Healthy children are the product of a community of caring and dedicated individuals, who invest themselves in the care and protection of our most valuable resource ... the children. Parents want to be assured that when they are unable to provide this care that there is a safe haven for their children away from home. To ensure the health and safety of Missouri's children in child care, a constant vigilance is necessary by those dedicated individuals who are committed to the delivery of child care services. The Missouri Department of Health and Senior Services recognizes the need for health and safety standards in all child care facilities.

On August 28, 1993, H.B. 376 gave the Department of Health and Senior Services authority to promulgate and issue licensing rules and to establish standards of care for child care facilities. The rules that follow outline the requirements facilities must meet to attain licensing. The Department of Health and Senior Services understands the vital role the child care providers play and pledges the availability of all possible resources in assisting you in this process. Child Care staff throughout the state are available for consultation and to provide technical assistance upon request.

Above all, it must be the goal of everyone involved in child care to protect children. This population needs and deserves our vigilance. Together we must maintain an assurance that they receive the opportunity to grow up in an healthy environment -a beginning toward healthy productive citizenship.

(2) "Child care facility", a house or other place conducted or maintained by any person who advertises or holds himself out as providing care for more than four children during the daytime, for compensation or otherwise, except those operated by a school system or in connection with a business establishment as a convenience for its customers, but a child care facility shall not include any private or religious organization elementary or secondary school, a religious organization academic preschool or kindergarten for four-and five-year-old children, a home school, as defined in section 167.031, RSMo, a weekly Sunday or Sabbath school, a vacation Bible school or child care made available while the parents or guardians are attending worship services or other meetings and activities conducted or sponsored by a religious organization;

(3) "Person", any person, firm, corporation, association, institution or other incorporated or unincorporated organization;

(4) "Religious organization", a church, synagogue or mosque; an entity that has or would qualify for federal tax exempt status as a nonprofit religious organization under section 501(c) of the Internal Revenue Code; or an entity whose real estate on which the child care facility is located is exempt from taxation because it is used for religious purposes.

(RSMo 1949 §210.200, §210.210, A.L. 1955 p. 685 §210.200, A.L. 1982 H.B. 1171, et A., A.L. 1989 S.B. 241, A.L. 1993 H.B. 376)

(1989) Where definitions in statute are clear and unambiguous, department may not promulgate a regulation which is in conflict with the statute. (Mo. App.) Div. of Family Serv. v. Patterson Schools, 772 S.W2d 823.

210.203. Complaints against child care facilities, open records to be kept by department.

The department of health shall maintain a record of substantiated, signed parental complaints against child care facilities licensed pursuant to this chapter, and shall make such complaints and findings available to the public upon request.

1. It shall be unlawful for any person to establish, maintain or operate a child care facility for children, or to advertise or hold himself or herself out as being able to perform any of the services as defined in section 210.201, without having in effect a written license granted by the department of health except that nothing in sections 210.203 to 210.245 shall apply to:

(1) Any person who is caring for four or fewer children. For purposes of this subdivision, children who are related by blood, marriage or adoption to such person within the third degree shall not be considered in the total number of children being cared for;

(2) Any person who has been duly appointed by a court of competent jurisdiction the guardian of the person of the child or children, or the person who has legal custody of the child or children;

(3) Any person who receives free of charge, and not as a business, for periods not exceeding ninety consecutive days, as bona fide, occasional and personal guests the child or children of personal friends of such person, and who receives custody of no other unrelated child or children;

(4) Any graded boarding school, summer camp, hospital, sanitarium or home which is conducted in good faith primarily to provide education, recreation, medical treatment, or nursing or convalescent care for children;

(5) Any child care facility maintained or operated under the exclusive control of a religious organization. When a nonreligious organization, having as its principal purpose the provision of child care services, enters into an arrangement with a religious organization for the maintenance or operation of a child care facility, the facility is not under the exclusive control of the religious organization;

(6) Any residential facility or day program licensed by the department of mental health pursuant to sections 630.705 to 630.760, RSMo, which provides care, treatment and habilitation exclusively to children who have a primary diagnosis of mental disorder, mental illness, mental retardation or developmental disability, as defined in section 630.005, RSMo; and

2. Notwithstanding the provisions of subsection 1 of this section, no child care facility shall be exempt from licensure if such facility receives any state or federal funds for providing care for children, except for federal funds for those programs which meet the requirements for participation in the Child and Adult Care Food Program pursuant to 42 U.S.C. 1766. Grants to parents for child care pursuant to sections 210.201 to 210.257 shall not be construed to be funds received by the facility.

(RSMo 1949 §210.230, A.L. 1955 p. 685 §210.210, A.L. 1982 H.B. 1171, et al., A.L. 1989 S.B. 241, A.L. 1993 H.B. 376)

*"This Act" (H.B. 376, 1993) contains numerous sections. Consult Disposition of Sections Table for a definitive listing.

(1976) Held, that a lawyer is not required to be licensed by the division of family services in order to render legal services in connection with adoptions. In re Schaeffer (Mo.), 530 S.W 2d 231.

210.215. Access to child and care providers during normal hours exception court orders restricting access.

Any parent or guardian of a child shall have access to the child care facility in which his child is enrolled and which is licensed pursuant to the provisions of sections 210.201 to 210.245 and shall have access to the providers of care in such facilities during normal hours of operation or when a child of such parent or guardian is in the care of such facility or provider, unless such parent or guardian is subject to a court order restricting access to the child.

210.221. Licenses to be issued by department of health-duty to fix standards and make investigations-- variance granted when, procedure

(1) After inspection, to grant licenses to persons to operate child care facilities if satisfied as to the good character and intent of the applicant and that such applicant is qualified and equipped to render care or service conducive to the welfare of children, and to renew the same when expired. No license shall be granted for a term exceeding two years. Each license shall specify the kind of child care services the licensee is authorized to perform, the number of children that can be received or maintained, and their ages and sex;

(2) To inspect the conditions of the homes and other places in which the applicant operates a child care facility, inspect their books and records, premises and children being served, examine their officers and agents, deny, suspend, place on probation or revoke the license of such persons as fail to obey the provisions of sections 210.201 to 210.245 or the rules and regulations made by the department of health. The director also may revoke or suspend a license when the licensee fails to renew or surrenders the license;

(3) To promulgate and issue rules and regulations the* department deems necessary or proper in order to establish standards of service and care to be rendered by such licensees to children. No rule or regulation promulgated by the division shall in any manner restrict or interfere with any religious instruction, philosophies or ministries provided by the facility and shall not apply to facilities operated by religious organizations which are not required to be licensed; and

(4) To determine what records shall be kept by such persons and the form thereof, and the methods to be used in keeping such records, and to require reports to be made to the department at regular intervals.

2. Any child care facility may request a variance from a rule or regulation promulgated pursuant to this section. The request for a variance shall be made in writing to the department of health and shall include the reasons the facility is requesting the variance. The department shall approve any variance request that does not endanger the health or safety of the children served by the facility. The burden of proof at any appeal of a disapproval of a variance application shall be with the department of health. Local inspectors may grant a variance, subject to approval by the department of health.

