MISSOURI DEPARTMENT OF Health AND SENIOR SERVICES

Bob Holden

Governor

P.O. Box 570, Jefferson City, MO 65102-0570 . 573/751/6400 - FAX 573/751-6010

Dear Child Care Providers:

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 which that 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.

Sincerely,

Lois Kollmeyer, B.S.N., Director

Division of Health Standards and Licensure

As used in sections 210.201 to 210.257, the following terms mean:

(1) "Child", an individual who is under the age of seventeen;

(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 al., A.L. 1989 S.B. 241, A.L. 1993 H.B. 376) Prior revision: 1929 §14133

(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. W. 2d 823.

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.

(L. 1993 H.B. 376)

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

(7) Any nursery school.

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.

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.

(L.1993 H.B.376)

1. The department of health shall have the following powers and duties:

(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 fall 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 falls 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 rule making 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 rule making 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 S.B. 277, A.L. I 993 H.B. 376 and S.B. 52)

Prior revision: 1929 §14135

*Word "the" does not appear in original rolls.

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.

(L. 1955 p. 685 §210.230, A.L. 1982 H.B. 1171, et al., A.L. 1993 H.B. :376)

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.

(L. 1955 p. 685 §210.240, A.L. 1993 H.B. 376)

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.

(L. 1955 p. 685, A.L. 1993 H.B. 376)

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.

(L. 1993 H.B. 376)

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 rule making 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 rule making authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void.

(L. 1993 H.B. 376 §1)

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.

2. The notice of parental responsibility shall include the following:

(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;

(5) The disciplinary philosophy and policies of the child care facility; and

(6) The educational philosophy and policies of the child care facility.

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.

(L. 1993 H.B. 376 §2 subsecs. 1, 2, 3)

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.*

(L. 1993 H.B. 376 §2 subsecs. 4, 5)

*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 I 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.

(L. 1993 H.B. 376 §3)

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

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

(1) An absence of statutory authority for the proposed rule;

(2) An emergency relating to public health, safety or welfare;

(3) The proposed rule is in conflict with state law;

(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 rule making 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 IV 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.

(L. 1993 H.B. 376 §4)

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.

(L. 1993 H.B. 376 § 6 subsec. 1)

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.

(L. 1993 H.B. 376 §6 subsee. 2)

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

2. As used in sections 3 to 15 of this act, the following terms shall mean:

(1) "Child care provider", any licensed or license-exempt child care home, any licensed or license-exempt child care center, child placing agency, residential care facility for children, group home, foster family group home, foster family home, employment agency that refers a child care worker to parents or guardians as defined in section 289.005, RSMo. The term "child care provider" does not include summer camps or voluntary associations designed primarily for recreational or educational purposes;

(2) "Child care worker", any person who is employed by a child care provider, or receives state or federal funds, either by direct payment, reimbursement or voucher payment, as remuneration for child care services;

(3) "Department", the department of health;

(4) "Elder care provider", any operator licensed pursuant to chapter 198, RSMo, or any employer of nurses or nursing assistants of home health agencies licensed pursuant to sections 197.400 to 197.477, RSMo, or any nursing assistants employed by a hospice pursuant to sections 197.250 to 197.280, RSMo, that portion of a hospital for which subdivision (3) of subsection 1 of section 198.012, RSMo, applies;

(5) "Elder care worker", any person who is employed by an elder care provider, or who receives state or federal funds, either by direct payment, reimbursement or voucher payment, as remuneration for elder care services;

(6) "Patrol", the Missouri state highway patrol;

(7) "Related child care", child care provided only to a child or children by such child's or children's grandparents, greatgrandparents, aunts or uncles, or siblings living in a residence separate from the child or children;

(8) "Related elder care", care provided only to an elder by an adult child, a spouse, a grandchild, a great-grandchild or a sibling of such elder.

Section 4.

1. To protect children and the elderly in this state, and to promote family and community safety by providing information concerning family caregivers, there is hereby established within the department of health a "Family Care Safety Registry and Access Line" which shall be available by January 1, 2001.

2. The family care safety registry shall contain information on child care workers' and elder care workers' background and on child care and elder care providers through:

(1) The patrol's criminal record check system pursuant to section 43.540, RSMo, including state and national information, to the extent possible;

(2) Probable cause findings of abuse and neglect pursuant to sections 210.109 to 210.183, RSMo;

(3) The division of aging's employee disqualification list pursuant to section 660.315, RSMo;

(4) Foster parent licensure denials, revocations and suspensions pursuant to section 210.496, RSMo;

(5) Child care facility license denials, revocations and suspensions pursuant to sections 210.201 to 210.259, RSMo; and

(6) Residential living facility and nursing home license denials, revocations, suspensions and probationary status pursuant to chapter 198, RSMo.

Section 5.

1. Every child care worker and elder care worker hired on or after January 1, 2001, shall complete a registration form provided by the department. The department shall make such forms available no later than January 1, 2001, and may, by rule, determine the specific content of such form, but every form shall:

(1) Request the valid social security number of the applicant;

(2) Include information on the person's right to appeal the information contained in the registry pursuant to section 7 of this act;

(3) Contain the signed consent of the applicant for the background checks required pursuant to this section; and

(4) Contain the signed consent for the release of information contained in the background check for employment purposes only.

2. Any person hired on or after January 1, 2001 shall complete a registration form within fifteen days of the beginning of such person's employment. Any person employed as a child care worker or elder care worker who falls to submit a completed registration form to the department of health as required by sections 3 to 15 of this act without good cause, as determined by the department, is guilty of a class B misdemeanor.

3. The costs of the criminal background check may be paid by the individual applicant, or by the provider if the applicant is so employed, or for those applicants receiving public assistance, by the state through the terms of the selfsufficiency pact pursuant to section 208.325, RSMo. Any moneys remitted to the patrol for the costs of the criminal background check shall be deposited to the credit of the criminal record system fund as required by section 43.530, RSMo.

4. Any person not required to register pursuant to the provisions of sections 3 to 15 of this act may also be included in the registry if such person voluntarily applies to the department for registration and meets the requirements of this section and section 6 of this act, including submitting to the background checks in subsection 1 of section 6 of this act.

5. The provisions of sections 3 to 15 of this act shall not extend to related care and related elder care.

Section 6.

