken in the event of a suspected or confirmed allergic reaction;

g. Name and policy number of the child's medical insurance, if applicable;

g. h. Names of persons other than the custodial parents who are authorized to pick up the child;

h. i. Appropriate legal paperwork when a custodial parent does not authorize the provider to release the child to the other parent; and

i. j. Chronic physical problems, pertinent developmental information, and any special accommodations needed;

3. First and last dates of attendance;

4. Parent's signed acknowledgement acknowledgment of the receipt of the information required by 22VAC40-111-70;

5. Proof of the child's age and identity and the names and addresses of previously attended child day care and schools as required by 22VAC40-111-80;

6. Immunization records for the child as required by 22VAC40-111-90;

7. Results of the health examination for the child as required by 22VAC40-111-100;

8. 6. Written authorization for emergency medical care should an emergency occur and the parent cannot be located immediately unless the parent presents a written objection to provision of medical treatment on religious or other grounds;

9. 7. Written authorization if a caregiver is to administer prescription or nonprescription medication to the child as required by 22VAC40-111-700 A 2;

10. 8. Written authorization if the child is to participate in swimming or wading activities as required by 22VAC40-111-660 B;

11. 9. Written authorization if the child is taken off the premises of the family day home as required by 22VAC40-111-980;

12. 10. Special instructions to the provider including, but not limited to, exception to an infant's sleeping position as required in 22VAC40-111-590 A, recommendations for the care and activities of a child with special needs as required in 22VAC40-111-620 A, and exception to an infant's being fed on demand as required in 22VAC40-111-960 A;

13. 11. Record of any accidents or injuries sustained by the child while at the family day home as required by 22VAC40-111-840; and

14. 12. Documentation of the review of the child's emergency contact information as required by 22VAC40-111-780 B;

13. Immunization records for the child as required by 22VAC40-111-90; and

14. Results of the health examination for the child as required by 22VAC40-111-100.

22VAC40-111-90. Immunizations for children.

A. Before a child may attend the family day home, the provider shall obtain documentation that the child has been adequately immunized according to the requirements of § 32.1-46 A of the Code of Virginia and applicable State Board of Health regulations.

1. The provider may allow a child to attend contingent upon a conditional enrollment. Documentation related to the child's conditional enrollment shall be maintained in the child's record.

2. Conditional enrollment means the enrollment of a child for a period of 90 days contingent upon the child having received at least one dose of each of the required vaccines and the child possessing a plan, from a physician or local health department, for completing his immunization requirements within the ensuing 90 calendar days. If the child requires more than two doses of hepatitis B vaccine, the conditional enrollment period, for hepatitis B vaccine only, shall be 180 calendar days.

3. If a child is homeless and does not have documentation of the required immunizations, the provider may allow the child to attend during a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of required immunizations. Enrollment of a homeless child without the required immunizations must be documented in the child's record.

B. Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose:

1. Parent submits an affidavit to the family day home on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent's or child's religious tenets or practices; or

2. Physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.

C. The family day home shall obtain documentation of additional immunizations for a child who is not exempt from the immunization requirements according to subsection B of this section:

1. Once every six months for children under the age of two years; and

2. Once between each child's fourth and sixth birthdays.

22VAC40-111-100. Physical examinations for children.

A. The provider shall obtain documentation of a physical examination by or under the direction of a physician prior (i) to a child's attendance or (ii) within 30 days after the first day of attendance.

If a child is homeless and does not have documentation of a physical examination, the provider may allow the child to attend during a grace period of no more than 90 days to allow the parent or guardian time to obtain documentation of the required physical examination. Enrollment of a homeless child without documentation of a physical examination must be documented in the child's record.

B. The physical examination prior to attendance shall have been conducted within:

1. Two months prior to attendance for children six months of age or younger;

2. Three months prior to attendance for children age seven months through 18 months;

3. Six months prior to attendance for children age 19 months through 24 months;

4. Twelve months prior to attendance for children two years of age through five years of age; or

5. Twenty-four months prior to attendance for children six years of age and above older.

EXCEPTIONS:

1. A new physical examination is not required if a copy of the physical examination is available to the admitting family day home for a child transferring from a facility licensed by the Virginia Department of Social Services, approved by a licensed family day system, voluntarily registered by the Virginia Department of Social Services or by a contract agency of the Virginia Department of Social Services, or transferring from a Virginia Department of Education-approved child care program.

C. When a child transfers from a facility licensed by the Virginia Department of Social Services, approved by a licensed family day system, voluntarily registered by the Virginia Department of Social Services, or approved by the Virginia Department of Education, a new physical examination is not required if a copy of the physical examination from the originating program is maintained in the child's record.