3. The department shall deny, suspend, place on probation or revoke a license if it receives official written notice that the local governing body has found that license is prohibited by any local law related to the health and safety of children. The department may, after inspection, find the licensure, denial of licensure, suspension or revocation to be in the best interest of the state.

4. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections 210.201 to 210,245 shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and if applicable, section 536.028 RSMo. All rulemaking authority delegated prior to August 28, 1999, is of no force and effect and repealed. Nothing in this section shall be interpreted to repeal or affect the validity of any rule filed or adopted prior to August 28,1999, if it fully complied with all applicable provisions of law, This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly, pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void.

(RSMo 1949 §210.240, A.L. 1955 p. 685 §210.220, A.L. 1987 SR 277, A.L. 1993 H.B. 376 and S.B. 52)

The department of health may designate to act for it, with full authority of law, any instrumentality of any political subdivision of the state of Missouri deemed by the department of health to be competent, to investigate and inspect licensees and applicants for a license. Local inspection of child care facilities may be accomplished if the standards employed by local personnel are substantially equivalent to state standards and local personnel are available for enforcement of such standards.

Any person aggrieved by a final decision of the department of health made in the administration of sections 210.201 to 210.245 shall be entitled to judicial review thereof as provided in chapter 536, RSMo.

210.245. Violations, penalties-prosecutor may file suit to oversee or prevent operation of day care center-attorney general may seek injunction, when, procedure

1. Any person who violates any provision of sections 210.201 to 210.245, or who for such person or for any other person makes materially false statements in order to obtain a license or the renewal thereof pursuant to sections 210.201 to 210.245, shall be guilty of an infraction for the first offense and shall be assessed a fine not to exceed two hundred dollars and shall be guilty of a class A misdemeanor for subsequent offenses. In case such guilty person is a corporation, association, institution or society, the officers thereof who participate in such misdemeanor shall be subject to the penalties provided by law.

2. If the department of health proposes to deny, suspend, place on probation or revoke a license, the department of health shall serve upon the applicant or licensee written notice of the proposed action to be taken. The notice shall contain a statement of the type of action proposed, the basis for it, the date the action will become effective, and a statement that the applicant or licensee shall have thirty days to request in writing a hearing before the administrative hearing commission and that such request shall be made to the department of health. If no written request for a hearing is received by the department of health within thirty days of the delivery or mailing by certified mail of the notice to the applicant or licensee, the proposed discipline shall take effect on the thirty-first day after such delivery or mailing of the notice to the applicant or licensee. If the applicant or licensee makes a written request for a hearing, the department of health shall file a complaint with the administrative hearing commission within ninety days or receipt of the request for a hearing.

3. The department of health may issue letters of censure or warning without formal notice or hearing. Additionally, the department of health may place a licensee on probation pursuant to chapter 621, RSMo.

4. The department of health may suspend any license simultaneously with the notice of the proposed action to be taken in subsection 2 of this section, if the department of health finds that there is a threat of imminent bodily harm to the children in care. The notice of suspension shall include the basis of the suspension and the appeal rights of the licensee pursuant to this section. The licensee may appeal the decision to suspend the license to the department of health. The appeal shall be filed within ten days from the delivery or mailing by certified mail of the notice of appeal. A hearing shall be conducted by the department of health within ten days from the date the appeal is filed. The suspension shall continue in effect until the conclusion of the proceedings, including review thereof, unless sooner withdrawn by the department of health, dissolved by a court of competent jurisdiction or stayed by the administrative hearing commission. Any person aggrieved by a final decision of the department made pursuant to this section shall be entitled to judicial review in accordance with chapter 536, RSMo.

5. In addition to initiating proceedings pursuant to subsection 1 of this section, or in lieu thereof, the prosecuting attorney of the county where the child care facility is located may file suit for a preliminary and permanent order overseeing or preventing the operation of a child care facility for violating any provision of sections 210.201 to 210.245. The order shall remain in force until such a time as the court determines that the child care facility is in substantial compliance. If the prosecuting attorney refuses to act or fails to act after of receipt of notice from the department of health, the department of health may request that the attorney general seek an injunction of the operation of such child care facility.

6. In cases of imminent bodily harm to children in the care of a child care facility, the department may file suit in the circuit court of the county in which the child care facility is located for injunctive relief, which may include removing the children from the facility, overseeing the operation of the facility or closing the facility.

210.251. State and federal funds to be made available to centers to upgrade standards.

1. By January 1, 1994, financial incentives shall be provided by the department of health through the child development block grant and other public moneys for child care facilities wishing to upgrade their standard of care and which meet quality standards.

2. The department of health shall make federal funds available to licensed or inspected child care centers pursuant to federal law as set forth in the Child and Adult Food Program, 42 U.S.C. 1766.

210.252. Fire, safety, health and sanitation inspections, procedure-variances to rules granted when-rules authorized.

1. All buildings and premises used by a child care facility to care for more than four children except those exempted from the licensing provisions of the department of health pursuant to subdivisions (1) (2) (3) (4) and (6) of section 210.211, shall be inspected annually for fire and safety, by the state fire marshal, the marshal's designee or officials of a local fire district and for health and sanitation by the department of health or officials of the local health department. Evidence of compliance with the inspections required by this section shall be kept on file and available to parents of children enrolling in the child care facility.

2. Local inspection of child care facilities may be accomplished if the standards employed by local personnel are substantially equivalent to state standards and local personnel are available for enforcement of such standards.

3. Any child care facility may request a variance from a rule or regulation promulgated pursuant to this section. The request for a variance shall be made in writing to the department of health and shall include the reasons the facility is requesting the variance. The department shall approve any variance request that does not endanger the health or safety of the children served by the facility. The burden of proof at any appeal of a disapproval of a variance application shall be with the department of health. Local inspectors may grant a variance, subject to approval by the department.

4. The department of health shall administer the provisions of sections 210.252 to 210.256, with the cooperation of the state fire marshal, local fire departments and local health agencies.

5. The department of health shall promulgate rules and regulations to implement and administer the provisions of sections 210.252 to 210.256. Such rules and regulations shall provide for the protection of children in all child care facilities whether or not such facility is subject to the licensing provisions of section 210.201 to 210.245.

6. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections 210.252 to 210.256 shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. All rulemaking authority delegated prior to August 28,1999, is of no force and effect and repealed. Nothing in this section shall be interpreted to repeal or affect the validity of any rule filed or adopted prior to August 28,1999, if it fully complied with all applicable provisions of law. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void.

210.254. Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually.

1. Child care facilities operated by religious organizations pursuant to the exempt status recognized in subdivision (5) of section 210.211, shall upon enrollment of any child provide the parent or guardian enrolling the child two copies of a notice of parental responsibility, one copy of which shall be retained in the files of the facility after the enrolling parent acknowledges, by signature, having read and accepted the information contained therein.