1. Upon submission of a completed registration form by a child care worker or elder care worker, the department, in coordination with the department of social services, shall:

(1) Determine if a probable cause finding of child abuse or neglect involving the applicant has been recorded pursuant to section 210.145, RSMo;

(2) Determine if the applicant has been refused licensure or has experienced licensure suspension or revocation pursuant to section 210.496, RSMo;

(3) Determine if the applicant has been placed on the employee disqualification list pursuant to section 660.315, RSMo;

(4) Determine through a request to the patrol pursuant to section 43.540, RSMo, whether the applicant has any conviction, plea of guilty or nolo contendere, or a suspended execution of sentence to a felony charge of any offense pursuant to chapters 198, 334, 560, 565, 566, 568, 569, 573, 575 and 578, RSMo; and

(5) If the background check involves a provider, determine if a facility has been refused licensure or has experienced licensure suspension, revocation or probationary status pursuant to sections 210.201 to 210.259, RSMo, or chapter 198, RSMo.

2. Upon completion of the background check described in subsection I of this section, the department shall include information in the registry for each registrant as to whether any felony convictions, employee disqualification listing pursuant to section 660.315, RSMo, probable cause findings, pleas of guilty or nolo contendere, or license denial, revocation or suspension have been documented through the records checks authorized pursuant to the provisions of sections 3 to 15 of this act.

3. The department shall notify such registrant in writing of the results of the determination recorded on the registry pursuant to this section.

Section 7.

The department's registration form for the family care safety registry and the department's notification pursuant to subsection I of section 5 and subsection 3 of section 6 of this act shall advise the person of a right to appeal the information contained in the registry Such right to appeal shall be limited only to the accuracy in the transfer of information to the registry and shall not include a right to appeal the accuracy of the substance of the information transferred. Any such appeal shall be filed in writing at the office of the director of the department of health within thirty days of receiving the results of the determination. An administrative appeal shall be set within thirty days of the filing of the appeal and a decision shall be made within sixty days. If the appeal is decided in favor of such person, the person's records shall be restored in the registry along with a copy of the hearing decision. If the appeal is decided against such person, the person may seek judicial review of such decision pursuant to sections 536.100 to 536.150, RSMo. An applicant's right to appeal herein is in addition to any other appeal rights granted by state law.

Section 8.

The department of corrections, the department of public safety and the department of social services shall collaborate with the department to compare records on child care and elder care workers, and the records of persons with criminal convictions and the background checks pursuant to subdivisions (1) to (6) of subsection 2 of section 4 of this act, and to enter into any interagency agreements necessary to facilitate the receipt of such information and the ongoing updating of such information. The department, in coordination with the department of social services, shall promulgate rules and regulations concerning such updating, including subsequent background reviews as listed in subsection 1 of section 6 of this act.

Section 9.

The department shall establish and maintain a toll free telephone service to promote family and community safety by allowing access to certain information recorded in the registry, as provided in section 10 of this act. The department shall develop strategies to promote public awareness of the family care safety registry and toll-free telephone service.

Section 10.

1. The department shall not provide any registry information pursuant to this section unless the department obtains by asking for the name and address of the person calling, and determines that the inquiry is for employment purposes only. For purposes of section 3 to 15 of this act, "employment purposes" includes direct employer-employee relationships, prospective employeremployee relationships, and screening and interviewing of persons or facilities by those persons contemplating the placement of an individual in a child or elder care setting. Disclosure of background information concerning a given applicant recorded by the department in the registry shall be limited to:

(1) Confirming whether the individual is listed in the registry; and

(2) Indicating whether the individual has been listed or named in any of the background checks listed in subsection 2 of section 4 of this act. If such individual has been so listed, the department of health shall only disclose the name of the background check in which the individual has been identified. Any specific information related to such background check shall only be disclosed after the department has received a signed request from the person calling, with the person's name, address and reason for requesting the information.

2. Any person requesting registry information shall be informed that the registry information provided pursuant to this section consists only of information relative to the state of Missouri and does not include information from other states or information that may be available from other states.

3. Any person who uses the information obtained from the registry for any purpose other than that specifically provided for in sections 3 to 15 of this act is guilty of a class B misdemeanor.

4. When any registry information is disclosed pursuant to subdivision (2) of subsection 1 of this section, the department shall notify the registrant of the name and address of the person making the inquiry.

5. The department of health staff providing information pursuant to sections 3 to 15 of this act shall have immunity from any liability, civil or criminal, that otherwise might result by reason of such actions; provided, however, any department of health staff person who releases registry information in bad faith or with ill intent shall not have immunity from any liability, civil or criminal. Any such person shall have the same immunity with respect to participation in any judicial proceeding resulting from the release of registry information. The department is prohibited form selling the registry or any portion of the registry for any purpose including "employment purposes" as defined in subsection 1 of section 10 of this section.

Section 11.

The department and the department of social services shall promulgate rules and regulations necessary to implement the provisions of sections 3 to 15 of this act. 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 3 to 15 of this act 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 rule making 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 the 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 unconstitional, then the grant of rule making authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void.

Section 12.

The department of health shall make an annual report, no late than July first of each year, to the speaker of the house of representatives and the president pro tern of the senate on the operation of the family care safety registry and toll-free telephone service, including date on the number of information requests received from the public, identification of any barriers encountered in administering the provisions of section 3 to 15 of this act, recommendations for removing or minimizing the barriers so identified, and any recommendations for improving the delivery of information on child care workers and elder care workers to the public.

Section 13.

By January 1, 2001, the department shall provide a report to the speaker of the house and president pro tem of the senate with recommendations on:

(1) Ensuring that thorough background checks are conducted on all providers pursuant to sections 3 to 15 of this act without duplicating background checks that are required or have been conducted pursuant to other provisions in state law;

(2) Ensuring that data obtained from background checks which are currently available or may be required by law after the effective date of this section are included in the registry;

(3) The feasibility of transferring the responsibility of conducting background checks on providers to the registry;

(4) Providing information and access to the registry for personal care attendants for the disabled;

(5) Including a national screening process on a voluntary and mandatory basis within the registry; and

(6) Effecting Internet access to the registry.

Section 14.

For any elder care worker listed in the registry or who has submitted the registration form as required by sections 3 to 15 of this act, an elder care provider may access the registry in lieu of the requirements established pursuant to section 660.315, RSMo, or to subsection 3, 4 and 5 of section 660.317, RSMo.

Section 15.

For purposes of providing background information pursuant to section 3 to 15 of this act, reports and related information pursuant to sections 198.070 and 198.090, RSMo, 210.109 to 210.183, RSMo, and sections 660.300 to 660.315, RSMo, shall be deemed public records.

