Daily Inspection for Illness

101626.1

(a) Notwithstanding Section 101226.1, the following shall apply:

(b) Upon arrival each day at the center, each child shall have a daily inspection for illness to determine if the child is appropriate for placement in the center.

(1) A qualified staff person shall perform and document the completion of the daily inspection for illness.

(A) A qualified staff person for a Level I center shall be a director as specified in Sections 101615(a) and (b), or a teacher as specified in Sections 101616.2(a) and (b).

(B) A qualified staff person for a Level II center shall be a licensed health professional.

(2) As part of the daily inspection for illness, a child's body temperature shall be determined by using a thermometer with a disposable plastic (Probe) cover.

(3) The licensee shall require the child's authorized representative to remain in the center until the daily inspection for illness is completed and the child is accepted for care.

(c) The licensee shall develop and implement a written procedure for completing daily inspections for illness, which shall include developing a form to document that a daily inspection for illness has been completed prior to a child's acceptance for care.

(1) As required by Section 101626(d), the health consultant shall be consulted on the development of the procedure and form specified in Section 101626.1(c).

(d) This subchapter shall not be interpreted to require the exclusion of a child with a chronic condition protected under the Americans With Disabilities Act of 1990 (42 U.S. Code Section 12101 et seq.) unless the child also has a condition/symptom/illness as specified in Sections 101626.1(e), (g) and (h) that would independently exclude the child from care in a center.

(e) Except as specified in Section 101626.1(f), the licensee shall not accept or retain for care any child with any of the following conditions/symptoms/illnesses or combination thereof:

(1) Body temperature of 102 F (38.9 C) (oral) or 103 F (39.4 C) (rectal or by ear) or 101 F (38.3 C) (axillary), or higher.

(A) For an infant two months of age or under, body temperature of 101.5 F (38.6 C) (rectal or by ear) or higher.

(2) Rapid or labored breathing.

(3) Body temperature of 101 F (38.3 C) (oral) or 102 F (38.9 C) (rectal or by ear) or 100 F (37.8 C) (axillary), or higher, with stiff neck, lethargy, irritability or persistent crying.

(4) Asthmatic with upper respiratory infection and coughing that are interfering with the child's ability to drink, talk or sleep.

(5) Undiagnosed acute rash of two weeks or less in duration.

(6) Yellowing of the eyes or skin.

(7) Abdominal pain that is persistent or intermittent.

(8) Vomiting three or more times, or lasting over a six-hour period, or with signs of dehydration.

(9) Diarrhea (that is, five or more stools in an eight-hour period or an increased number of stools compared to the child's normal pattern, and with increased stool water and/or decreased form), in addition to one or more of the following:

(A) Signs of dehydration (for example, no urine produced for an eight-hour period).

(B) Blood or mucus in the stool unless a physician determines that at least one stool culture demonstrates absence of shigella, salmonella, campylobacter, pathogenic E. coli or other pathogens.

(C) Persistence beyond three days.

(10) Severe lethargy.

(11) Open lesions of the skin or mucous membranes.

(12) Other conditions as may be determined by a qualified staff person on an individual basis.

(f) A Level I or Level II center may accept a child with any of the conditions/symptoms/illnesses as specified in Section 101626.1(e) if the licensee has obtained a written health clearance stating that the child has been diagnosed and reexamined; and is not contagious or a health risk to the child or other children in care.

(1) The written health clearance, which shall be kept in the child's record, shall be obtained from a physician or other health professional working under the supervision of a physician.

(2) A licensee may accept a child for care under Section 101626.1(f) upon the verbal approval of a physician or other health professional working under the supervision of a physician if the required written health clearance is obtained within 24 hours.

(A) Receipt of verbal approval as specified in Section 101626.1(f)(2) shall be recorded immediately in the child's record. The notation shall include the name of the physician or other health professional who gave the verbal approval, the date and time the verbal approval was given, and the name of the qualified staff person who made the notation.

(g) The licensee shall not accept or retain for care any child with any of the following conditions/symptoms/illnesses except as specified:

(1) Diarrhea due to confirmed shigella, salmonella or giardia except as specified in Section 101626.1(i).

(2) Contagious stages of chicken pox or mumps except as specified in Section 101626.1(j).

(h) The licensee shall not, under any circumstances, accept or retain for care any child with any of the following conditions/symptoms/illnesses:

(1) Diarrhea due to campylobacter or cryptosporidium.

(2) Contagious stages of measles, rubella, pertussis, diphtheria or tuberculosis.

(3) Untreated infestation (such as head lice, scabies).

(i) A Level II center may accept a child with diarrhea due to confirmed shigella, salmonella or giardia 24 hours after treatment has been initiated if prior approval is obtained from the Department and the following conditions are met:

(1) In addition to Section 101626.1(b), prior to accepting the child the licensee shall obtain documentation from a physician or other health professional working under the supervision of a physician stating that, based on his/her knowledge of the isolation and separation procedures specified below, the child has been diagnosed and poses no serious health risk to the child or other children in care. This documentation shall be kept in the child's record.

(A) Verbal approval, with written follow-up, shall be acceptable if the procedures specified in Section 101626.1(f)(2) are followed.

(2) The licensee shall provide care for children with each illness in a specific area of a room or a room that is physically separate from those used by children with other illnesses.

(A) In addition to separate rooms, physical separation shall include, but not be limited to, moveable partitions and accordion wall dividers.

(3) Each separate area/room shall include:

(A) Separate toilet and Hand washing facilities.

(B) Separate equipment and toys.

(C) Notwithstanding Section 101561(d), staff assigned exclusively to the care of children in each area/room.

(4) Sanitation procedures as specified in Section 101638.1 shall be followed.

(A) The licensee shall document, in the staff file, when staff must follow sanitation procedures as specified in Section 101638.1(d) to prevent the spread of illnesses.

(j) A Level II center may accept a child in the contagious stages of chicken pox or mumps, if prior approval is obtained from the Department and the following conditions are met:

(1) In addition to Section 101626.1(b), prior to accepting the child the licensee shall obtain documentation from a physician or other health professional working under the supervision of a physician stating that, based on his/her knowledge of the isolation and separation procedures specified below, the child has been diagnosed and poses no serious health risk to the child or other children in care. This documentation shall be kept in the child's record.

(A) Verbal approval, with written follow-up, shall be acceptable if the procedures specified in Section 101626.1(f)(2) are followed.

(2) The child shall be isolated from children with other illnesses and cared for in a separate room with children having the same illness.

(A) Children with chicken pox and mumps shall not be cared for simultaneously in the same isolation room.

(3) Each isolation room shall include:

(A) A separate door to the outside of the center.

(B) Floor-to-ceiling walls.

(C) A separate ventilation system, preferably a positive airflow system.

(D) Separate toilet and Hand washing facilities.

(E) Separate equipment and toys.

(F) Notwithstanding Section 101561(d), staff assigned exclusively to the care of children in each isolation room.

(4) Sanitation procedures as specified in Section 101638.1 shall be followed.

(A) The licensee shall document, in the staff file, when staff must follow sanitation procedures as specified in Section 101638.1(d) to prevent the spread of illnesses.

NOTE: Authority cited: Section 1596.81, Health and Safety Code. Reference: Sections 1596.72, 1596.73 and 1596.81, Health and Safety Code.