(1) Notification that the child care facility is exempt as a religious organization from state licensing and therefore not inspected or supervised by the department of health other than as provided herein and that the facility has been inspected by those designated in section 210.252 and is complying with the fire, health and sanitation requirements of sections 210.252 to 210.257;

(2) The names, addresses and telephone numbers of agencies and authorities which inspect the facility for fire, health and safety and the date of the most recent inspection by each;

(3) The staff/child ratios for enrolled children under two years of age, for children ages two to four and for those five years of age and older as required by the department of health regulations in licensed facilities, the standard ratio of staff to number of children for each age level maintained in the exempt facility, and the total number of children to be enrolled by the facility;

(4) Notification that background checks have been conducted on each individual care giver and all other personnel at the facility. The background check shall be conducted upon employment and every two years thereafter on each individual care giver and all other personnel at the facility. Such background check shall include a screening for child abuse or neglect through the division of family service, and a criminal record review through the Missouri highway patrol pursuant to section 43.540, RSMo. The fee for the criminal record review shall be limited to the actual costs incurred by the Missouri highway patrol in conducting such review not to exceed ten dollars;

3. A copy of notice of parental responsibility, signed by the principal operating officer of the exempt child care facility and the individual primarily responsible for the religious organization conducting the child care facility and copies of the annual fire and safety inspections shall be filed annually during the month of August with the director of the department of health. Exempt child care facilities which begin operation after August 28, 1993, shall file such notice at least five days prior to starting to operate.

210.255. Religious organizations operating facility in violation, procedure noncompliance after notice, prosecutor may act or attorney general.

1. A parent or guardian of a child enrolled in a child care facility established, maintained or operated by a religious organization who has cause to believe that this section and section 210.254 is being violated may notify appropriate local law enforcement authorities.

2. If a child care facility maintained or operated under the exclusive control of a religious organization is suspected of violating any provision of sections 210.252 to 210.255, or if there is good cause to believe that the signatory made a materially false statement in the notice of parental responsibility required by sections 210.252 to 210.255, the department of health shall give twenty days written notice to the facility concerning the nature of its suspected noncompliance. If compliance is not forthcoming within the twenty days, the department shall thereafter notify the prosecuting attorney of the county wherein the facility is located concerning the suspected noncompliance. If the prosecuting attorney refuses to act or fails to act within thirty days of receipt of notice from the department, the department of health may notify the attorney general concerning the suspected noncompliance and the attorney general may proceed under section 210.248.*

*Revisor's Note: Apparent typographical error since section 210.248 did not exist in the Missouri Revised Statutes at the time of the passage of this section.

1. Any person who violates any provision of sections 210.252 to 210.255, or who for such person or for any other person makes a materially false statement in the notice of parental responsibility required by sections 210.254 and 210.255, shall be guilty of an infraction for the first offense and shall be assessed a fine not to exceed two hundred dollars and shall be guilty of a class A misdemeanor for subsequent offenses. In case such guilty person is a corporation, association, institution, or society, the officers thereof who participate in such violation shall be subject to the same penalties.

2. In addition to initiating proceedings pursuant to subsection 1 of this section, or in lieu thereof, the prosecuting attorney of the county where the child care facility is located may file suit for a preliminary and permanent order overseeing or preventing the operation of a child care facility for violating any provision of section 210.252. The injunction shall remain in force until such time as the court determines that the child care facility is in substantial compliance.

3. In cases of imminent bodily harm to children in the care of a child care facility, the department of health may apply to the circuit court of the county in which the child care facility is located for injunctive relief, which may include removing the children from the facility, overseeing the operation of the facility or closing the facility.

1. No rule or portion of a rule promulgated under the authority of section 210.252 shall become effective until it has been approved by the joint committee on administrative rules in accordance with the procedures provided herein, and the delegation of the legislative authority to enact law by the adoption of such rules is dependent upon the power of the joint committee on administrative rules to review and suspend rules pending ratification by the senate and the house of representatives as provided herein.

2. Upon filing any proposed rule with the secretary of state, the filing agency shall concurrently submit such proposed rule to the committee, which may hold hearings upon any proposed rule or portion thereof at any time.

3. A final order of rulemaking shall not be filed with the secretary of state until thirty days after such final order of rulemaking has been received by the committee. The committee may hold one or more hearings upon such final order of rulemaking during the thirty-day period. If the committee does not disapprove such order of rulemaking within the thirty-day period, the filing agency may file such order of rulemaking with the secretary of state and the order of rulemaking shall be deemed approved.

4. The committee may, by majority vote of the members, suspend the order of rulemaking or portion thereof by action taken prior to the filing of the final order of rulemaking only for one or more of the following grounds:

(4) A substantial change in circumstance since enactment of the law upon which the proposed rule is based.

5. If the committee disapproves any rule or portion thereof, the filing agency shall not file such disapproved portion of any rule with the secretary of state and the secretary of state shall not publish in the Missouri Register any final order of rulemaking containing the disapproved portion.

6. If the committee disapproves any rule or portion thereof, the committee shall report its findings to the senate and the house of representatives. No rule or portion thereof disapproved by the committee shall take effect so long as the senate and the house of representatives ratify the act of the joint committee by resolution adopted in each house within thirty legislative days after such rule or portion thereof has been disapproved by the joint committee.

7. Upon adoption of a rule as provided herein, any such rule or portion thereof may be suspended or revoked by the general assembly either by bill or, pursuant to section 8, article TV of the constitution, by concurrent resolution upon recommendation of the joint committee on administrative rules. The committee shall be authorized to hold hearings and make recommendations pursuant to the provisions of section 536.037, RSMo. The secretary of state shall publish in the Missouri Register, as soon as practicable, notice of the suspension or revocation.

210.258. Religious organizations operating facility, no interference permitted with curriculum, personnel or selection of children-discipline policies, explanation required for parent.

1. The provisions of this section and section 210.259 apply to a child care facility maintained or operated under the exclusive control of a religious organization. Nothing in sections 210.252 to 210.257 shall be construed to authorize the department of health or any other governmental entity:

(1) To interfere with the program, curriculum, ministry, teaching or instruction offered in a child care facility;

(2) To interfere with the selection, certification, minimal formal educational degree requirements, supervision or terms of employment of a facility's personnel;

(3) To interfere with the selection of individuals sitting on any governing board of a child care facility;

(4) To interfere with the selection of children enrolled in a child care facility; or

(5) To prohibit the use of corporal punishment. However, the department of health may require the child care facility to provide the parent or guardian enrolling a child in the facility a written explanation of the disciplinary philosophy and policies of the child care facility.

210.259. Nonreligious organization's agreement for child care facility on property of religious organization not deemed to be exclusive control by religious organization.

When a nonreligious organization, having as its principal purpose the provision of child care services, enters into an arrangement with a religious organization for the maintenance or operation of a child care facility on the property of the religious organization, the facility is not under the exclusive control of the religious organization.

Section B.

The provisions of section 3 through 15 of this act shall terminate on January 1, 2004.

(L. 1993 H.B. 376 §6 subsec. 2)

PURPOSE: This rule defines the terms used throughout this chapter.

