414-180-0015 Health (1) The provider must give the children’s needs first priority, assuring that they get adequate care and attention. (2) The child care facility must be a healthy environment for children. (3) All caregivers shall take appropriate precautions to prevent shaken baby syndrome and abusive head trauma. (4) There must be at least one flush toilet and one hand-washing sink available to children. Drinking water for preparing food, infant formula, drinking or cooking shall not be obtained from hand-washing sinks. (5) The facility shall identify the location of all drinking water faucets and fixtures accessible to children or used to obtain water for preparing food, infant formula, drinking or cooking and shall sample the water from these faucets and fixtures for lead. The facility shall sample in accordance with United States Environmental Protection Agency 3T’s for Reducing lead in Drinking Water in Schools: Revised guidance dated October 2006 and shall use an Oregon Environmental Laboratory Accreditation Program (ORELAP) accredited drinking water laboratory. (6) Lead testing as required by 414-180-0015(5) shall be conducted within the past six years of the effective date of this section and no later than six months after the effective date of this section and at least once every six years. (7) The test results shall be kept on the facility premises at all times and a copy provided to the CCLD within ten (10) days of receiving the results. (8) Irrespective of test results, the facility must immediately notify all parents and guardians verbally, in writing, or by email, of the test results and post results in a prominent place in the facility where they will be seen by parents and guardians within one business day. Information provided to parents and guardians shall be in accordance with United States Environmental Protection Agency 3T’s for Reducing Lead in Drinking Water in Schools: Revised guidance dated October 2006. (9) If the test results are at or above 15 parts per billion (ppb), the facility must immediately: (a) Prevent children from using or consuming water from faucets or fixtures identified in 414-180-0015(5) that have test results at or above 15 ppb, supplying water from drinking water faucets or fixtures identified in 414-180-0015(5) that have test results below 15 ppb or bottled or packaged water to meet the requirements of this section; (b) Within sixty days of receiving the test results, the provider shall submit a corrective action plan for approval by the CCLD for any faucet or fixture that has test results at or above 15 ppb, following the United States Environmental Protection Agency 3T’s for Reducing Lead in Drinking Water in Schools: Revised guidance dated October 2006; (c) The facility must implement corrective actions or remedies identified in the approved plan within 30 days of CCLD approval; and (d) The facility must conduct follow-up sampling and results must demonstrate lead below 15 ppb before the facility may resume use of faucets or fixtures identified in 414-180-0015(5) that previously tested at or above 15 ppb. (10) A provider may submit documented lead testing results obtained within six years immediately preceding the effective date of this section to the CCLD. This provision applies only to tests conducted in accordance with the United States Environmental Protection Agency 3T’s for Reducing Lead in Drinking Water in Schools: Revised guidance dated October 2006 and the results were below 15 ppb. The CCLD shall determine whether the tests submitted conform to the requirements of OAR 414-180-0015(5). (11) Irrespective of results obtained in accordance with 414-180-0015(5), actions to protect children from exposure to lead contamination in drinking water include: (a) Flushing pipes before using to prepare food, infant formula, drinking or cooking by running the tap each time before use until the water is noticeably cooler (30 seconds to two minutes); and (b) Using only cold water from drinking water faucets or fixtures identified in 414-180-0015(5) that have test results below 15 ppb for preparing food, infant formula, drinking or cooking. (c) Boiling water does not remove lead from water and is not considered an acceptable action to protect children from exposure to lead contamination in drinking water. (12) Existing programs must submit test results by September 30, 2018. (13) If a provider replaces any faucets or fixtures identified pursuant to OAR 414-180-0015(5) at any time, the provider must notify CCLD and sample the water from these faucets and fixtures pursuant to the requirements of OAR 414-180-0015(5) and provide the test results to the CCLD within ten (10) days of receiving the results. The provider may not allow access to the replaced faucet or fixture until the CCLD approves access. (14) The provider must comply with local, state and federal laws related to immunizations, child care restrictable diseases, child safety systems and seat belts in vehicles, bicycle