2. D. Pursuant to subsection D of § 22.1-270 of the Code of Virginia, physical examinations are not required for any child whose parent objects on religious grounds. The parent must submit a signed statement noting that the parent objects on religious grounds and certifying that to the best of the parent's knowledge the child is in good health and free from communicable or contagious disease.

3. E. For a school age child, a copy of the physical examination required for his entry into a Virginia public kindergarten or elementary school is acceptable documentation to meet the requirements of this section.

22VAC40-111-130. General qualifications for caregivers.

A. Caregivers shall:

1. Be of good character and reputation;

2. Be physically and mentally capable of carrying out assigned responsibilities;

3. Be courteous, respectful, patient, and affectionate toward the children in care;

4. Be able to speak, read, and write in English as necessary to:

a. Carry out assigned job responsibilities, and

b. Communicate effectively with emergency responders; and

5. Meet the requirements specified in 22VAC40-191, Background Checks for Child Welfare Agencies.

B. Caregivers shall have current certification in cardiopulmonary resuscitation (CPR) as appropriate to the age of the children in care from an organization such as the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council. The training shall include an in-person competency demonstration.

C. Unless a caregiver is a registered nurse or licensed practical nurse with a current license from the Board of Nursing, the caregiver shall have current certification in first aid from an organization such as the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council.

22VAC40-111-140. Qualifications and requirements for providers and substitute providers.

A. Providers and substitute providers shall be 18 years of age or older.

B. Providers licensed after and substitute providers employed after June 30, 2010, shall have:

1. (i) A high school program completion or the equivalent or (ii) evidence of having met the requirements for admission to an accredited college or university; and

2. Three months of programmatic experience;.

3. Current certification in cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care, from the American Red Cross, American Heart Association, American Safety and Health Institute, or the National Safety Council, or current CPR certification issued within the past two years by a community college, a hospital, a rescue squad, or a fire department; and

4. Current certification in first aid from the American Red Cross, American Heart Association, American Safety and Health Institute, or the National Safety Council, or current first aid certification issued within the past three years by a community college, a hospital, a rescue squad, or a fire department.

EXCEPTION: A provider or substitute provider who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification.

C. Use of a substitute provider shall be limited to no more than a total of 240 hours per calendar year.

D. A substitute provider shall record and sign the time of arrivals and departures on each day that the substitute provider works.

22VAC40-111-150. Qualifications and requirements for assistants.

A. Assistants shall be 16 years of age or older.

B. An assistant under the age of 18 years of age shall always work under the direct supervision of the provider or substitute provider. Direct supervision means being able to hear or see the assistant and children at all times.

C. An assistant 18 years of age or older shall not be left alone with children in care for more than two hours per day.

D. An assistant 18 years of age or older who is left alone with children in care shall have:

1. Current certification in cardiopulmonary resuscitation (CPR), as appropriate to the age of the children in care, from the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council, or current CPR certification issued within the past two years by a community college, a hospital, a rescue squad, or a fire department; and

2. Current certification in first aid from the American Red Cross, American Heart Association, American Safety and Health Institute, or National Safety Council, or current first aid certification issued within the past three years by a community college, a hospital, a rescue squad, or a fire department.

EXCEPTION: An assistant who is a registered nurse or licensed practical nurse with a current license from the Board of Nursing shall not be required to obtain first aid certification.

E. D. An assistant 18 years of age or older who meets the requirements for a substitute provider may act as the substitute provider when the provider is absent from the home for more than two hours.

22VAC40-111-200. Orientation.

A. The provider shall orient the substitute provider and assistant by the end of their first week of assuming job responsibilities.

B. The orientation shall cover the following topics:

A. Caregivers shall complete a minimum of 16 hours of orientation training in areas relevant to their job responsibilities.

B. The Virginia Department of Social Services-sponsored orientation course shall be completed within 90 business days of employment.

C. Orientation shall include, but not be limited to, all topics within this section.

D. The provider shall orient the substitute provider and assistants on the following topics prior to working alone with children and within seven days of the date of hire:

1. Job responsibilities;

2. Requirements for parental notifications listed in 22VAC40-111-650;

3. Standards in this chapter that relate to the substitute provider's or assistant's responsibilities;

4. Emergency evacuation, relocation, and shelter-in-place procedures;

5. 4. Location of emergency numbers, first aid kit, and emergency supplies;

6. 5. Confidential treatment of information about children in care and their families; and

7. Requirement for reporting suspected child abuse and neglect.

6. Recognizing child abuse and neglect and the legal requirements for reporting suspected child abuse as required by § 63.2-1509 of the Code of Virginia;

7. The provider's policies and procedures on the administration of medication;

8. Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a human-caused event such as violence at a family day home and the home's specific emergency preparedness plan as required by 22VAC40-111-800 through 22VAC40-111-830;

9. Prevention and control of infectious diseases;

10. Prevention of sudden infant death syndrome and use of safe sleep practices; and

11. Prevention of shaken baby syndrome and abusive head trauma including procedures to cope with crying babies or distraught children.