(1) The following definitions shall be used in interpreting the rules of this chapter:

(A) Adult is an individual eighteen (18) years of age or older;

(B) Bureau is the Bureau of Child Care of the Department of Health responsible for enforcement of child care rules and laws;

(D) Child care is care of a child away from his/her own home for any part of the day or night;

(E) Department is the Missouri Department of Health;

(F) Infant is a child less than twelve (12) months of age;

(G) Kindergarten is a children's educational program offered to prepare children for the first grade;

(H) License-exempt facility or facility is a nursery school not operated by a religious organization or a child care operation run by a religious organization;

(I) Local health department is an entity that enforces local public health codes and ordinances and provides other services related to public health;

(J) Nursery school is a program for preschool children that is operated for no more than four (4) hours per child per day;

(K) Premises is a house(s), dwelling(s) or building(s) and the adjoining land of a license-exempt facility;

(L) Preschool child is a child between two and five (2 - 5) years of age not enrolled in kindergarten;

(M) Registered professional nurse or registered nurse is one (1) licensed under the provisions of sections 335.011 to 335.096 to engage in the practice of professional nursing;

(N) Religious organization academic preschool is a child care program provided exclusively for four- and five-yearold children that is operated by a religious organization;

(0) Sanitarian is a person employed by a state or local health department that conducts sanitation inspections for licenseexempt child care facilities;

(P) School-age child is a child four (4) years of age or older who is enrolled in kindergarten or elementary school;

(Q) Staff/child ratio is the number of caregivers required for the number or children in care;

(R) Toddler is a child between twelve (12) and twenty-four (24) months of age; and

(S) Variance is approval by the department for a provider not to be required to meet a specific requirement of the rules of this chapter.

PURPOSE: This rule establishes how a facility director may apply for annual fire safety and health and sanitation inspections and how the inspections are conducted.

(1) The director of each facility shall apply to the department of health for an annual fire safety inspection by the state fire marshal, his/her designee or officials of a local fire district, and for a health and sanitation inspection by the department or officials of a local health department. Religious organization academic preschools are not required to apply for annual fire and safety inspections or the health and sanitation inspections.

(2) Facility inspections shall be conducted during normal business hours and may be unannounced. The facility director shall be given a copy of the completed inspection form.

(3) The agency, organization or person that owns the facility and the person delegated as director of the facility shall be identified on the application for a fire safety and a health and sanitation inspection.

(4) When a facility is incorporated, the chairperson of the board of directors, or the person delegated as director of the facility, shall sign the application for a fire safety and a health and sanitation inspection.

(5) The facility director shall request a child abuse/neglect screening from the Department of Social Services for each employee who may come into contact with children during child care hours. The request shall be made within ten (10) days of employment. The results of the screenings shall be maintained in the facility's files.

(6) If there is a change of ownership of the facility, the new owner(s) or the facility director shall request a fire safety inspection and a health and sanitation inspection.

(7) Inspections of child care facilities operated by religious organizations and nursery schools not operated by religious organizations will be phased in over a one (1) year period following the effective date of this rule. During the phase-in period, necessary action will be taken by the department of health in any situations posing a threat of bodily harm to children.

PURPOSE. This rule establishes criteria for local health departments to conduct health and safety inspections and for local fire districts to conduct fire safety inspections of licenseexempt child care facilities

(1) Sanitation inspections of license-exempt facilities may be delegated to local health departments if the standards employed for inspections are substantially equivalent to 19 CSR 30-60.090, Sanitation Requirements. Fees, as provided for in section 192.300, RSMo, may be charged at the option of the local health department.

(2) Fire safety inspections of license-exempt facilities may be delegated to local fire districts if the standards employed for inspections are equivalent to 19 CSR 3060.080, Fire Safety Requirements.

PURPOSE: This rule establishes the procedure for a facility director to request a variance from any portion of the rules of this chapter.

(1) Any facility director may request a variance from any portion of the rules of this chapter. The request for a variance shall be made in writing to the department and shall include the reasons for requesting the variance. The department shall approve any variance request that does not endanger the health or safety of the children served by the facility. Local inspectors may grant a variance, subject to approval by the department.

(2) If a variance request is not recommended by the bureau, the facility owner or director shall be advised in writing of the basis for the recommendation. If the owner or facility director does not agree with the recommendation to deny the variance, s/he may request the department to make a final decision regarding the denial.

PURPOSE: This rule establishes staffing requirements for license-exempt facilities.

(1) Supervision and basic care shall be provided at all license-exempt facilities.

(A) Caregivers shall provide care conducive to the health and safety of children and shall be capable of handling emergencies;

(B) Caregivers and other personnel, including volunteers, shall not be under the influence of alcohol or illegal drugs while on the premises and shall not be impaired by the use of medications;

(C) Prior to starting work, all caregivers shall read the rules of this chapter and sign a statement that they have read the rules. The statements shall be maintained on file at the facility;

(D) No person shall be present during child care hours who is a threat to the health or safety of children; and

(E) A caregiver shall be in charge at all times child care is provided.

(2) Nursery schools not operated by religious organizations shall meet the following requirements for staff/child ratios:

(A) Staff/child ratios in subsections (2)(B) through (H) of this rule shall be maintained at all times;

(B) Groups composed of mixed ages birth through two (2) years shall have no less than one (1) adult caregiver to four (4) children;

(C) Groups composed solely of two-(2-) year-old children shall have no less than one (1) adult caregiver to eight (8) children;

(D) Groups composed solely of three- (3-) and four(4-) year-old children shall have no less than one (1) adult caregiver to ten (10) children;

(E) Groups composed solely of five- (5-) year-old children and older shall have no less than one (1) adult caregiver to sixteen (16) children;

(F) Groups composed of mixed ages of children two (2) years of age and older shall have no less than one (1) adult caregiver to ten (10) children with a maximum of four (4) two- (2-) year-olds. Groups composed of more than four (4) two- (2-) year-old children in a mixed group shall have no less than one (1) adult caregiver to eight (8) children;

(G) If a facility has an attendance of more than fifty (50) children, the caregiver in charge shall not be included in staff/child ratios except during naptime; and

(H) Caregivers shall be eighteen (18) years of age or older in order to be counted in meeting staff/child ratios. Persons sixteen (16) and seventeen (17) years of age who assist with children may be counted in staff/child ratios only if they are physically supervised by an adult who is present with the children.

(3) Nursery schools not operated by religious organizations shall meet the following requirements for facility directors:

(A) The facility director shall be responsible for planning, monitoring and managing the daily program;

(B) Directors shall have a high school diploma or General Education Development (GED) certificate;

(C) Directors shall have at least thirty (30) college semester hours with six (6) college semester hours in child-related courses; or twelve months' (12) experience with six (6) college semester hours in childrelated courses; or a child development associate (CDA) credential; and

(D) All experience counted toward director qualifications shall be responsible, supervised, fulltime (a minimum of thirty-five (35) hours per week) paid experience working with children in a child care setting. Part-time experience may be prorated to a fulltime equivalent. Each month of full-time experience may be substituted for two (2) college semester hours in unspecified courses, not for the required child related courses.

(4) Nursery schools not operated by religious organizations shall meet the following requirements for child care related training:

(A) The director and other caregivers counted in staff/child ratios shall obtain at least twelve (12) clock hours of child care related training during each year of employment in training approved by the department in health, safety, nutrition, guidance and discipline, appropriate activities and learning experiences for children, positive communication and interaction with parents, planning and setting up an appropriate environment for children, professional and administrative practices, or other child-related areas; and

(B) All training shall be documented with the dates, the number of hours of training completed, the subject and the name of the person(s) who conducted the training. This information shall be on file at the facility and available for review.

