TITLE 8. EDUCATION
TITLE 8. EDUCATION
STATE BOARD OF EDUCATION
Fast-Track Regulation
Title of Regulation: 8VAC20-790. Child Care Program (amending 8VAC20-790-250, 8VAC20-790-350, 8VAC20-790-400, 8VAC20-790-520, 8VAC20-790-600, 8VAC20-790-770).
Statutory Authority: § 22.1-16 of the Code of Virginia.
Public Hearing Information: No public hearing is currently scheduled.
Public Comment Deadline: December 17, 2025.
Effective Date: January 1, 2026.
Agency Contact: Tatanishia Armstrong, Legislative Consultant, Department of Education, Office of Child Care Health and Safety, 101 North 14th Street, 14th Floor, Richmond, VA 23219, telephone (804) 382-5047, or email tatanishia.armstrong@doe.virginia.gov.
Basis: Section 22.1-16 of the Code of Virginia authorizes the State Board of Education to promulgate regulations necessary to carry out its powers and duties and the provisions of Title 22.1 of the Code of Virginia. Section 22.1-289.046 of the Code of Virginia requires the board to adopt regulations for the activities, services, and facilities to be employed by persons and agencies required to be licensed under Chapter 14.1 (§ 22.1-289.02 et seq.) of Title 22.1 of the Code of Virginia, which shall be designed to ensure that such activities, services, and facilities are conducive to the welfare of the children under the control of such persons or agencies.
Purpose: This action is essential to enhancing the health, safety, and welfare of children in care because it protects children with undiagnosed allergies in cases where exposure to the allergen may result in anaphylaxis that could be deadly. The action is required to comply with the provisions of Chapters 122 and 123 of the 2023 Acts of Assembly.
Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because it is required by Chapters 122 and 123 of the 2023 Acts of Assembly.
Substance: The amendments (i) add requirements for training and policies to address the possession and administration of epinephrine at subsidy vendor child day centers; (ii) add requirements for family day home providers to be trained in the administration of epinephrine and provide notification to parents; and (iii) include technical edits.
Issues: The advantage of this action to the public and the Commonwealth is that the requirement for stock epinephrine to be available in centers increases protections for children and could potentially save the life of a child who experiences anaphylactic shock as a result of an allergic reaction. There are no disadvantages to this action.
Department of Planning and Budget Economic Impact Analysis:
The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.1
Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 122 and Chapter 123 of the 2023 Acts of Assembly (legislation), which amended § 22.1-289.059 of the Code of Virginia, the Board of Education (board) proposes several amendments to the regulation concerning the possession and administration of epinephrine at child day programs.
Background. The regulation defines Child Care Subsidy Program as the Department of Education (DOE) program that: assists eligible low-income families with the cost of child care and those activities that assist eligible families in the arrangement for or purchase of child care for children for care that is less than a 24-hour day. It also includes activities that promote parental choice, consumer education to help parents make informed choices about child care, activities to enhance health and safety standards established by the state, and activities that increase and enhance child care and early childhood development resources in the community. The proposed amendments pertain to child day centers and family day homes that participate in the Child Care Subsidy Program.
Child Day Centers. Consistent with § 22.1-289.02 of the Code of Virginia, the regulation defines child day center as a child day program offered to (i) two or more children less than 13 years of age in a facility that is not the residence of the provider or of any of the children in care or (ii) 13 or more children at any location. Pursuant to the legislation, the board proposes to require in the regulation that (i) child day centers possess and store weightbased dosages of undesignated or stock epinephrine in a locked or inaccessible container or area in the center; (ii) the undesignated or stock epinephrine is only administered by a nurse at the center, an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine, and (iii) at least one of the above individuals has the means to access the epinephrine at all times during regular facility hours. If the person administering the epinephrine is neither a nurse nor an employee of a local health department, the board proposes to require that their training must be from (i) a program for this purpose developed by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist, (ii) a course on this topic developed or approved by DOE in consultation with the Department of Health (VDH), or (iii) a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following: (a) recognizing signs and symptoms of anaphylaxis, (b) emergency procedures for responding to anaphylaxis, and (c) instructions and procedures for administering epinephrine. The proposed regulation expands upon the legislation, which only requires that the employee be trained in the administration of epinephrine.