safety, civil rights laws, and the Americans with Disabilities Act. (15) The following safe sleep practices must be followed: (a) Each infant shall sleep in a crib, portable crib, bassinet or playpen with a clean, non-absorbent mattress. All cribs, portable cribs, bassinets and playpens must comply with current Consumer Product Safety Commission (CPSC) standards; (b) Bassinets may only be used until the infant is able to roll over on their own; (c) Each mattress shall: (A) Fit snugly; and (B) Be covered by a tightly fitting sheet. (d) A clean sheet shall be provided for each child; (e) Infants must be placed on their backs on a flat surface for sleeping; (f) While on the child care premises, if an infant falls asleep in a place other than their crib, portable crib, bassinet or playpen, the provider must immediately move the infant to an appropriate sleep surface; (g) No child shall be routinely left in a crib, portable crib, bassinet or playpen except for sleep or rest; (h) There shall be no items in the crib, portable crib, bassinet or playpen with the infant, except a pacifier (e.g. bottles, toys, pillows, stuffed animals, blankets, bumpers); (i) Swaddling or other clothing or covering that restricts the child's movement is prohibited; (j) Clothing or items that could pose a strangulation hazard (e.g. teething necklaces, pacifier attachments, clothing drawstrings) are prohibited; and (k) Car seats are to be used for transportation only. Children who are asleep in a car seat must be removed upon arrival to the child care facility and placed in an appropriate sleep surface. (16) If the parent(s) so request, siblings may share the same bed. (17) The upper level of bunk beds shall not be used for children under ten years of age. (18) Children who cannot feed themselves shall be held or, if able to sit alone, fed in an upright position. (a) Infants up to 6 months of age shall be held or sitting up in a caregiver’s lap for bottle feeding; (b) Bottles shall never be propped. The child or a caregiver shall hold the bottle; and (c) Infants no longer being held for feeding shall be fed in a manner that provides safety and comfort. (19) Children of any age shall not be laid down with a bottle. (20) First aid supplies and a chart or handbook of first aid instructions shall be maintained in one identified place and kept out of reach of children. (21) The first aid supplies shall include: band aids, adhesive tape, sterile gauze pads, soap or sealed antiseptic towelettes or solution to be used as a wound cleaning agent, a solution for disinfecting after a blood spill, a sanitary temperature taking device. (22) Illness: (a) Except for mild cold symptoms that do not impair a child’s daily functioning, sick children shall not be in care. (b) A provider shall not admit or retain in care, except with the written approval of the local health office, a child who: (A) Is diagnosed as having or being a carrier of a child care restrictable disease, as defined in Oregon Health Authority administrative rule; or (B) Has one of the following symptoms or combination of symptoms or illness; (i) Fever over 100°F, taken under the arm; (ii) Diarrhea (more than one abnormally loose, runny, watery or bloody stool); (iii) Vomiting; (iv) Nausea; (v) Severe cough; (vi) Unusual yellow color to skin or eyes; (vii) Skin or eye lesions or rashes that are severe, weeping, or pus-filled; (viii) Stiff neck and headache with one or more of the symptoms listed above; (ix) Difficult breathing or abnormal wheezing; or (x) Complaints of severe pain. (c) A child who, after being admitted into child care, shows signs of illness, as defined in this rule, whenever possible will be separated from the other children, and the parent(s) notified and asked to remove the child from the child care facility as soon as possible. (d) If a child has mild cold symptoms that do not impair his/her normal functioning, the child may remain in the child care facility and the parent(s) notified when they pick up their child. (23) Section 22 of this rule does not apply when the provider is caring only for children from the same family and no other unrelated child care children are present, except that the provider shall notify the parent if a child who, after being admitted into child care, shows signs of illness. (24) Parents must be notified if their child is exposed to an outbreak of a communicable disease. (25) If a child with allergies is enrolled who needs a specific plan for caring for that child, such a plan shall be developed in writing between the provider and parents, and, if necessary, outside specialists. All caregivers who come in contact with that child shall be fully aware of the plan. (26) No person shall smoke or carry any lighted smoking instrument, including an e-cigarette or vaporizer in the child care facility or within ten feet of any entrance, exit, or window that opens or any ventilation intake that serves an enclosed area, during child care hours or when child care