PURPOSE: This rule establishes health requirements for child care providers and children in license-exempt child care facilities.

(1) Facility staff shall meet the following health requirements:

(A) The director or other caregiver shall report to the local health department when any child in a facility is suspected of having a reportable communicable disease listed in sections (1) - (5) of 19 CSR 20-20.020. In the event of an unusual outbreak of a reportable communicable disease, caregivers shall implement control measures recommended by the department or local health department;

(B) Caregivers shall use proper handwashing techniques with soap and warm, running water after toileting, after assisting a child with toileting, after diapering a child, and at other times as needed. Good hygiene practices shall be followed during food preparation. These practices include, but are not limited to, washing hands properly after smoking, eating, drinking, using the restroom, after touching raw food products and before preparing and serving food. Hands shall be dried with single-service towels. Caregivers shall teach and see that children wash their hands at appropriate times: before eating, after toileting, and as needed when hands are soiled;

(C) Caregivers shall not work when ill and likely to transmit an illness that might endanger the health or well-being of children. This may include symptoms such as fever, coughing, upper respiratory infection, vomiting or diarrhea;

(D) All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment.

1. Physical assessment reports shall be completed not more than twelve (12) months before beginning work in the facility. The reports may be transferred to another facility for future employment.

2. The facility may use the department's physical assessment form, MO 580-1879 (6-94), or the facility may use its own form, if it contains all the information on the department's form.

3. After the initial physical assessment, all caregivers working in a facility during child care hours shall be tested for tuberculosis at least every two (2) years. Caregivers with previously positive tuberculin tests shall be under the management of a physician.

(E) No person shall smoke or use tobacco products in any area of a child care facility while children are in care.

(2) Within thirty (30) days following the admission of an infant, toddler or preschool child, a physical assessment report signed by a licensed physician or registered professional nurse shall be on file at the facility. The facility may use the department's physical assessment form, MO 580-1878 (6-94), or the facility may use its own form if it contains all the information on the department's form. The report shall have been completed not more than twelve (12) months before admission.

(3) Child care facilities shall meet immunization requirements for children as defined by section 210.003 RSMo, (1994).

(4) A parent of a school-age child shall provide a statement at the time of enrollment indicating the child's health history, any current health problems and any restrictions necessary for the child's care.

(5) Each child shall be observed for contagious diseases and other signs of illness on arrival and throughout each day.

(6) A parent or guardian shall .,, contacted when signs of illness are observed.

(7) When a child exhibits any of the following in subsection (A) through (0) of this section, the parent(s) shall be contacted and the child shall be sent home. Parental contact shall be recorded and filed in the child's records. Symptoms that require parental contact and sending a child home are

(A) More than one (1) abnormally loose stool;

(B) Red or blue in the face or makes high- pitched croupy or whooping sounds after coughing;

(D) Yellowish skin or eyes;

(E) Tears, redness of eyelid lining or irritation, followed by swelling or discharge of pus;

(F) Unusual spots or rashes;

(G) Sore throat or swallowing difficulty;

(H) An infected skin patch - crusty, bright yellow, dry or gummy areas of the skin;

(I) Unusually dark, tea-colored urine;

(J) Gray or white stool;

(K) Fever over one hundred one degrees Fahrenheit (101'F) by mouth or one hundred degrees Fahrenheit (100' F) under the arm;

(L) Headache and stiff neck;

(M) Vomiting more than once;

(N) A child is in the contagious period of a disease; or

(0) Severe itching of the body or scalp or scratching of the scalp which may be symptoms of lice or scabies.

(8) An ill child shall be kept isolated from the other children and a caregiver shall be in close proximity to the child until a parent arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that indicate a need for assistance.

(9) A parent of each child shall be notified when any reportable communicable disease in 19 CSR 20-20.020 (1) - (5) occurs in the facility.

(10) Providers are not required to administer medication, but may if they choose.

(A) All medication shall be given to a child only with the dated, written permission of a parent, stating the length of time the medication may be given.

(B) Prescription and nonprescription medication shall be in the original container and labeled with the child's name, instructions for administration, including the times and amounts of dosages, and the physician's name. Sample medication provided by a physician may be used.

(D) Medication shall be returned to storage immediately after use.

(E) Medication needing refrigeration shall be kept in the refrigerator in a container separate from food.

(F) Unused medication shall be returned to the parent or disposed of immediately after it is no longer needed.

(G) The date and time(s) of administration, the name of the individual giving the medication and the quantity of medication given shall be recorded promptly after administration. This form shall be filed in the child's record after the medication is no longer necessary.

(11) In case of an accident or injury to a child, the provider shall notify a parent immediately. If a child requires emergency medical care, a parent's prior written instructions shall be followed. A form shall be completed indicating the circumstances and the date and time of the injury. The form shall be signed by the caregiver and his/her supervisor. A copy of the form shall be given to the parent the day of the accident or injury and necessary explanation shall be given. The form shall be filed in the child's record.

PURPOSE: This rule establishes the responsibilities of caregivers in license-exempt facilities.

(1) The responsibilities of caregivers are:

(A) Children shall not be left without adult supervision.

1. A caregiver shall personally admit each child upon arrival and personally dismiss each child upon departure. Children shall be dismissed only to a parent, guardian, legal custodian, or to individuals approved by a parent, guardian or legal custodian.

2. A caregiver shall remain in the room with infants, preschool and school-age children while the children are napping and shall be able to see and hear the children if they have difficulty during napping or when they awaken.

3. Caregivers shall be alert to various needs of each child such as thirst, hunger, diaper change, aggression by other children and need for attention.

(B) Facility directors, with the exception of directors in facilities operated by religious organizations, shall establish a written discipline plan that includes simple, understandable rules for children's behavior.

1. Expectations for a child's behavior shall be appropriate for the developmental level of the child and explained to the child.

2. Only constructive, age-appropriate methods of discipline that help children develop self-control and assume responsibility for their own actions shall be used.

3. Physical punishment including, but not limited to, spanking, slapping, shaking, biting or pulling hair is prohibited.

4. Any discipline technique that is humiliating, threatening or frightening to children is prohibited. Children shall not be shamed, ridiculed or spoken to harshly, abusively or with profanity.

5. Punishment or threat of punishment shall not be associated with food, rest, toileting accidents or toilet training.

6. Children shall not be placed in a closet, a locked or unlighted room, or any other frightening place.

7. Children shall not be permitted to intimidate or harm others, harm themselves or destroy property.

(C) Facility directors, with the exception of directors in facilities operated by religious organizations, shall establish a daily schedule of activities for all children in care. The schedule shall include the following:

1. A total of at least one (1) hour of outdoor play for children in full-day attendance, unless prevented by weather extremes or medical reasons;

2. Toileting and handwashing times;

3. Regular snack and meal times, with infants being fed according to the individualized feeding schedule established by a parent; and

4. A supervised nap or rest period for preschool children after the noon meal, with infants allowed to remain in bed a maximum of thirty (30) minutes after awakening. Toddlers shall be taken out of bed for other activities when they awaken.