Section 16.

Any applicant for a grant or contract who offers early childhood development, education or care programs and who receives funds derived from an appropriation to the department of elementary and secondary education pursuant to paragraph (d) of subdivision (3) of section 313.835, RSMo, shall be licensed by the department of health pursuant to sections 210.201 to 210.259, RSMo, prior to opening of the facility. The provisions of this section shall not apply to any grant or contract awarded to a request for proposal issued prior to August 28, 1999.

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

PURPOSE: This rule defines the terms used in the licensing rules for group day care homes and child day care centers.

(1) Adult is any individual eighteen (18) years of age or older.

(2) Caregiver is the child care provider or other child care staff.

(3) Child care provider, group day care home provider or provider is the person(s) licensed or required to be licensed under section 210.211, RSMO in order to establish, conduct or maintain a child care facility. This person(s) shall have the following rights and responsibilities as determined by the division:

(A) Ultimate responsibility for making and implementing decisions regarding the operation of the facility; and

(B) Ultimate financial control of the operation of the facility.

(4) A child day care center or center, whether known or incorporated under another title or name, is a child care program conducted in a location other than the provider's permanent residence, or separate from the provider's living quarters, where care is provided for children not related to the child care provider for any part of the twenty-four (24)-hour day.

(5) Day care is care of a child away from his/her own home for any part of the twenty-four (24)-hour day for compensation or otherwise. Day care is a voluntary supplement to parental responsibility for the child's protection, development and supervision. Day care may be given in a family day care home, group day care home or day care center.

(6) A day care facility or facility is a day care home, day care center or group day care home.

(7) Director is the director of the Missouri Department of Health.

(8) Department is the Missouri Department of Health.

(9) A family day care home or home, whether known or incorporated under another title or name, is a child care program where care is given by a person licensed as a day care home provider for no more than ten (10) children not related to the provider for any part of the twenty-four (24)-hour day. The provider may be licensed to operate no more than one (1) family day care home or group day care home.

(10) Graded boarding school is a public or private school which provides education in at least the first through the sixth grade and which provides lodging and meals for the pupils for the standard school term.

(11) A group day care home, whether known or incorporated under another title or name, is a child care program where care is given by a person licensed as a group day care home provider for eleven (11), but not more than twenty (20), children not related to the child care provider for any part of the twenty-four (24)hour day. A group day care home shall be in a location other than the provider's permanent residence or separate from the provider's living quarters. The provider may be licensed to operate no more than one (1) group day care home or family day care home.

(12) Infant is any child under twelve (12) months of age.

(13) Night is the part of the twenty-four (24)-hour day between 9:00 p.m. and 6:00 a.m.

(14) Nursery school is a program operated by a person or organization with the primary function of providing an educational program for preschool-age children for no more than four (4) hours per child per day.

(15) Premises is a house(s), dwelling(s) or building(s) and its adjoining land.

(16) Preschool child is any child two through five (25) years of age who is not in kindergarten for five (5)year-old children.

(17) Related is any of the following relationships by marriage, blood or adoption between the provider and the children in care: parent, grandparent, great-grandparent, brother, sister, stepparent, stepbrother, stepsister, uncle, aunt, niece, nephew or first cousin.

(18) Review board is the Child Care Licensing Review Board.

(19) School-age child is any child five (5) years of age or older who is in kindergarten or elementary school.

(20) School system is a program established primarily for education and which meets the following criteria:

(A) Provides education in at least the first through the sixth grade; and

(B) Provides evidence that the school system's records will be accepted by a public or private school for the transfer of any student.

(21) Staff/child ratio is the number of caregivers required in relation to the number of children in care.

(22) Summer camp is a program operated from May to September by a person or organization with the primary function of providing a summer recreational program for children no younger than five (5) years of age, and providing no day care for children younger than five (5) years of age in the same building or in the same outdoor play area.

(23) Toddler is any child between twelve to twenty-four (12-24) months of age.

(24) A well-known religious order is defined as

(A) An entity that qualifies for federal tax exemption status as a not-for-profit religious organization under Section 501(c)(3) of the Internal Revenue Code of 1954; and

(B) An entity whose real estate on which the child care facility is located is exempt from taxation because it is used for religious purposes.

PURPOSE: This rule defines the basis on which a group day care home or a child day care center may qualify for exemption from licensure.

(1) A day care facility does not qualify for exemption from licensure unless it is under the exclusive control of an entity qualifying for exemption under section 210.211, RSMO.

(2) When a non-religious organization, having as its principal purpose the provision of child care services, enters into an arrangement with a well-known religious order to provide continuing assistance in the maintenance or operation of a child care facility, the facility is not under the exclusive control of the well known religious order and does not qualify for exemption from licensure under section 210.211(5), RSMO.

(3) If the person(s) operating the facility claims exemption from licensure, s/he shall file all information requested by the department to make a determination of exemption prior to opening. Facilities may waive the right to apply for exemption and request voluntary licensure. These facilities shall comply with all licensing rules.

PURPOSE: This rule defines the requirements for the organization and administration of group day care homes and child day care centers.

(1) Each day care facility shall be organized according to written policies and procedures which clearly establish job responsibilities and lines of administrative authority.

(2) If a group day care home is incorporated, the corporation shall designate one (1) of the officers of the corporation to be responsible for the daily operation of the facility and to meet the requirements of the group day care home provider. When the responsibility for the operation of a group day care home rests with a board of directors, the Child Care Licensing Unit shall be notified immediately if there is a change of the officer designated to be responsible for the daily operation of the facility and to meet the requirements of the group day care home provider. References and child abuse/neglect screening information shall be provided as required by 19 CSR 30-62.042 Initial Licensing Information.

(3) When the responsibility for operation of a facility rests with a board of directors, the Child Care Licensing Unit shall be notified immediately if there is a change of the board president or chairperson. Child abuse/neglect screening information shall be provided as required by 19 CSR 30-62.042 Initial Licensing Information.

(4) The person(s) operating a day care facility shall be responsible for meeting all debts and obligations incurred by the facility and for maintaining compliance with all licensing rules for group day care homes and day care centers.

PURPOSE: This rule describes the procedures for application for licensure, the licensing investigation and provisions for continued licensing investigations after the initial license is granted.

(1) Licensing Authority.