Family Day Homes. Consistent with § 22.1-289.02 of the Code of Virginia, the regulation defines family day home as 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 less than 13 years of age, exclusive of the provider's own children and any children who reside in the home, when at least one child receives care for compensation. The legislation, as codified in § 22.1-289.059 of the Code of Virginia, states that the board shall amend its regulations to require each family day home provider or at least one other caregiver employed by such provider in the family day home to be trained in the administration of epinephrine and to notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine in the residence or home in which the family day home operates. The board proposes to amend the regulation in this manner. The epinephrine training requirements are essentially the same as for child day centers. Unlike child day centers, possession of epinephrine would be optional for family day homes. The family day homes would be required to notify parents in writing whether it stores an appropriate weight-based dosage of undesignated or stock epinephrine in the residence or home in which the family day home operates.
Estimated Benefits and Costs. Anaphylaxis is a severe, life-threatening allergic reaction. It can happen seconds or minutes after a person has been exposed to an allergen.2 Immediate use of an epinephrine autoinjector can keep anaphylaxis from worsening and can be lifesaving.3 Thus, the proposed requirements that child day centers possess and store appropriate weight-based dosages of undesignated or stock epinephrine, and that at least one person qualified to administer epinephrine has access to the epinephrine at all times during regular facility hours, has the potential to save the lives of children with undiagnosed allergies in cases when exposure to the allergen may result in anaphylaxis. An EpiPen package comes with two auto-injectors of 0.3 mg and is approved for adults and children who weigh 66 lbs or more. The EpiPen JR package comes with two auto-injectors of 0.15 mg and is approved for children who weigh 33 lbs to 66 lbs.4 There are now also Food and Drug Administration (FDA) approved epinephrine auto-injectors of 0.1 mg for infants and toddlers.5 Retail prices for a package of two brand name epinephrine auto-injectors range from $650 to $750 without insurance.6 FDA authorized generic epinephrine is available from CVS at $109.99 per two-pack.7 Epinephrine autoinjectors have a shelf life of 12 to 18 months from the date of manufacture.8 For a child day center with children that fall into all three weight groups, and uses the FDA-authorized generic epinephrine from CVS, it would cost approximately $330 annually to maintain non-expired epinephrine on hand.9 DOE has indicated that it has no estimate for the costs of training for epinephrine administration. The American Red Cross has an online course called Anaphylaxis and Epinephrine Auto-Injector.10 The following is the course description: This online course will teach you the signs and symptoms of anaphylaxis and how to care for a person having a severe allergic reaction including how to administer epinephrine using an auto-injector device. The course which includes video activities that reinforce key information and a learning assessment will take approximately 30 minutes to complete. The fee is $35, but it does not appear to meet all of the requirements for training as described in the proposed regulation. Accordingly, the potential cost of the required training is not known.
Businesses and Other Entities Affected. The proposed amendments would affect the 531 child day programs (includes child day centers and family day homes) that participate in the Child Care Subsidy Program. DOE believes that most would qualify as small businesses. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.11 An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.12 The costs from requiring that child day centers possess and store appropriate weight-based dosages of undesignated or stock epinephrine stem from the legislation. Requiring training for the administration of epinephrine is also in the legislation, but the proposed text on training is more restrictive than the legislation. For example, the $35 half hour online course from the American Red Cross would appear to qualify for training as described in the legislation, but appears to not qualify in the proposed regulatory text. DOE does not have estimates for training costs that meet the proposed regulatory options, and the option of completing a training course developed or approved by DOE in consultation with VDH has not been developed, but it seems likely the costs in dollars or time would be higher to meet the regulatory requirements than the statutory requirement. Thus, an adverse impact is indicated.
Small Businesses13 Affected.14
Types and Estimated Number of Small Businesses Affected: Per DOE, most of the 531 child day programs would qualify as small businesses.
Costs and Other Effects: Requiring that child day centers possess and store appropriate weight-based dosages of undesignated or stock epinephrine increases costs for the small centers as described above. Requiring training for child day centers and family day homes also increases costs.
Alternative Method that Minimizes Adverse Impact: Permitting anaphylaxis and epinephrine auto-injector training via online courses such as that provided by the American Red Cross could potentially reduce adverse impact.
Localities15 Affected.16 The proposed amendments neither appear to disproportionally affect particular localities nor affect costs for local governments.
Projected Impact on Employment. The proposed amendments do not appear to substantively affect total employment.
Effects on the Use and Value of Private Property. The increase in costs, which are largely due to the legislation, may moderately reduce the value of some child day programs. The proposed amendments do not affect real estate development costs.
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1 Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.
2 Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.
3 Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474.