(D) Facility directors shall not allow animals which may pose a threat to the health or safety of children on the premises or the animals shall be penned securely in an area that is inaccessible to children.

(E) A caregiver shall supervise children in the bathroom.

(F) Caregivers shall meet the following requirements regarding diapering areas:

1. A safe, waterproof and washable diapering surface shall be used for changing diapers. The diapering area shall be located within or adjacent to the infant/toddler group so the caregiver using the diapering surface can maintain supervision of his/her group of children at all times;

2. One (1) diapering surface shall be provided for every group of eight (8) infants/toddlers and one (1) diapering surface shall be provided for every group of sixteen (16) two- (2-) year-old children in the infant/toddler unit;

3. A diapering surface shall be available in the preschool unit if children who are not toilet trained are accepted;

4. Children shall be attended at all times while on the diapering surface;

5. No effort shall be made to toilet train a child until the parent and caregiver agree on when to begin; and

6. Extra clothing shall be available for children in case they accidentally soil themselves.

(G) If meals are served, the facility director is responsible for assuring that the children's diets are planned according to recognized nutrition standards.

(H) In facilities providing care for less than four (4) hours per day or less than twenty (20) hours per week, children may bring sack lunches.

(I) Caregivers shall meet the following requirements for kitchens:

1. Kitchens shall not be used for children's play activities unless the activities are part of a learning program and the children are supervised by adults-,

2. Kitchens shall not be used for napping or as passageways for children;

3. Kitchens shall be separated from all other areas by walls or partitions at least thirty-six inches (36") high; and

4. Animals which may pose a threat to children shall not be permitted on the premises or shall be located in an area that is inaccessible to the children. Animals shall not be permitted in food preparation and storage areas.

PURPOSE: This rule establishes the fire safety requirements for all license-exempt child care facilities.

(1) These general fire safety requirements shall be followed at all facilities:

(A) At least one (1) portable, operable flashlight shall be accessible to staff,

(B) All flammable materials shall be stored properly and accessible only to authorized persons;

(C) House numbers shall be plainly visible from the street, or the location of the facility shall be made known to the local fire department;

(D) If child care is provided after dark, emergency lighting with a battery back-up shall be required;

(E) Facilities beginning operation after the effective date of these rules shall have a minimum ceiling height of seven feet (7') in all areas used for child care; and

(F) Providers shall notify the nearest fire department when the facility begins operation.

(2) These requirements for exits and doors shall be followed at all facilities:

(A) Each floor occupied by children shall have no less than two (2) exits remote from each other. Exit doors shall swing in the direction of exit travel and shall lead directly, or through an enclosed fire-resistant stairway, to the outside. This includes basement areas;

(B) Children shall not be permitted to sleep above the second floor;

(C) Doors in a means of egress shall swing in the direction of exit travel. This does not apply to facilities caring for ten (10) or less children;

(D) Outside doors shall not be locked to prevent exit while the building is occupied;

(E) Every bathroom door lock or bathroom stall door shall be designed to permit opening from the outside in an emergency. All closet latches shall allow children to open the doors from the inside; and

(F) Facilities shall have smokestop partitions with a one (1) hour fire resistant rating between each floor. All doors providing separation between floors shall have a forty-five (45) minute fire resistant rating with an attached self-closing device. This does not apply to facilities caring for ten (10) or fewer children.

(3) These requirements for detection and extinguishment systems shall be followed at all times:

(A) Each facility caring for more than ten (10), but less than fifty (50) children at one (1) time shall have

1. Manual pull stations by every exit or where designated by the fire inspector. They shall be connected to an alarm that is audible throughout the facility. One (l)-room facilities that exit directly to the outside are not subject to this requirement; and

2. At least one (1) underwriter's laboratory (UL) or Factory Mutual (FM)-approved individual home-type detector shall be located on each floor and in each hazardous area. The number and location of detectors shall be determined by the fire inspector. Detectors shall be tested monthly and batteries changed as needed. A record shall be kept of the dates of testing and changing of batteries.

(B) Facilities caring for fifty (50) or more children at one (1) time shall have a full-coverage electrical fire alarm system with battery back-up, smoke detectors, heat sensors and pull stations. All equipment shall be U.L. or FM-certified;

(C) Facilities caring for more than one hundred (100) children at one (1) time shall have a fire alarm that is transmitted to the local fire department or official authority;

(D) Commercial stoves, commercial cooking ranges and deep fryers shall be equipped with a range hood and extinguishing system with an automatic cut off of fuel supply, and an exhaust system;

(E) A portable five (5) pound, 2A10BC fire extinguisher shall be located near the kitchen. The location shall be at the discretion of the fire inspector. Additional extinguishers may be required by the fire inspector; and

(F) Janitor closets, maintenance shops and boiler or furnace rooms in child care space shall be separated from other parts of the building with construction having at least a one (1) hour fire resistant rating. The opening shall have solid core doors to close off the area.

(4) Heating equipment shall be installed with permanent connections and proper ventilation.

(A) Space heaters, floor furnaces, wood burning stoves and fireplaces shall have a noncombustible guard or partition to prevent children from touching or tampering with them.

(B) Unvented gas and oil heater shall not be used.

(C) All gas and electrical heating equipment shall be equipped with thermostatic controls. All hot water heaters shall have a temperature/pressure relief valve, be vented properly and equipped with thermostatic controls. The drain line on the pressure relief valve shall extend to approximately six inches (6") above the floor.

(D) Only commercially manufactured heating equipment shall be used.

(5) Fire and tornado drills shall be conducted at least every three (3) months and shall include all children in care. Unscheduled drills shall be held at the discretion of the state fire marshal or department. Each fire drill shall include a complete evacuation of all persons from the building.

(A) An emergency plan for fires and tornadoes; shall be posted conspicuously and shall include the route for the drills and special instructions for nonambulatory infants and children.

(B) A written record shall be kept of the dates and types of drills conducted.

PURPOSE: This rule establishes the requirements for maintaining proper sanitation in license exempt child care facilities.

(1) The premises of facilities shall be clean and free of unsanitary conditions and observable insects, spiders and rodents.

(A) Floors in bathrooms and kitchens shall be clean. Carpet shall not be used in bathrooms.

(B) Infant and toddler toys shall be kept clean and shall be sanitized after any contact with body fluids.

(D) If toothbrushes, combs, hairbrushes or other personal-care items are used, they shall be individually air-dried and labeled with each child's name.

(2) Bathrooms shall meet the following requirements:

(A) Toilets, urinals and handwashing sinks shall be clean and odor free;

(B) Toilet and handwashing facilities shall be in working order and convenient for the children's use;

(C) Paper towels or a hot-air dryer that is installed and maintained properly, soap and toilet paper shall be provided and accessible so the children can reach them without assistance;

(D) Potty chair shall be located in the bathroom and shall be emptied, cleaned and sanitized after each use; and

(E) Bathrooms shall be enclosed with full walls and solid doors.