(A) According to section 210.221, RSMO, the department has the authority to issue uniform rules deemed necessary and proper to establish standards of service and care to be rendered by the provider. To implement the rules, the department shall be responsible for inspecting, evaluating and licensing all group day care homes and child day care centers.

(B) The department or any other agency of Missouri that the department asks to assist it is authorized to make an inspection and investigation of any proposed or operating child care facility, and of any personnel connected with that facility to the extent that this inspection and investigation is required to determine if the facility will be, or is being, operated in accordance with state statutes and licensing rules for group day care homes and day care centers.

(2) Persons Subject to Licensure.

(A) Any person(s) planning to offer day care for more than four (4) unrelated children at any one (1) time, except those coming under the exceptions of the law, shall apply for licensure and meet the requirements of the licensing rules before accepting more than four (4) unrelated children for care.

(B) Group day care homes shall meet all the requirements of these rules unless otherwise indicated in these rules.

(C) Licensing rules shall not apply to children related to the owner(s) of the facility as defined in 19 CSR 30-62.010(17). In order to document the exemption for related children, identifying information shall be on file at the facility on related children as required by 19 CSR 30-62.132 Admission Policies and Procedures.

(D) In an incorporated facility, the exemption for related children does not apply since a corporation cannot have relatives.

(3) Licensing Process.

(A) Upon receipt of an inquiry regarding day care licensing, an interview shall be held to discuss the licensing rules and the licensing process.

(B) Upon receipt of a completed application for license on the form provided by the department, a licensing investigation shall be made. If licensing rules are not met within six (6) months, the application shall be void and another application shall be filed.

(C) The licensing investigation shall include an inspection of the entire premises of the facility by the licensing representative.

(D) Prior to the granting of a license, the following shall be submitted by the applicant:

1. A sketch or diagram of the facility showing the arrangement of the rooms, including the location of toilet and handwashing facilities, the kitchen, the office and the doors. The licensing representative and the applicant shall measure the facility jointly;

2. A sketch or diagram of the outdoor play area and placement of equipment. The licensing representative and the applicant shall measure the area jointly;

3. Written policies pertaining to the program goals, admission, care and discharge of children;

4. A schedule of daily activities for each age group in care (infant/toddler, preschool and school-age);

5. A sample weekly menu;

6. An itemized list of available materials and equipment to be used by children;

7. A written narrative description of child care practices and concepts, including discipline and guidance policies;

8. A staff sheet;

9. If a facility is not incorporated, the names and addresses of two (2) references not related to the applicant who have knowledge of the applicant's character, experience and ability;

10. If a group day care home is incorporated, the names and addresses of two (2) references for the officer designated to be responsible for the daily operation of the facility and to meet the requirements of the group day care home provider. The references shall not be related to the officer designated by the corporation;

11. Sample forms used, other than those supplied by the department;

12. Evidence of compliance with local or state, or both, sanitation requirements;

13. Evidence of compliance, if applicable, with local building and zoning requirements;

14. If the facility is incorporated, Articles of Incorporation, Certificate of Incorporation and the Annual Registration Report as issued by the Missouri secretary of state;

15. Written policies and procedures which clearly establish job responsibilities and lines of administrative authority. This shall include a statement of the kind and extent of authority and the duties delegated to the director employed to carry out the program;

16. Official verification of the center director or group day care home provider's education and experience; and

17. Other information required by the department to make a determination regarding licensure of the facility.

(E) Prior to the granting of a license, the provider shall meet the requirements of 19 CSR 30-62.087 Fire Safety.

(F) Medical examination reports for all adults working in the facility, as required by 19 CSR 3062.122 Medical Examination Reports, shall be on file at the facility and available for review.

(G) Medical examination reports shall be on file at the facility within thirty (30) days following the admission of each infant, toddler or preschool child as required by 19 CSR 30-62.122 Medical Examination Reports. A health report for school-age children shall be on file as required by 19 CSR 30-62.122.

(H) Enrollment information for each child shall be on file at the facility as required by 19 CSR 30-62.132 Admission Policies and Procedures.

(I) Identifying information shall be on file at the facility for each child to be cared for who is related to the facility owner(s) as required by 19 CSR 30-62.132 Admission Policies and Procedures.

(J) The facility owner(s), board president or chairperson and the center director or group day care home provider shall be screened for child abuse/neglect prior to initial issuance of the license.

(K) The child abuse/neglect screening request form shall be submitted to the department for all personnel employed during child care hours, with a copy on file at the facility

(L) Prior to initial issuance of the license, the child care provider shall request and have on file the results of a criminal record review from the Missouri State Highway Patrol for the child care provider, the owner(s), board president or chairperson, the center director or group day care home provider, all persons employed by the child care provider, and all volunteers counted in staff/child ratios. The child care provider shall request a criminal record review within ten (10) days following a change of the facility owner(s), board president or chairperson, the center director or group day care home provider, employees of the provider, or volunteers counted in staff/child ratios. The department may request a criminal record review from the Missouri State Highway Patrol for any adult present in the facility when child care children are present. The criminal record reviews shall include records of criminal convictions, pending criminal charges, and suspended imposition of sentence during the term of probation. Requests for criminal record reviews shall be made on a form provided by the highway patrol.

1. When the department determines that a nationwide check is warranted, the department may request a criminal record review from the Missouri State Highway Patrol for classification and search of fingerprints for any person seeking employment with the provider or for any person seeking issuance or renewal of a license as provided in sections 43.530 and 43.543, RSMO. Requests for criminal record reviews shall be made on a form provided by the highway patrol that shall be signed by the subject of the request. The provider shall submit the signed form to the department with two (2) sets of fingerprints for each person who is the subject of a criminal record review.

2. Information received by the provider shall be retained in the individual's file in a confidential manner.

(M) The facility shall not provide care for more than four (4) unrelated children until it is in compliance with state statutes and licensing rules for group day care homes and day care centers.

(N) After approval by a licensing representative and a licensing supervisor, a temporary license may be granted by the department for a period not to exceed sixty (60) days.

(0) The official license shall be granted for up to two (2) years and may be renewed upon reapplication and reinvestigation. Until the official license is received, the temporary license shall be posted near the entrance of the facility where it may be seen easily by parents or others who visit. Thereafter, the official license shall be posted near the entrance of the facility.

(P) The address and telephone number of the Child Care Licensing Unit shall be posted near the license.

(Q) The granting of a license shall be denied by the director upon failure of the applicant to comply with state statutes and licensing rules for group day care homes and day care centers.