4 See https://www.goodrx.com/epinephrine-epipen/how-to-save-cost.
5 See https://www.fda.gov/media/127806/download.
6 Supra, note 4.
7 See https://www.cvs.com/content/epipen-alternative.
8 See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720482/.
9 Average of $110 per epinephrine auto-injector package, and three separate packages for the three different weight groups.
10 See https://www.redcross.org/take-a-class/classes/anaphylaxis-and-epinephrine-auto-injector---onlinecourse/a6R0V0000015EUe.html.
11 Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.
12 Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.
13 Pursuant to § 2.2-4007.04, 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."
14 If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.
15 "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.
16 Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.
Agency Response to the Economic Impact Analysis: The State Board of Education thanks the Department of Planning and Budget for its thorough economic impact analysis.
Summary:
Pursuant to Chapters 122 and 123 of the 2023 Acts of Assembly, the amendments (i) require center-based programs that participate in the Child Care Subsidy Program to implement policies for the possession and administration of epinephrine to be administered by certain authorized and trained individuals to any child believed to be having an anaphylactic reaction; (ii) require that at least one authorized and trained individual has the means at all times during regular facility hours to access any such appropriate weight-based dosage of epinephrine that is stored in a locked or otherwise generally inaccessible container or area; and (iii) require each family day home provider or at least one other caregiver employed by such provider in the family day home to be trained in the administration of epinephrine and to notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine in the residence or home in which the family day home operates.
8VAC20-790-250. Caregiver training and development.
A. Prior to approval as a subsidy vendor, the perspective vendor shall complete Virginia Preservice Training for Child Care Staff sponsored by the Department of Education, which shall include the following topics and training modules:
1. Building and physical premises safety;
2. Emergency preparedness and response planning;
3. Prevention of sudden infant death syndrome (SIDS) and safe sleep practices;
4. Administration of medication, consistent with standards of parental consent;
5. Prevention of shaken baby syndrome and abusive head trauma (AHT);
6. Prevention of and response to emergencies due to food and allergic reactions;
7. Recognizing child abuse and neglect and reporting responsibilities;
8. Preventing the spread of disease, including immunization requirements;
9. Handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluids;
10. Transportation;
11. Foundations of child development;
12. Inclusion: Exploring the meaning and the mindset;
13. Oral health; and
14. Introduction to the Child Care Subsidy Program.
B. Within the first 90 days of employment or service, all caregivers shall complete Virginia Preservice Training for Child Care Staff sponsored by the Department of Education, which shall include training on the following topics and training modules:
1. Building and physical premises safety;
2. Emergency preparedness and response planning;
3. Prevention of sudden infant death syndrome (SIDS) and safe sleep practices;
4. Administration of medication, consistent with standards of parental consent;
5. Prevention of shaken baby syndrome and abusive head trauma (AHT);
6. Prevention of and response to emergencies due to food and allergic reactions;
7. Recognizing child abuse and neglect and reporting responsibilities;
8. Preventing the spread of disease, including immunization requirements;
9. Handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluids;
10. Transportation;
11. Foundations of child development;
12. Inclusion: Exploring the meaning and the mindset;
13. Oral health; and
14. Introduction to the Child Care Subsidy Program.
C. Orientation training for caregivers shall be completed on the following specific topics prior to the caregiver working alone with children and within seven days of the date of employment or the date of subsidy vendor approval:
1. Playground safety procedures;
2. Responsibilities for reporting suspected child abuse or neglect;
3. Confidentiality;
4. Supervision of children, including arrival and dismissal procedures;
5. Procedures for action in the case of lost or missing children, ill or injured children, and medical and general emergencies;
6. Medication administration procedures, if applicable;
7. Emergency preparedness plan as required in 8VAC20-790-420 B;
8. Procedures for response to natural and man-made disasters;
9. Prevention of shaken baby syndrome or abusive head trauma, including coping with crying babies and fussy or distraught children;
10. Prevention of sudden infant death syndrome and use of safe sleeping practices;
11. Caregivers who work with children who have food allergies shall receive training in preventing exposure to foods to which the child is allergic, preventing cross contamination, and recognizing and responding to any allergic reactions; and
12. Transportation.
D. All caregivers shall have, within 90 days of employment or 90 days from subsidy vendor approval:
1. Current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in-person competency demonstration; and
2. Current certification in first aid appropriate to the ages of children in care. However, a caregiver 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.
During the 90-day period, there must always be at least one caregiver with current cardiopulmonary and first aid training present during operating hours of the family day home.