(3) Diapering areas shall meet the following requirements:

(A) Diapering supplies and a handwashing sink with warm, running water shall be in a location that allows the caregiver to maintain supervision of the children in care at all times;

(B) Disposable tissues or wipes shall be used to clean the child at each time of diapering. Any diapering creams, powders or other products applied at the time of diapering shall be approved or provided by the parent(s) and labeled with the child's name;

(D) Diapers and wet clothing shall be changed promptly;

(E) Wet or soiled disposable diapers shall be placed in an airtight disposal container located in the diaper change area and discarded daily. If cloth diapers are used, they shall be stored in airtight plastic bags and removed from the building daily; and

(F) The diapering and handwashing areas shall be separate from food service areas and food-related materials.

(4) Kitchens and meals shall meet the following requirements:

(A) A kitchen shall be required for meal preparation if a provider serves meals, unless meals are catered from a source approved by a state or local health department;

(B) A kitchen used for meal preparation shall have sufficient equipment to serve the number of children in care. Equipment shall include a stove, sink, hot and cold running water, a refrigerator, and storage space for food, dishes and cooking utensils;

(C) If meals are catered, a sink with hot and cold running water, a refrigerator and storage space shall be provided; and

(D) Floors shall be a hard, smooth surface, easily cleanable and in good repair. Facilities caring for ten (10) or less children may use carpet.

(5) Food equipment and utensils shall meet the following requirements:

(A) All food equipment, utensils and food preparation surfaces shall be cleaned properly and sanitized with a sanitizer approved by the department;

(B) Kitchen equipment that produces excessive heat and moisture shall be vented properly;

(C) If a mechanical dishwasher is used, it shall have the capacity to sanitize all dishes and utensils used in meal preparation;

(D) Facilities caring for more than twenty (20) children shall use a three (3)-vat sink; single-service utensils, cups and plates in conjunction with the sink; or a commercial dishwasher. Facilities caring for twenty (20) children or less may use a two (2)-vat sink and a container large enough to sanitize the largest utensil used;

(E) Sinks shall be equipped with hot and cold running water and an area for draining dishes. Approved dishwashing methods shall be used;

(F) Facilities caring for more than twenty (20) children shall have separate handwashing sinks in food preparation areas equipped with hot and cold running water, hand cleanser and paper towels;

(G) Food preparation areas shall have adequate lighting;

(H) An accurate thermometer shall be located in each refrigerator. Each refrigerator shall be maintained at a temperature of fortyone degrees Fahrenheit (41'F) or less;

(I) Freezers shall keep foods in a frozen solid state; and

(J) A metal stem bayonet-type thermometer for checking food temperatures shall be used to check temperatures.

(6) Nonpublic water systems shall meet the requirements of section 256.600, RSMo.

(A) Public water systems shall meet the requirements of sections 640.010 and 640.140, RSMo.

(B) All water systems shall be free of cross-connections and threaded faucets shall have a backflow preventive device.

(7) Sewage systems shall be designed for the capacity of the facility, operate properly, be nuisance free and meet applicable laws and rules of the department and the Department of Natural Resources.

(8) Adequate refuse disposal and storage shall be provided. A sufficient number of nonabsorbent containers and lids shall be available.

(9) Providers shall observe the following food preparation practices:

(A) Cross-contamination of raw and cooked foods is prohibited. Hands shall not be washed in equipment washing vats;

(B) Home-canned foods shall not be used;

(D) All food shall be in sound condition;

(E) Catered food shall be from a caterer that is inspected and approved by a state or local health department and shall be received at the facility meeting all temperature requirements;

(F) Adequate equipment shall be provided for onsite storing and serving of food;

(G) Food items shall be covered properly or packaged and protected from contamination;

(H) Food placed on the table family style shall be discarded if not eaten;

(1) Food shall be thawed properly; and

(J) Food shall be cooked, stored and served at safe temperatures. Foods requiring hot storage shall have an internal temperature of one hundred forty degrees Fahrenheit (140'F) or above. Cool foods requiring refrigeration after preparation shall have an internal temperature of forty-one degrees Fahrenheit (41') or below.

PURPOSE: This rule sets forth the requirements for the physical plant, indoor and outdoor space, supplies and equipment for license-exempt child care facilities.

(1) The premises of all facilities shall be safe and suitable for the care of children.

(A) Children shall have no access to areas not approved for child care.

(B) Porches, decks, stairwells or other areas in approved child care space shall have protective handrails and guardrails if there is a drop-off of more than twentyfour inches (24") from which children might fall and be injured. Guardrails shall be at least thirty-six inches (36") high, and shall have bars placed at intervals of no more than three and one-half inches (31/2"), or have protective material to prevent a three and one-half inch (31/2") sphere from passing through the bars.

(D) Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.

(E) Ammunition, guns, hunting knives, bows and arrows or other weapons shall not be on the premises unless stored in a locked cabinet or closet.

(F) Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.

(2) Indoor space requirements shall include

(A) Adequate artificial or natural lighting throughout each room used for child care;

(B) Room temperatures that are no less than sixtyeight degrees Fahrenheit (68F) and no more than eighty-five degrees Fahrenheit (85'F) measured two feet (2') from the floor;

(D) Police, fire department, poison control, ambulance and other emergency numbers posted near the telephone; and

(E) At least thirty-five (35) square feet of usable floor space for each preschool and school-age child, and at least forty-five (45) square feet of usable floor space for each infant/toddler.

1. Floor space shall be measured wall-to-wall from the inside walls of areas used for children's activities.

2. Floor space shall not include kitchens, bathrooms, closets, staff lounges, office space, hallways used exclusively as passageways and floor space occupied by furniture or shelving not used for children or their activities.

3. In a facility located in an owner's permanent residence, the area used for child care, including play space and bathrooms, shall be separate from the family living quarters unless the facility is providing care for ten (10) or fewer children.

(F) Facilities providing infant and toddler care shall meet the following requirements:

1. The floor shall be covered with material that can be cleaned. Carpets or rugs shall be spot-cleaned when soiled. They shall be sanitized with an approved sanitizer when contaminated with body fluids;

2. A facility with a capacity of more than twenty (20) children or more than four (4) infants and toddlers shall have infant and toddler space separate from the older children. The space shall be separated by floor-to-ceiling walls with separate play, sleeping and bathroom space;

3. No more than twenty-four (24) infants/toddlers shall be in a single room. A room is an area separated from other parts of the building by floor to ceiling walls. Stable partitions, a minimum of four feet (4') in height, shall be used to separate the infant/toddler and two- (2-) year-old groups with a room; and

4. No more than eight (8) infant/toddlers or sixteen (16) two- (2-) year-olds shall be in a group.

(3) General requirements for bathrooms shall include

(A) One (1) flush toilet and one (1) adjacent handwashing facility with running water available for every twenty (20) children. Urinals may be substituted for up to one-half (1/2) the required number of toilets, with a minimum of one (1) toilet per bathroom;

(B) Water temperatures at handwashing facilities accessible to children shall not exceed 120 degrees Fahrenheit (120' F);

(D) If a facility provides care for more than fifty (50) children, a separate bathroom or bathroom stall shall be available for caregivers;

(E) When a facility offers care for more than twenty (20) children, including school-age children in first grade or above, bathrooms shall be provided as follows:

1. Separate girls' and boys' bathrooms; or

2. If twenty (20) or fewer school-age children are in care, one (1) bathroom may be designated for schoolage children only.