(R) The name(s), address(es) and telephone number(s) of the facility owner(s), or the board president or chairperson, or his/her designee shall be posted prominently near the license.

(S) The license shall not be transferable and shall apply only to the person(s) and address shown on the license.

(T) If there is a change of ownership of the facility, the new owner(s) shall meet the requirements of the current licensing rules. A licensing investigation shall be made as required by 19 CSR 30-62.042 Initial Licensing Information.

(U) The license shall be the property of the department and shall be subject to revocation by the director upon failure of the provider to comply with state statutes and licensing rules for group day care homes and day care centers. The license shall be returned to the department if revoked or not renewed.

(V) If a facility's license is revoked or denied due to failure to comply with state statutes and licensing rules, the department shall not accept a subsequent application from the provider for that facility within twelve (12) months after the effective date of revocation or denial, or within twelve (12) months after all appeal rights have been exhausted, whichever is later. Any subsequent application shall be reviewed by the Day Care Licensing Review Board prior to a decision being made to grant a license.

(W) The number and ages of children the facility is authorized to have in care at any one (1) time shall be specified on the license and shall not be exceeded except as permitted within these rules.

(X) All day care provided on the premises of a licensed facility shall be in compliance with the licensing rules and the conditions specified on the license.

(Y) Upon issuance of the license, a licensing representative shall visit the facility throughout the licensing period for supervision and consultation. Both announced and unannounced visits shall be made. Visits shall be at varying times during the hours child care is provided, with the entire premises subject to inspection.

(Z) Upon the department's receipt of a complaint regarding the facility, a complaint investigation shall be made as determined necessary by the department.

(AA) The provider shall permit the department access to the facility, premises and records during all visits.

(BB) A child care provider shall not deny a child admission to, or the benefits of, any program provided by the facility on the basis of race, sex, religion or national origin.

(CC) Licensing records are public records and may be reviewed by appointment with the Child Care Licensing Unit as authorized by sections 610.010610.150, RSMO.

PURPOSE: This rule defines the procedures for license renewal.

(1) An application for license renewal shall be filed at least sixty (60) days prior to expiration of the license. In addition, the following information is required:

(A) Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee;

(B) Evidence of compliance with local or state, or both, sanitation requirements;

(D) If incorporated, a copy of the current Annual Registration Report filed with the Missouri secretary of state;

(E) Medical examination reports on file at the facility as required by 19 CSR 30-62.122 Medical Examination Reports;

(F) A health report on file at the facility for each school-age child in care as required by 19 CSR 3062.122 Medical Examination Reports;

(G) Enrollment information on file at the facility for each child in care as required by 19 CSR 30-62.132 Admission Policies and Procedures;

(H) Identifying information on file at the facility regarding children who are related to the center owner(s) or group day care home provider as required by 19 CSR 30-62.132 Admission Policies and Procedures;

(I) A current list of available equipment;

(J) Current staff sheet; and

(K) Materials and information which have changed since the previous licensing period.

(2) The facility owner(s), board president or chairperson, and the center director or group day care home provider shall be screened for child abuse/neglect prior to renewal of the license.

(3) After the child care provider applies for renewal of the license, the provider shall request the results of a criminal record review from the Missouri State Highway Patrol for the child care provider, the owner(s), board president or chairperson, the center director or group day care home provider, all persons employed by the child care provider, and all volunteers counted in staff/child ratios. The child care provider shall request a criminal record review within ten (10) days following a change of the facility owner(s), board president or chairperson, the center director or group day care home provider, employees of the provider, or volunteers counted in staff/child ratios. The department may request a criminal record review from the Missouri State Highway Patrol for any adult present in the facility when child care children are present. The criminal record reviews shall include records of criminal convictions, pending criminal charges, and suspended imposition of sentence during the term of probation. Requests for criminal record reviews shall be made on a form provided by the highway patrol.

(A) When the department determines that a nationwide check is warranted, the department may request a criminal record review from the Missouri State Highway Patrol for classification and search of fingerprints for any person seeking employment with the provider or for any person seeking issuance or renewal of a license as provided in sections 43.530 and 43.543, RSMO. Requests for criminal record reviews shall be made on a form provided by the highway patrol that shall be signed by the subject of the request. The provider shall submit the signed form to the department with two (2) sets of fingerprints for each person who is the subject of a criminal record review.

(B) Information received by the provider shall be retained in the individual's file in a confidential manner.

(4) Upon determination of the applicant's continued compliance with state statutes and licensing rules for group day care homes and day care centers, an official license shall be granted for up to two (2) years.

PURPOSE: This rule sets forth the requirements for the physical plant and indoor and outdoor space.

(1) General Requirements.

(A) The premises shall be safe and suitable for the care of children.

(B) The premises shall conform to the fire and safety requirements of the State Fire Marshal or his/her designee and requirements for state or local zoning, building and sanitation.

(D) Stairways in approved child care space shall be well-lighted and free of obstructions. Stairways in approved child care space having more than three (3) steps shall have a handrail the children can reach.

(E) Porches, decks, stairwells or other areas in approved child care space having a drop-off of more than twenty-four inches (24") from which children might fall and be injured shall have an approved railing or approved barrier. The railing or barrier shall be constructed to prevent the child from crawling or falling through or becoming entrapped.

(F) Approved safety gates at stair-ways and doors shall be provided and used as needed.

(G) Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

(H) Heaters, floor furnaces, radiators, hot water heaters or other equipment which pose a threat to children shall meet the requirements of 19 CSR 3062.087 Fire Safety.

(I) All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.

(J) Ammunition, guns, hunting knives, bows and arrows or other weapons shall be stored in a locked cabinet or locked closet.

(K) Smoking shall be prohibited in child care areas and in food preparation and food service areas.

(2) Indoor Space.

(A) General Requirements.

1. Any floor of a building used for child care shall be approved by the State Fire Marshal or his/her designee.

2. Open windows and doors shall be screened securely. Barriers to prevent children from falling against windows or falling from windows shall be provided when windows are less than twenty-four inches (24") from the floor and not constructed of safety glass or other non breakable material.

3. Clear glass doors shall be marked plainly at varying heights to avoid impact.

4. Artificial or natural lighting shall supply at least ten (10) foot candles of light throughout each room used for child care.