E. CPR and first aid training may count toward the annual training hours required in subsection H I of this section if documentation for training as required in subdivision 5 of 8VAC20-790-200 is maintained.
F. Caregivers who work directly with children shall, in addition to preservice and orientation training required in subsections A through D of this section, annually attend at least 16 hours of training, to include the department's health and safety update course. This training shall be related to child safety, child development, health and safety in the family day home environment, and any required department sponsored training.
G. To safely perform medication administration practices, whenever a vendor agrees to administer prescribed medications, the (i) administration shall be performed by a caregiver who (i) has satisfactorily completed a training program for this purpose developed by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist or (ii) administration shall be performed by a caregiver who is licensed by the Commonwealth of Virginia to administer medications.
The vendor may determine by policy what medications, if any, will be administered at its family day home, including prescription medications or over-the-counter or nonprescription medications.
H. Caregivers The administration of undesignated or stock epinephrine shall be performed by the vendor or a caregiver who:
1. Meets the requirements of subsection G of this section;
2. Has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Virginia Department of Health; or
3. Has completed a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following:
a. Recognizing signs and symptoms of anaphylaxis.
b. Emergency procedures for responding to anaphylaxis; and
c. Instructions and procedures for administering epinephrine.
I. The vendor and caregivers required to have the training required in subsection I subsections G and H of this section shall be retrained at three-year intervals.
J. The vendor, or at least one other caregiver, shall receive training in the administration of epinephrine pursuant to subsections H and I of this section.
8VAC20-790-350. Parental involvement and notifications.
A. The caregiver shall notify the parent immediately if a child is lost, requires emergency medical treatment, sustains a serious injury, or dies.
B. The caregiver shall notify the parent by the end of the day of any known minor injuries.
C. The caregiver shall maintain a written record of children's serious and minor injuries in which entries are made the day of occurrence. The record shall include the following:
1. Date and time of injury;
2. Name of injured child;
3. Type and circumstance of the injury;
4. Caregiver present and treatment;
5. Date and time when parents were notified; and
6. Caregiver and parent signatures.
D. Parents shall be notified immediately of any confirmed or suspected allergic reactions and the ingestion of any food identified in the written care plan required in 8VAC20-790-190 B 12 even if a reaction did not occur.
E. Parents shall be informed of the vendor's emergency preparedness plan.
F. Caregivers shall promptly inform parents when persistent behavioral problems are observed and identified.
G. Caregivers shall provide information weekly to parents about the child's health, development, behavior, adjustment, or needs.
H. Parents shall be informed of the reason for a child's termination from care.
I. A custodial parent shall be admitted to any child day program. Such right of admission shall apply only while the child is in the care of the vendor, pursuant to § 22.1-289.054 of the Code of Virginia.
J. When children at the family day home have been exposed to a communicable disease listed in the Virginia Department of Health's current communicable disease chart, the parents shall be notified within 24 hours or the next business day of the vendor's having been informed unless forbidden by law. Children's exposure to life threatening life-threatening diseases shall be reported to parents immediately.
K. Parents shall be notified in writing of whether the provider stores an appropriate weight-based dosage of undesignated or stock epinephrine in the residence or home in which the family day home operates as required by § 22.1-289.059 of the Code of Virginia.
8VAC20-790-400. General requirements for medication administration.
A. Prescription and nonprescription medications shall be given to a child:
1. According to the home's written medication policies,; and
2. Only with written authorization from the parent.
B. The vendor may administer prescription medication that would normally be administered by a parent or guardian to a child, provided:
1. The medication is administered by a caregiver who meets the requirements of 8VAC20-790-250 I and J G and H;
2. The caregiver administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and
3. The caregiver administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration.
C. The vendor may administer nonprescription medication, provided the medication is:
1. Administered by a caregiver 18 years of age or older;
2. Labeled with the child's name;
3. In the original container with the manufacturer's direction label attached; and
4. Given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication.
D. Nonprescription medication shall not be used beyond the expiration date of the product.
E. Medications for children in care shall be stored separately from medications for household members and caregivers.
F. When needed, medication shall be refrigerated.
G. When medication is stored in a refrigerator used for food, the medications shall be stored together in a container or in a clearly defined area away from food.
H. Medication, except for those prescriptions designated otherwise by written physician's order, including refrigerated medication and medications for caregivers and household members, shall be kept in a locked place using a safe locking method that prevents access by children. If a key is used, the key shall be inaccessible to the children.
