Code of Virginia — Title 32.1 (Health), Chapter 5 (Regulation of Medical Care Facilities and Services)
§ 32.1-162.15:1.12. (Effective July 1, 2026) Operation and management; staffing.
A. Each Center shall have an administrator who oversees the operation of the Center. Such administrator shall be a physician with a current license, an advanced practice registered nurse, a licensed nursing home administrator, a child day center director, or a registered nurse with at least five years of experience in pediatric medicine.

B. Operation of the Center shall include:

1. Coordination of emergency transportation arrangements with the emergency medical services of the locality where the Center is located, including the provision of an adult staff member of the Center who accompanies any child who requires emergency transportation;

2. Creation of a documented preventative maintenance program that emphasizes ensuring that all durable medical equipment functions correctly and safely;

3. Maintenance of medical records, data, and information related to the children and programs in the Center for inspection by the Commissioner;

4. Provision of appropriate and readily available emergency services that include (i) an emergency drug kit and (ii) a crash cart with a defibrillator appropriate for children;

5. Creation of a written disaster plan that addresses natural disasters, weather emergencies, bomb threats, emergency drills, manufactured disasters, and financial disasters;

6. Documentation of all incidents and accidents;

7. A process for reporting to the Commissioner any incidents and accidents that affect the health, safety, or welfare of a child; and

8. Coordination and collaboration with other agencies that may serve the child.

C. Each Center shall have a medical director who is responsible for basic and supportive services, including medical, pharmaceutical, and nursing services. The medical director shall be responsible for (i) the prevention, reporting, and investigation of abuse; (ii) the delivery of medical and therapeutic services; (iii) the control and delivery of pharmaceutical services; (iv) infection control; and (v) policies for prevention of incidents and accidents. The medical director shall ensure compliance with any policies and procedures developed by the Board.

D. Each Center shall employ:

1. A supervisor that holds a valid relevant professional license issued by the Board of Medicine, Board of Nursing, Board of Pharmacy, Board of Physical Therapy, or Board of Audiology and Speech-Language Pathology.

2. At least one direct care staff member who is qualified as a licensed advanced practice registered nurse, registered nurse, physical therapist, respiratory therapist, occupational therapist, or speech-language pathologist.

E. Each Center shall abide by the following applicable staffing ratio:

1. For a Center with fewer than 13 children, the Center shall be staffed by two registered nurses and two other staff members.

2. For a Center with no less than 13 and no more than 18 children, the Center shall be staffed by two registered nurses, one licensed practical nurse, and three other staff members.

3. For a Center with no less than 19 and no more than 24 children, the Center shall be staffed by two registered nurses, two licensed practical nurses, and four other staff members.

4. For a Center with more than 24 children, the number of licensed practical nurses and other staff members shall increase by one each for up to six additional children enrolled.

2025, c. 451.