5. The facility shall be dry, temperature controlled, well-ventilated and free of drafts. Children shall not be overheated or chilled. The temperature of the rooms shall be no less than sixty-eight degrees Fahrenheit (68'F) and no more than eighty-five degrees Fahrenheit (85'F) when measured two feet (2') from the floor.

6. Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.

7. Concrete floors in areas counted as child care space shall be covered with carpet, tile, linoleum or other floor covering.

8. Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

9. The facility shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.

10. A telephone in working order shall be available for incoming and outgoing calls. If a telephone answering machine is used, it must be turned on so incoming messages can be heard and parents' calls can be returned promptly.

11. Telephone numbers for the police, fire department, ambulance and other emergency telephone numbers shall be posted near the telephone.

(B) Floor Space Calculations and Utilization.

1. General requirements.

A. At least thirty-five (35) square feet of usable floor space shall be provided for each preschool and school-age child coming into the facility for day care.

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

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

D. Space occupied by permanently placed cots, cribs, beds or playpens used for napping cannot be counted as usable floor space. Cots shall not be set up early or left in place to interfere with children's play activities.

E. Storage space for play materials shall be provided. Some of the space shall be on low shelves and accessible to the children.

F. Each child shall be provided individual space, accessible to the child, for storage of each childs' clothing and other personal belongings.

G. Space shall be provided for office equipment, the making and keeping of records and for transaction of business. This space shall not interfere with the children's play areas.

H. An area for staff breaks shall be provided in the facility separate from child care space.

I. In a facility located in a provider's permanent residence, the area used for child care, including play space and bathrooms, shall be separate from the family living quarters.

J. The family kitchen of a facility licensed for no more than twenty (20) children, located in a provider's permanent residence, may be used for food preparation with approval of the sanitarian.

K. If school-age children are in care, there shall be space apart from the preschool program equipped for their use.

2. Infant and toddler space.

A. For group day care homes licensed for a maximum of four (4) infants/toddlers or for day care centers licensed for a maximum of twenty (20) children, including no more than four (4) infant/toddlers, the following shall apply:

(I) At least thirty-five (35) square feet of usable floor space shall be provided for each infant and toddler. Space occupied by cribs and playpens used for napping shall be deducted from usable floor space; and

(II) A crawl area protected by stable dividers shall be provided. The area shall have a resilient and washable floor covering which shall be mopped and sanitized daily. Washable area rugs that are laundered daily may be used.

B. For all other group day care homes licensed for more than four (4) infant/toddlers and for all day care centers licensed for more than twenty (20) children or more than four (4) infant/toddlers, the following shall apply:

(I) For facilities initially licensed for infant/toddler care after the effective date of these rules or facilities adding new infant/toddler space, at least forty-five (45) square feet of usable floor space shall be provided in the facility for each infant and toddler. Space occupied by napping equipment does not have to be deducted from usable floor space;

(II) Two (2)-year-old children may be cared for in an infant/toddler unit. At least thirty-five (35) square feet of usable floor space shall be provided for each child in groups composed solely of two (2)-year olds;

(III) If a unit for infants and toddlers is auxiliary to a facility for older children, centers initially licensed for infant/toddler care after the effective date of these rules or facilities adding new infant/toddler space, shall have play, sleeping and bathroom space in the infant and toddler unit. This space shall be separated from the space used for older children by floor-to-ceiling walls;

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

(V) In facilities initially licensed for infant/toddler care after the effective date of these rules or facilities adding new infant/toddler space, no more than twenty-four (24) infants/toddlers and/or two (2)-year olds shall be in a room. A room shall be defined as an area separated from other parts of the building by floor-to-ceiling walls. Stable partitions a minimum of four feet K) in height shall be used to separate the infant/toddler or two (2)-year old groups, or both, in a room;

(VI) Floors shall be tile, linoleum or wood and shall be mopped and sanitized daily. Washable area rugs that are laundered daily may be used. Centers initially licensed after the effective date of these rules or facilities adding new infant/toddler space shall not use carpet;

(VII) Facilities initially licensed after the effective date of these rules or facilities adding new infant/toddler space shall provide refrigeration for bottles and a method for heating bottles in the infant/toddler unit; and

(VIII) Infant/toddler areas may not be used by staff or older children as passageways to other areas of the building.

(3) Bathrooms.

(A) General Requirements.

1. One (1) flush toilet and one (1) adjacent handwashing facility with running water shall be available for every twenty (20) children.

2. 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.

3. Toilet and handwashing facilities shall be in working order and convenient for the children's use.

4. Paper towels, soap and toilet paper shall be provided and easily accessible so the children can reach them without assistance.

5. Locks or latches shall not be used on bathroom or bathroom stall doors used by children below the first grade.

6. Children shall be monitored while in the bathroom.

7. Bathrooms shall be clean and odor free.

8. If a center is licensed for more than fifty (50) children, a separate bathroom or bathroom stall shall be available for staff.

(B) School Age.

1. When a center offers care for school-age children in first grade or above, bathroom facilities shall be provided as follows:

A. Separate girls' and boys' bathrooms shall be provided; or

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

1. 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.

2. One (1) potty chair, junior commode or toilet with an adapter seat shall be provided for every four

(4) children being toilet trained. Potty chairs shall be located in the bathroom and shall be emptied, cleaned and disinfected after each use.

(4) Diapering Area.

(A) A safe diapering table with a waterproof washable surface shall be used for changing diapers. The diapering table shall be located within or adjacent to the group space so the caregiver using the diapering table can maintain supervision of his/her group of children at all times.

(B) Facilities initially licensed for infant/toddler care after the effective date of these rules or facilities adding new infant/toddler space shall have one (1) diapering table for every group of eight (8) infant/toddlers and one (1) diapering table for every group of sixteen (16) two (2)-year olds.

(C) Facilities initially licensed after the effective date of these rules and accepting two (2)-year olds for care in the preschool unit shall have a diapering table available in the preschool unit.

(D) Diapering supplies and warm, running water shall be adjacent to the diapering area.

(5) Kitchens.

(A) A kitchen shall be required for meal preparation unless meals are catered from a source approved by the local or state sanitarian, or both.

(B) Kitchens used for meal preparation shall have sufficient equipment to accommodate the licensed capacity of the facility. The 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, hot and cold running water, a refrigerator and storage space for food, dishes and cooking utensils shall be provided.

(D) Kitchens shall be maintained in compliance with state or local rules, or both, governing food service sanitation.

(E) Kitchens shall not be used for children's play activities unless the activities are part of the learning program and the children are supervised by adults.