I. The vendor shall keep a record of prescription and nonprescription medication given children, which shall include the following:
1. Name of the child to whom the medication was administered;
2. Amount and type of medication administered to the child;
3. The day and time the medication was administered to the child;
4. Name of the caregiver administering the medication;
5. Any adverse reactions; and
6. Any medication error.
8VAC20-790-520. Operational responsibilities.
A. The vendor shall ensure compliance with the standards in this part, the terms of the vendor agreement, and all relevant federal, state, or local laws and regulations.
B. Pursuant to § 22.1-289.040 of the Code of Virginia, the vendor shall ensure that the applicant and any staff who is or will be involved in the day-to-day operations of the center or is or will be alone with, in control of, or supervising one or more of the children (i) has not been convicted of any barrier crime as defined in § 19.2-392.02 of the Code of Virginia and (ii) is not the subject of a founded complaint of child abuse or neglect within or outside the Commonwealth.
C. The vendor shall ensure that the center does not exceed the capacity of children cared for as allowed by law or regulation.
D. When at least one child receives care for compensation, all children who are in care and supervision count in the capacity of children being cared for. When children 13 years or older are enrolled in the program and receive supervision in the program, they shall be counted in the number of children receiving care, and the vendor shall comply with the standards in this part for these children.
E. The vendor shall inform all staff who work with children of children's allergies, sensitivities, and dietary restrictions.
F. The vendor shall maintain, in a way that is accessible to all staff who work with children, a current written list of all children's allergies, sensitivities, and dietary restrictions. This list shall be dated and kept confidential in each room or area where children are present.
G. Religious exempt child day centers that are exempt from licensure in accordance with § 22.1-289.031 of the Code of Virginia shall be in compliance with all requirements of § 22.1-289.031.
H. The vendor shall implement policies for the possession and administration of undesignated or stock epinephrine pursuant to § 22.1-289.059 of the Code of Virginia that ensure:
1. Undesignated or stock epinephrine is only administered by a nurse at the center, an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine pursuant to 8VAC20-790-600 J to a child believed to be having an anaphylactic reaction;
2. At least one nurse at the center, an employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine, or staff at the center authorized by a prescriber and trained in the administration of epinephrine pursuant to 8VAC20-790-600 J has the means to access at all times during regular facility hours appropriate weight-based dosages of undesignated or stock epinephrine based on the children in care at the center; and
3. Undesignated or stock epinephrine is stored in a locked or inaccessible container or area in the center.
8VAC20-790-600. Staff training and development.
A. Prior to approval as a subsidy vendor, the vendor or designee shall complete the Virginia Preservice Training for Child Care Staff, which shall include training on the following topics and training modules:
1. Building and physical premises safety;
2. Emergency preparedness and response planning;
3. Prevention of sudden infant death syndrome (SIDS) and safe sleep practices;
4. Administration of medication, consistent with standards of parental consent;
5. Prevention of shaken baby syndrome and abusive head trauma (AHT);
6. Prevention of and response to emergencies due to food and allergic reactions;
7. Recognizing child abuse and neglect and reporting responsibilities;
8. Preventing the spread of disease, including immunization requirements;
9. Handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluids;
10. Transportation;
11. Foundations of child development;
12. Inclusion: Exploring the meaning and the mindset;
13. Oral health; and
14. Introduction to the Child Care Subsidy Program.
B. Within the first 90 days of employment or subsidy vendor approval, all staff who work directly with children shall complete Virginia Preservice Training for Child Care Staff, which shall include training on the following topics and training modules:
1. Building and physical premises safety;
2. Emergency preparedness and response planning;
3. Prevention of sudden infant death syndrome (SIDS) and safe sleep practices;
4. Administration of medication, consistent with standards of parental consent;
5. Prevention of shaken baby syndrome and abusive head trauma (AHT);
6. Prevention of and response to emergencies due to food and allergic reactions;
7. Recognizing child abuse and neglect and reporting responsibilities;
8. Preventing the spread of disease, including immunization requirements;
9. Handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluids;
10. Transportation;
11. Foundations of child development;
12. Inclusion: Exploring the meaning and mindset;
13. Oral health; and
14. Introduction to the Child Care Subsidy Program.
C. Orientation training for staff shall be completed on the following facility specific facility-specific topics prior to the staff member working alone with children and within seven days of the date of employment or the date of subsidy vendor approval:
1. Playground safety procedures;
2. Responsibilities for reporting suspected child abuse or neglect;
3. Confidentiality;
4. Supervision of children, including arrival and dismissal procedures;
5. Procedures for action in the case of lost or missing children, ill or injured children, and medical and general emergencies;
6. Medication administration procedures, if applicable;
7. Emergency preparedness plan as required in 8VAC20-790-790 B;
8. Prevention of shaken baby syndrome and abusive head trauma, including coping with crying babies and fussy or distraught children;
9. Prevention of sudden infant death syndrome and use of safe sleeping practices;
10. Staff who work with children that have food allergies shall receive training in preventing exposure to foods to which the child is allergic, preventing cross contamination, and recognizing and responding to any allergic reactions; and
11. Transportation.
D. All staff who work directly with children shall have, within 90 days of the date of employment or 90 days from subsidy vendor approval:
1. Current certification in cardiopulmonary resuscitation (CPR) appropriate to the ages of children in care. The training shall include an in-person competency demonstration; and
2. Current certification in first aid appropriate to the ages of children in care. However, staff 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.
During the 90-day period, there must always be at least one staff with current CPR and first aid training present during operating hours of the center.
E. CPR and First Aid first aid training may count toward the annual training hours required in subsection H of this section if documentation for training as required in subdivision 5 of 8VAC20-790-550 is maintained.
F. Staff who work directly with children shall, in addition to preservice and orientation training required in subsections A through D of this section, annually attend at least 16 hours of training and staff development activities, to include the department's health and safety update course. Training shall be related to child safety, child development, the function of the center, and any required department sponsored training.
G. To safely perform medication administration practices, whenever a vendor agrees to administer prescribed medications, the (i) administration shall be (i) performed by a staff member who has satisfactorily completed a training program for this purpose developed by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist; or (ii) administration shall be performed by a staff member who is licensed by the Commonwealth of Virginia to administer medications.
The administration of medicines by a vendor may be limited by policy to:
1. Prescription medications;
2. Over-the-counter or nonprescription medications; or
3. No medications.
H. Staff required to have the training specified in subsection subsections G, I, and J of this section shall be retrained at three-year intervals.
I. There shall be at least one staff on duty who has obtained, within the last three years, instruction in performing a daily health observation of children. Daily health observation training shall include:
1. Components of daily health check for children;
2. Inclusion and exclusion of a child when the child is exhibiting symptoms that indicate possible illness;
3. Description of how diseases are spread and procedures and methods for reducing the spread of disease;
4. Information concerning the Virginia Department of Health Notification of Reportable Diseases pursuant to 12VAC5-90-80 and 12VAC5-90-90, also available from the local health department and the website of the Virginia Department of Health; and
5. Staff occupational health and safety practices in accordance with Occupational Safety and Health Administration's bloodborne pathogens regulation (29 CFR 1910.1030).
J. The administration of undesignated or stock epinephrine shall be performed by:
1. A nurse at the center or employee of a local health department authorized by a prescriber and trained in the administration of epinephrine;
2. A staff member at the center who is authorized by a prescriber and meets the requirements of subsection G of this section;
3. A staff member who has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Virginia Department of Health; or
4. A staff member who has satisfactorily completed a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following:
a. Recognizing signs and symptoms of anaphylaxis.
b. Emergency procedures for responding to anaphylaxis; and
c. Instructions and procedures for administering epinephrine.
8VAC20-790-770. Medication.
A. The vendor may administer prescription medication to a child with written permission of the parent, provided:
1. The medication is administered by a staff who meets the requirements of 8VAC20-790-600 I and J G and H;
2. The staff administers only those drugs that were dispensed from a pharmacy and maintained in the original, labeled container; and
3. The staff administers drugs only to the child identified on the prescription label in accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration.
B. The vendor may administer over-the-counter or nonprescription medication to a child with written permission from the parent, provided the medication is:
1. Administered by a staff 18 years of age or older;
2. Labeled with the child's name;
3. In the original container with the manufacturer's direction label attached; and
4. Given only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication.
C. When needed, medication shall be refrigerated.
D. Medication, except for those prescriptions designated otherwise by written physician's order, including refrigerated medication and staff's personal medication, shall be kept in a locked place using a safe locking method that prevents access by children.
E. The vendor shall keep a record of prescription and nonprescription medication given to children, which shall include the following:
1. Name of the child to whom the medication was administered;
2. Amount and name of medication administered to the child;
3. The day and time the medication was administered to the child;
4. Name of staff administering the medication;
5. Any adverse reaction; and
6. Any medication error.
VA.R. Doc. No. R26-7611; Filed October 28, 2025