E. The provider shall orient the substitute provider and assistant by the end of the first 30 days of assuming job responsibilities in the following topics:

1. Child development including, but not limited to: physical, cognitive, social, and emotional development; behavior management; and positive guidance techniques;

2. Prevention of and response to emergencies due to food and other allergic reactions including:

a. Recognizing the symptoms of an allergic reaction;

b. Responding to allergic reactions;

c. Preventing exposure to the specific food and other substances to which the child is allergic; and

d. Preventing cross-contamination.

3. Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic;

4. Handling and storage of hazardous materials and the appropriate disposal of diapers and other items contaminated by body fluids; and

5. Precautions in transporting children, if applicable.

C. F. Documentation of the orientation shall be signed and dated by the provider and substitute provider or by the provider and assistant.

G. Caregivers who are employed prior to (the effective date of this chapter) shall complete the Virginia Department of Social Services-sponsored orientation training as required in subsection B of this section within one year of (the effective date of this chapter). This training may count towards annual training requirements in section 22VAC40-111-210.

22VAC40-111-210. Annual Ongoing training.

A. In addition to satisfactory completion of first aid training and CPR training, caregivers shall obtain a minimum of eight clock hours of training annually in areas relevant to their job responsibilities.

1. Effective July 1, 2011, caregivers shall obtain 12 clock hours of training annually.

2. Effective July 1, 2012, caregivers shall obtain 14 clock hours of training annually.

3. Effective July 1, 2013, caregivers shall obtain 16 clock hours of training annually.

B. The annual training shall cover areas such as, but not limited to:

1. Physical, intellectual, social, and emotional child development;

2. Behavior management and discipline techniques;

3. Health and safety in the family day home environment;

4. Art and music activities for children;

5. Child nutrition;

6. Recognition and prevention of child abuse and neglect;

7. Emergency preparedness as required by 22 VAC 40-111-800 C; or

8. Recognition and prevention of the spread of communicable diseases.

A. Caregivers shall complete a minimum of 20 hours of training annually.

B. Annual training shall include topics relevant to the caregiver's job responsibilities and the care of children.

C. Training on the following health and safety topics shall be completed every two years:

1. Child development including but not limited to: physical, cognitive, social, and emotional development;

2. Behavior management and positive guidance techniques;

3. Prevention and control of infectious diseases;

4. Prevention of sudden infant death syndrome and use of safe sleep practices;

5. Prevention of and response to emergencies due to food and other allergic reactions including:

a. Recognizing the symptoms of an allergic reaction;

b. Responding to allergic reactions;

c. Preventing exposure to the specific food and other substances to which the child is allergic; and

d. Preventing cross-contamination.

6. The home's policies and procedures on the administration of medication;

7. Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic;

8. Prevention of shaken baby syndrome and abusive head trauma including procedures to cope with crying babies or distraught children;

9. Signs and symptoms of child abuse and neglect and requirements for mandated reporters;

10. Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a human-caused event such as violence at a family day home and the home's specific emergency preparedness plan as required by 22VAC40-111-800 through 22VAC40-111-830. Training on the home's emergency preparedness plan shall be completed annually and each time the plan is updated;

11. Handling and storage of hazardous materials and the appropriate disposal of diapers and other items contaminated by body fluids;

12. Precautions in transporting children, if applicable; and

13. If applicable, the recommended care requirements related to the care and development of children with special needs.

D. CPR and first aid training may count towards the annual training hours required in subsection A of this section if requirements in 22VAC-40-111-230 B are met.

22VAC40-111-230. Documentation of education and training.

A. The provider shall maintain written documentation of each caregiver's applicable education and programmatic experience, applicable first aid and CPR certification, orientation, annual training, and applicable medication administration training.

B. Written documentation of annual training shall include:

1. Name of the caregiver;

2. Name of the training session Training topic;

3. Evidence that training in each topic required in 22VAC40-111-210 C has been completed;

4. Date and total hours of the session; and

4. 5. Name of the organization that sponsored the training and the trainer.

22VAC40-111-650. Parent notifications.