(F) Kitchens shall not be used for napping or as passageways for children.

(6) Outdoor Space.

(A) General Requirements.

1. A fenced outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. For facilities initially licensed after the effective date of these rules or for the installation of new fences in existing facilities, the fence shall be at least forty-two inches (42") high. An outdoor play area used exclusively for school-age children shall not be required to have a fence. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped.

2. A minimum of seventy-five (75) square feet of outdoor play area per child at the time of use shall be provided. A sufficient area shall be available to accommodate one-third (1/3) the licensed capacity of the facility at one (1) time, with no less than seven hundred fifty (750) square feet.

3. Adult supervision shall be provided at all times when children are outside. For children three (3) years of age and above, staff/child ratios may be one and one half (1 1/2) times the indoor staff/child ratios. The required indoor staff/child ratios shall be maintained on the premises at all times.

4. The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.

5. The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact-absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.

6. The provider shall be responsible for the type, depth and fall-zone area of resilient material necessary for the protection of children.

7. Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.

8. Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

(B) Infants and Toddlers.

1. Outdoor play space for infants and toddlers shall be separate from that used for older children or the same space shall be used at different times. (This rule does not apply to group day care homes with a maximum of four (4) infant/toddlers or to day care centers licensed for a maximum of twenty (20) children, including no more than four (4) infant/toddlers.)

2. Staff/child ratios for infant/toddlers and two (2)year olds shall be maintained at all times.

(7) Swimming and Wading Pools.

(A) Swimming and wading pools used by children shall be constructed, maintained and used in a manner which safeguards the lives and health of children.

(B) Swimming and wading pools shall have a water filtration system. The water in swimming and wading pools shall be treated, cleaned and maintained in accordance with health practices and rules as determined by the local or state health authority, or both.

(C) Swimming and wading pools shall be fenced to prevent access by children. For facilities initially licensed after the effective date of these rules, the fence shall be at least forty-two inches (42") high and shall have a locked gate. Above-the-ground pools may use a forty-two inch (42") fence around the top of the pool with barricades of the steps to the pool deck.

(D) Children using swimming or wading pools shall be instructed in water safety and supervised by an adult at all times.

(E) An adult with a current lifeguard training certificate, including infant/child cardiopulmonary resuscitation (CPR) training, shall be on duty at all times when a swimming or wading pool containing a depth of forty-eight inches (48") or more of water is being used.

(F) An adult who has completed a course in basic water safety, which includes infant/child CPR, shall be on duty when a swimming or wading pool containing less than forty-eight inches (48") of water is being used.

(8) Animals.

(A) Animals which may pose a threat to the health or safety of children shall not be permitted on the premises or shall be penned securely in an area which is inaccessible to the children.

(B) If an animal bites a child, the parent(s) shall be notified immediately. The provider shall contact a veterinarian to determine a course of action in the diagnosis of possible rabies in the animal. If possible, the provider shall restrain the animal for observation by a veterinarian.

(D) No animals shall be permitted in food preparation areas.

(E) Areas used by children shall be free of animal excrement.

(F) Litter boxes shall not be located in areas used by children or in food preparation areas.

(G) Food and water dishes used by animals shall not be accessible to the children.

PURPOSE: This rule establishes the fire safety requirements for group day care homes and child day care centers.

(1) The following definitions shall be used in interpreting this rule:

(A) Alterations are changes made to the structure or floor plan of the facility by removing or adding walls and doors or adding space;

(B) Dead-end is a corridor or hallway with no exit at the end that causes occupants to retrace their path to reach an exit;

(C) Exit is the portion of a means of egress that is separated from all other areas of the building or structure by construction or equipment required to provide a protected way of travel to the exit discharge. Exits include exterior exit doors, exit passageways, horizontal exits, separated exit stairs, and separated exit ramps;

(D) Exit access is the portion of a means of egress that leads to an exit;

(E) Exit discharge is the portion of a means of egress between the termination of an exit and a public way;

(F) Fire barrier is a structural element, either vertical or horizontal, such as a wall or floor assembly that is designed and constructed with a specified fire resistance rating to limit the spread of fire and restrict the movement of smoke. Such barriers may have protected openings;

(G) Fire resistance rating is the length of time in minutes or hours that materials or structural elements can withstand fire exposure;

(H) Flame resistant material is the property of material or their structural elements that prevents or retards the passage of excessive heat, hot gases, or flames under the conditions in which they are used;

(I) Flame retardant is a chemical applied to material or other substance that is designed to retard ignition or the spread of fire;

(J) Interior finish includes the interior wall and ceiling finish, and interior floor finish;

(K) Level exit discharge is a horizontal plane that is located from the point at which an exit terminates and the exit discharge begins. The horizontal plane shall not vary more than two inches (2") in rise or fall;

(L) Level is the portion of a building included between the upper surface of a floor and the ceiling above it, or any upper surface of a floor and the ceiling above it that is separated by more than five (5) steps on a stairway;

(M) Means of egress is a continuous and unobstructed way of travel from any point in a building or structure to a public way. A means of egress consists of three (3) distinct parts: the exit access, the exit, and the exit discharge;

(N) Mixed occupancy is when a facility is located in the same building or structure as another occupancy. This may include a business or place of assembly;

(0) Public way is an area such as a street or sidewalk that is open to the outside and is used by the public for moving from one (1) location to another;

(P) Remote exit or means of egress is when two (2) exits or two (2) exit access doors are required. Each exit or exit access door shall be placed at a distance apart equal to at least one-half (1/2) the length of the maximum overall diagonal dimension of the building or area to be used;

(Q) Self-closing means to be equipped with an approved device that will ensure closing after having been opened;

(R) Smoke barrier is a structural element, either vertical or horizontal, such as a wall, floor, or ceiling assembly that is designed and constructed to restrict the movement of smoke. A smoke barrier may or may not have a fire resistance rating; and

(S) Supervised automatic sprinkler system is a system with the initiating devices monitored by the fire alarm control panel. This may include switches used to monitor the position of valves, a low air pressure switch, a water flow switch, and a tamper switch.

(2) General Requirements.

(A) The Missouri Division of Fire Safety shall inspect the facility annually for the capacity specified on the license application and the fire inspection request. The inspection shall include a determination of whether or not the facility is approved for overlap care as provided in 19 CSR 30-62.162 Overlap Care of Children.