(F) For infants, toddlers and children not toilet trained, one (1) flush toilet and one (1) adjacent handwashing facility with running water shall be available for every twenty-four (24) children in an infant/toddler unit. One (1) potty chair, junior commode or toilet with an adapter seat shall be provided for every four (4) children being toilet trained.

(4) Outdoor space requirements shall include

(A) An outdoor play area available on or adjoining the child care property. Facilities with a capacity of more than ten (10) children shall have a fenced play area. Play areas in facilities with a capacity of ten (10) or fewer children shall be fenced when necessary for the protection of children from traffic, water or other hazards. Fences shall be at least forty-two inches (42") high. Openings in fences shall be no greater than three and onehalf inches (31/2");

(B) A minimum of seventy-five (75) square feet per child of outdoor play area. A sufficient area shall be available to accommodate one-third (1/3) of the capacity of the facility at one time with a minimum of seven hundred fifty (750) square feet;

(C) The play area shall be safe for children's activities. It shall be well-maintained and free of hazards such as poisonous plants, broken glass, barbed wire, open wells, rocks and other debris, and shall have good drainage;

(D) The fall-zone area under and around outdoor equipment over twenty-four inches (24") high covered with impactabsorbing materials that will effectively cushion the fall of a child. Materials may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material;

(E) Outdoor play space for infants and toddlers separate from that used for older children, or the same space used at different times. This does not apply to facilities caring for a maximum of twenty (20) children, including no more than four (4) infants/toddlers;

(F) Swimming and wading pools used by children that are constructed, maintained and used in a manner that protects the health and safety of children.

1. Swimming and wading pools shall be enclosed by a fence at least forty-two inches (42") high with a locked gate.

2. Swimming and wading pools shall have a water filtration system. The water shall be treated, cleaned and maintained in manner approved by a state or local health authority;

(G) Outdoor equipment shall be safely constructed, in good condition, and free of sharp, loose or pointed parts. Stationary equipment such as swings, slides and climbers shall be anchored securely; and

(H) Any part of outdoor equipment from which children might fall shall not exceed six feet (6') in height.

(5) When children are napped on the premises, indoor equipment requirements shall include

(A) An individual mat, cot or bed with an individually assigned sheet and blanket provided for each child who naps or sleeps. Upper levels of bunk beds shall not be used. If mats are used, they shall have nonabsorbent, cleanable coverings and shall not be placed directly on concrete, linoleum, hardwood, or tile floors when children are resting or napping. They shall be used only over carpeting and shall be long enough so the child's head or feet do not rest off the mat. Mats shall be washed and sanitized at least weekly, or more often as needed, and shall be cleaned and sanitized before use by another child;

(B) Clean bedding with sheets laundered at least once a week or when soiled. Once bedding has been used by a child, it shall not be used by another child until it is laundered;

(D) An individually assigned crib, portable crib or playpen for each infant. Stack cribs shall not be used. Cots or mats may be used for napping for toddlers twelve (12) months and older with parental consent. Infants shall not use mats for napping.

1. Cribs and playpens shall have side and end rail spokes not more than two and three-eights inches (23/811) apart.

2. The crib mattress or playpen pad shall be sized correctly to the crib or playpen. The pad shall be in good condition, waterproof, clean and dry. Sheets and covers shall be changed when soiled or wet.

(6) Individual seating and table space shall be available for children twelve (12) months of age and older.

(A) Facilities shall have one (1) piece of mealtime feeding equipment for every four (4) infants/toddlers.

(B) Equipment shall allow children to sit comfortably and securely while being fed. Appropriate restraints shall be used and infants shall not be left unattended.

(7) Indoor play equipment and materials shall be provided and shall be clean and in good condition with all parts intact. Infants and toddlers shall have safe toys. Toys, parts of toys or other materials small enough to be swallowed shall not be used.

PURPOSE: This rule identifies the requirements the provider in a license-exempt child care facility is responsible for when transporting children and taking field trips.

(1) The caregiver shall ensure the care, safety and supervision of children when children are transported away from the premises.

(A) Written parental consent shall be on file for field trips and transportation, and the facility director shall have a procedure on file for handling emergencies.

(B) Parents shall be informed when field trips are planned.

(C) Short, unscheduled walks may be taken without parent notification. Unscheduled outings shall be discussed with a parent at the time of enrollment.

(D) All children shall be seated in a stationary seat in the vehicle and restrained by seat belts or child restraint devices as required by Missouri law.

(E) Identifying information, including the name and address of the facility, the names of the children and the name, addresses and telephone number of each child's parent(s) shall be carried in the vehicle and available to staff members responsible for the children.

(F) Children shall remain seated while the vehicle is in motion and doors shall be locked when the vehicle is moving.

(G) Children shall be assisted when necessary while entering or leaving the vehicle and shall enter and leave the vehicle from the curbside unless the vehicle is in a protected area or driveway. Children shall not be left unattended in a vehicle at any time.

(H) Caregivers shall have a procedure for taking head counts before leaving the facility, during field trips and when back at the facility

(2) The driver of any vehicle used to transport children shall be no less than eighteen (18) years of age and shall have a valid driver's license.

(3) All vehicles used to transport children shall be licensed. Children shall not be transported in campers, trailers or the back of trucks.

PURPOSE: This rule establishes admission procedures, records and reports that facility directors are required to keep for children and caregivers.

(1) The facility director shall have an admitting procedure for each child in care that includes a plan for caring for the child if s/he becomes ill or needs emergency medical treatment. The director shall maintain an individual file on each child in order to communicate with the parent(s), guardian or legal custodian. The director shall have a plan for any child with special health needs, identified through a physical assessment by a licensed physician or an advance practice nurse, to ensure that those needs are met during care.

(2) The facility director shall obtain and file the following written information on each child:

(A) The child's full name, address, birthdate and the date care begins and ends;

(B) The full name of the parent(s), guardian or legal custodian, home address, work schedule, home and work telephone numbers, and employer's name and address;

(C) Full name, address and phone number of a friend or relative who might be reached in an emergency when a parent, guardian or legal custodian can not be reached;

(D) Name and phone number of a physician and preferred hospital to be used in an emergency;

(E) The name of the individual(s) authorized to take the child from the premises; and

(F) Information concerning any accident or injury to a child while in care or any emergency medical care given.

(3) Individual records of a child shall be retained for one (1) year after the child discontinues attendance.

(4) Facility directors shall obtain and file the following acknowledgements by a parent of each child:

(A) S/he has been informed of the required health and safety inspections and that the inspection forms are available for review; and

(B) S/he understands and agrees that the child may not be accepted for care when ill.

(5) A copy of the completed application for child abuse/neglect screening (BSIU-2, 7-88) shall be on file in each employee's record.

(6) All enrollment records, physical assessment reports and attendance records shall be filed in a place known to caregivers and shall be accessible during normal visiting hours for inspection by the department. Records shall not be in a locked area or removed from the premises during operating hours.

1. Sections 3 to 15 of this act shall be known and may be cited as the "Family Care Safety Act".

Section 4.

Section 5.

Section 6.

Section 7.

Section 8.

Section 9.

Section 10.

Section 11.

Section 12.

Section 13.

Section 14.

Section 15.

Section 16.

Section B.