A. The provider shall provide written notification to the parent within 10 business days after the effective date of the change when there is no longer liability insurance in force on the family day home operation.

1. The provider shall obtain the parent's written [ acknowledgement acknowledgment ] of the receipt of this notification, and

2. A copy of the parent's written [ acknowledgement acknowledgment ] of the receipt of this notification shall be maintained in the child's record.

B. Caregivers shall provide information daily to parents about the child's health, development, behavior, adjustment, or needs.

C. The provider shall give parents prior notice when a substitute provider will be caring for the children.

D. Caregivers shall notify parents when persistent behavioral problems are identified and such notification shall include any disciplinary steps taken in response.

E. The provider shall notify the parent immediately when the child:

1. Has a head injury or any serious injury that requires emergency medical or dental treatment;

2. Has an adverse reaction to medication administered;

3. Has been administered medication incorrectly;

4. Is lost or missing; or

5. Has died.

F. The provider shall notify a parent the same day whenever first aid is administered to the child.

G. When a child has been exposed to a communicable disease listed in the Department of Health's current communicable disease chart, the provider shall notify the parent within 24 hours or the next business day of the home's having been informed, unless forbidden by law, except for life-threatening diseases, which must be reported to parents immediately. The provider shall consult the local health department if there is a question about the communicability of a disease.

H. A parent shall be notified immediately of any confirmed or suspected allergic reaction and the ingestion of prohibited food even if a reaction did not occur.

I. Parents shall be informed of any changes in the home's emergency preparedness and response plan.

I. J. Except in emergency evacuation or relocation situations, the provider shall inform the parent and have written permission as required by 22VAC40-111-980 whenever the child will be taken off the premises of the family day home, before such occasion.

J. K. If an emergency evacuation or relocation is necessary, the parent shall be informed of the child's whereabouts as soon as possible.

22VAC40-111-760. First aid and emergency medical supplies.

A. The following emergency supplies shall be in the family day home, accessible to outdoor play areas, on field trips, in vehicles used for transportation, and wherever children are in care:

1. A first aid kit that contains at a minimum:

a. Scissors;

b. Tweezers;

c. Gauze pads;

d. Adhesive tape;

e. Adhesive bandages, assorted sizes;

f. Antiseptic cleaning solution or pads;

g. Digital thermometer;

h. Triangular bandages;

i. Single use gloves such as surgical or examination gloves;

j. In homes located more than one hour's travel time from a healthcare facility, activated charcoal preparation (to be used only on the direction of a physician or the home's local poison control center); and

k. j. First aid instructional manual.

2. An ice pack or cooling agent.

B. The first aid kit shall be readily accessible to caregivers and inaccessible to children.

22VAC40-111-800. Emergency preparedness and response plan.

A. The family day home shall have a written emergency preparedness and response plan that:

1. Includes emergency evacuation, emergency relocation, and shelter-in-place, and lockdown procedures;

2. Addresses the most likely to occur scenarios, including but not limited to fire, severe storms, flooding, tornadoes, and loss of utilities, earthquakes, intruders, violence on or near the premises, chemical spills, and facility damage and other situations that may require evacuation, shelter-in-place, or lockdown; and

3. Includes provisions for a responsible person who is 18 years of age or older and is able to arrive at the family day home within 10 minutes for emergency backup care until the children can be picked up by their parents.

B. The provider shall review the emergency plan at least annually and update the plan as needed. The provider shall document in writing each review and update to the emergency plan.

C. The provider shall ensure that each caregiver receives training regarding the emergency evacuation, emergency relocation, and shelter-in-place, and lockdown procedures by the end of his first week of assuming job responsibilities, on an annual basis, and at the time of each plan update.

22VAC40-111-810. Evacuation and relocation procedures.

Evacuation procedures shall include:

1. Methods to alert caregivers and emergency responders;

2. Designated primary and secondary routes out of the building;

3. Designated assembly point away from the building;

4. Designated relocation site;

5. Methods to ensure all children are evacuated from the building and, if necessary, moved to a relocation site;

6. Methods to account for all children at the assembly point and relocation site;

7. Methods to ensure essential documents, including emergency contact information, medications, and supplies are taken to the assembly point and relocation site;

8. Method of communication with parents and emergency responders after the evacuation; and

9. Method of communication with parents after the relocation;

10. Accommodations or special requirements for infants, toddlers, and children with special needs to ensure their safety during evacuation or relocation; and

11. Procedures to reunite children with a parent or authorized person designated by the parent to pick up the child.

22VAC40-111-820. Shelter-in-place and lockdown procedures.