children are present. (27) No person shall use smokeless tobacco in the child care facility during child care hours or when child care children are present. (28) No person shall smoke, carry any lighted smoking instrument, including an e-cigarette, or vaporizer or use smokeless tobacco in motor vehicles while child care children are passengers. (29) No one shall consume alcohol on the child care facility premises during child care hours or when child care children are present. (30) No one shall be under the influence of alcohol on the child care facility premises during child care hours or when child care children are present. (31) No one shall possess, use or store illegal controlled substances on the child care facility premises. No one shall be under the influence of illegal controlled substances on the child care facility premises. (32) No one shall grow or distribute marijuana on the premises of the child care facility. No adults shall use marijuana on the child care facility premises during child care hours or when child care children are present. (33) Child care providers and any individual supervising, transporting, preparing meals, or otherwise working in the proximity of child care children and those completing daily attendance and billing records shall not be under the influence. (34) “Under the influence" means observed abnormal behavior or impairments in mental or physical performance leading a reasonable person to believe the individual has used alcohol, any controlled substances (including lawfully prescribed and over-the-counter medications), marijuana (including medical marijuana), or inhalants that impairs their performance of essential job function or creates a direct threat to child care children or others. Examples of abnormal behaviors include, but are not limited to hallucinations, paranoia, or violent outbursts. Examples of impairments in physical or mental performance include, but are not limited to slurred speech as well as difficulty walking or performing job activities. (35) All marijuana, marijuana derivatives and associated paraphernalia must be stored under child safety lock. (36) Any animal at the child care facility shall be in good health and be a friendly companion for the children in care. (37) Dogs and cats must be vaccinated according to a licensed veterinarian's recommendations. (38) Dogs and cats shall be kept free of fleas, ticks and worms. (39) Animal litter boxes shall not be located in areas accessible to children or areas used for food storage or preparation. (40) Exotic animals, including, but not limited to: reptiles (e.g. lizards, turtles, snakes) amphibians, monkeys, hook-beaked birds, baby chicks and ferrets are prohibited unless they are housed in and remain in a tank or other container which precludes any direct contact by children. Educational programs that include prohibited animals and are run by zoos, museums and other professional animal handlers are permitted. (41) Prescription and non-prescription medication shall only be given to a child if the provider has written authorization from the parent. (42) Prescription and non-prescription medications must be properly labeled and stored. (43) Non-prescription medications or topical substances must be labeled with the child's name. (44) Prescription medications must be in the original container and labeled with the child's name, the name of the drug, dosage, directions for administering, and the physician's name. (45) Medication requiring refrigeration must be kept in a separate, tightly covered container, marked "medication," in the refrigerator. (46) Parents must be informed daily of any medications given to their child or any injuries their child has had. (47) Sunscreen may be used with written parental authorization. (a) In instances where parent has provided written permission to use sunscreen, providers must reapply sunscreen every two hours while the child care children are exposed to the sun. (b) Providers shall use a sunscreen with an SPF of 15 or higher and must be labeled as “Broad Spectrum”. (c) Providers shall not use aerosol sunscreens on child care children. (d) Sunscreen shall not be used on child care children younger than six months. (48) Parents must be given the telephone number so they can contact the provider if needed. Statutory/Other Authority: ORS 326.425 & ORS 329A.020 Statutes/Other Implemented: ORS 329A.505, ORS 329A.010, ORS 329A.020 & ORS 329.500 History: DELC 73-2023, minor correction filed 11/22/2023, effective 11/22/2023 ELD 3-2020, amend filed 01/30/2020, effective 01/30/2020 ELD 9-2019, amend filed 03/28/2019, effective 03/28/2019 ELD 17-2018, temporary amend filed 10/31/2018, effective 10/31/2018 through 04/27/2019 ELD 13-2018, amend filed 10/16/2018, effective 10/16/2018 ELD 5-2018, amend filed 03/23/2018, effective 03/23/2018 ELD 4-2018, amend filed 03/06/2018, effective 09/30/2018 ELD 6-2017, f. & cert. ef. 3-27-17 ELD 2-2017, f. & cert. ef. 1-31-17 ELD 2-2016, f. & cert. ef. 6-29-16