A. Shelter-in-place procedures shall include:

1. Methods to alert caregivers and emergency responders;

2. Designated safe location within the home;

3. Designated primary and secondary routes to the safe location;

4. Methods to ensure all children are moved to the safe location;

5. Methods to account for all children at the safe location;

6. Methods to ensure essential documents, including emergency contact information, and supplies are taken to the safe location; and

7. Method of communication with parents and emergency responders;

8. Accommodations or special requirements for infants, toddlers, and children with special needs to ensure their safety during shelter-in-place; and

9. Procedure to reunite children with a parent or authorized person designated by the parent to pick up the child.

B. Lockdown procedures, to include facility containment, shall include:

1. Methods to alert caregivers and emergency responders;

2. Methods to account for all children at the lockdown location;

3. Methods of communication with parents and emergency responders;

4. Accommodations or special requirements for infants, toddlers, and children with special needs to ensure their safety during lockdown; and

5. Procedure to reunite children with a parent or authorized person designated by the parent to pick up the child.

22VAC40-111-830. Emergency response drills.

A. The emergency evacuation procedures shall be practiced monthly with all caregivers and children in care during all shifts that children are in care.

B. Shelter-in-place procedures shall be practiced a minimum of twice per year.

C. Lockdown procedures shall be practiced at least annually.

D. Documentation shall be maintained of emergency evacuation and, shelter-in-place, and lockdown drills that includes:

1. Identity of the person conducting the drill;

2. The date and time of the drill;

3. The method used for notification of the drill;

4. The number of caregivers participating;

5. The number of children participating;

6. Any special conditions simulated;

7. The time it took to complete the drill;

8. Problems encountered, if any; and

9. For emergency evacuation drills only, weather conditions.

D. E. Records of emergency evacuation and, shelter-in-place, and lockdown drills shall be maintained for one year.

22VAC40-111-850. Reports to department.

A. The provider shall report to the department within 24 hours inform the department's representative as soon as possible but not to exceed one business day of the circumstances surrounding the following incidents:

1. Lost or missing child when local authorities have been contacted for help;

2. Serious injury to a child while under the family day home's supervision; and

3. 2. Death of a child while under the family day home's supervision; and

3. The suspension or termination of all child care services for more than 24 hours as a result of an emergency situation and any plans to resume child care.

B. The provider shall inform the department's representative as soon as practicable, but not to exceed two business days, of any serious injury to a child while under the home's supervision.

C. A written report shall be completed and submitted to the department within five working days of the date the incident occurred.

22VAC40-111-870. General requirements for meals and snacks.

A. Meals and snacks shall be served in accordance with the times children are in care, which include:

1. For family day homes operating less than four consecutive hours at least one snack shall be served.

2. For family day homes operating four to seven consecutive hours at least one meal and one snack shall be served.

3. For family day homes operating seven to 12 consecutive hours at least one meal and two snacks or two meals and one snack shall be served.

4. For family day homes operating 12 to 16 consecutive hours at least two meals and two snacks or three meals and one snack shall be served.

B. A family day home shall ensure that children arriving from a half-day, morning program who have not yet eaten lunch receive a lunch.

C. The family day home shall schedule have scheduled snacks or meals so there is a period of at least 1-1/2 hours, but no more than three hours, between each meal or snack unless there is a scheduled rest or sleep period for children between the meals and snacks.

D. Children shall be served small-sized portions.

E. Food shall be prepared, stored, served, and transported in a clean and sanitary manner.

F. E. Leftover food shall be discarded from individual plates following a meal or snack.

G. F. Tables and high chair trays shall be cleaned after each use, but at least daily.

G. Food shall be prepared, stored, served, and transported in a clean and sanitary manner.

H. When food is prepared that a child in care is allergic to, the caregiver shall take steps to avoid cross-contamination in order to prevent an allergic reaction.

I. Caregivers who prepare and serve food to children, or supervise meals, shall be aware of the food allergies, sensitivities, and dietary restrictions for each child.

J. Caregivers shall not serve prohibited food to a child.

22VAC40-111-990. Requirements for drivers.

A. Drivers must be 18 years of age or older.

B. The provider shall ensure that during transportation of children the driver has:

1. A valid driver's license;

2. The name, address, and telephone number of the family day home;

3. A copy of the parent's written permission to transport the child;

4. A copy of each child's emergency contact care information as required in 22VAC40-111-60 B 2;

5. Allergy care plan and information as required in 22VAC40-111-60 B 2;

5. 6. Emergency supplies as required in 22VAC40-111-760; and

6. 7. A mechanism for making telephone calls to emergency responders and parents (e.g., change, calling card, cellular phone) such as a cellular phone.