(B) Hangings or draperies shall not be placed over exit doors or located to conceal or obscure any exit. All hangings and draperies shall be treated with a flame retardant material with verification of the treatment on file at the facility and available for review by the fire inspector.

(D) Art work and teaching materials attached directly to the walls shall not exceed thirty percent (30%) of the wall area. No art work or teaching materials shall be hung from the ceilings or in the doorways.

(E) The evacuation/emergency plan for fires and tornadoes shall be posted conspicuously and shall include the route for the drills and special instructions for infants and non-ambulatory children.

(F) Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

1. Unscheduled drills may be held at the fir inspector's discretion.

2. A full evacuation of the facility may be postponed during severe weather.

3. An evacuation/emergency plan that is approved by the fire inspector shall be posted in each area of the facility used for child care. The plan shall include special instructions for infants and non-ambulatory children.

4. The fire alarm system in the building shall be activated during all fire drills.

5. Fire drills shall be conducted as follows:

A. Drills shall simulate an actual fire condition;

B. The children shall not obtain clothing or other items after the alarm has sounded;

C. The children shall proceed to a predetermined location outside the building that is sufficiently remote to avoid fire danger, interference with fire department operations, or confusion among different groups of children; and

D. Groups shall remain in place until a recall to the building is issued or the children are dismissed.

(G) Children shall have no access to areas of the building that do not meet fire safety requirements.

(H) All flammable or combustible liquids, matches, lighters, or other hazardous items shall be stored so they are inaccessible to the children.

(I) The house numbers shall be plainly visible from the street in case of emergency.

(J) Housekeeping practices that ensure fire safety shall be maintained daily.

(K) Stairways, walks, ramps, and porches shall be kept free of ice and snow.

(L) The provider shall immediately report any fire in the facility to the Office of the State Fire Marshal and the Department of Health, Bureau of Child Care.

(M) No fresh-cut Christmas trees shall be used unless they are treated with a flame resistant material. Documentation of the treatment shall be on file at the facility and available for review by the fire inspector.

(N) The Division of Fire Safety may make additional requirements that provide adequate life safety protection if it is determined that the safety of the occupants is endangered. Every building or structure shall be constructed, arranged, equipped, maintained, and operated to avoid danger to the lives and safety of its occupants from fire, smoke, fumes, or resulting panic during the period of time necessary for escape from the building.

(0) Before construction begins or occupancy occurs, a full set of construction plans shall be submitted to the Division of Fire Safety for review and approval for new construction and for alterations to existing buildings.

(P) During the construction or remodeling process, the provider shall request a framing and wiring inspection and an inspection for the rough-in wiring for the fire alarm system by the Division of Fire Safety before the walls are enclosed. Failure to have these inspections conducted will result in an unapproved fire inspection from the Division of Fire Safety.

(Q) Mobile homes manufactured after November 27, 1973, shall comply with the Missouri Public Service Commission, regulations for mobile home tie-down systems. Manufactured homes shall comply with section 700.070, RSMO 1994, regarding tie-down systems.

(R) All facilities shall comply with all local building codes, fire codes, and ordinances.

(S) The latest edition of the National Fire Protection Association (NFPA), Chapter 101, Life Safety Code, shall prevail in the interpretation of this rule.

(T) When the licensed capacity increases, hours of care change, alterations are completed, or other changes occur that affect fire safety, the provider shall meet all the requirements of this rule unless otherwise excepted by the Division of Fire Safety.

(U) Facilities that were licensed and areas approved for child care prior to the effective date of this rule shall have ceilings at least seven feet (T) in height. Facilities initially licensed and areas initially approved for child care on or after the effective date of this rule shall meet all the requirements of this rule and shall have ceilings at least seven feet, six inches (7'6") in height. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet all the requirements of this rule and shall have ceilings at least seven feet, six inches (7'6") in height in the altered space. The fire inspector may make an allowance for the installation of ductwork and plumbing.

(V) Facilities served by a volunteer or membership fire department shall be a member in good standing with the fire department. A copy of the membership or receipt for membership shall be on file at the facility and available for review.

(W) Clothes dryers shall be vented and maintained properly.

(3) Mixed Occupancies.

(A) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall meet the following requirements. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space

1. When a facility is located in a building containing mixed occupancies, the other occupancies shall be separated from the facility by at least a one (l)hour fire barrier; and

2. In facilities in apartment buildings, when both exit accesses exit into the same corridor, the corridor shall be protected throughout by a fire barrier with at least a one (l)-hour fire resistance rated construction. All doors that open into the corridor shall have a one (l)-hour fire resistance rating and shall be self-closing.

(B) No facility shall be located next to a high hazard area or occupancy. A high hazard area or occupancy is an area, building, structure, or portions thereof, that contains heat-producing appliances, or that manufactures, processes, generates or stores materials that constitute a high fire, explosion, or health hazard. This includes any area, structure, or building posing a degree of hazard greater than normal to the general occupancy of the area, structure, or building.

(4) Exiting and Means of Egress.

(A) Each level occupied by children shall have at least two (2) remotely located means of egress. Each door opening in a means of egress shall be at least twenty-eight inches (28") wide. In new construction, each door opening shall be a minimum of thirty-two inches (32") wide.

(B) No room or space that is accessible only by a ladder, folding stairs, overhead door, or through a trap door shall be occupied at any time.

(C) Exit doors shall swing in the direction of egress travel and shall be marked with a lighted exit sign with a battery backup of ninety (90) minutes.

1. Exit doors required to be kept closed shall be self-closing.

2. Any door in a required means of egress from a facility having an occupant load of one hundred (100) or more persons, or any facility caring for children during nighttime hours, shall be equipped with panic hardware or fire exit hardware. No other latching devices shall be used.

3. No door in a means of egress shall be locked against egress travel when the building is occupied. Locking devices that impede or prohibit egress or that cannot be disengaged easily shall not be used. Dead bolt locks that require a key to unlock the door from the inside shall not be used. Locking or latching devices installed on doors shall not be located higher than fifty inches (50") above the finished floor.

4. Closet door latches shall be designed so children can open the doors from the inside. Bathroom door locks shall be designed to permit opening of the door from the outside in an emergency. The opening device or key shall be readily accessible to the staff.

(D) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall have emergency lighting with a ninety (90)-minute battery backup installed to light the path of egress. The fire inspector shall determine the location and number of emergency lights. if alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet this requirement in the altered space.

(E) Stairways, landings, and ramps shall be free of all objects.

(F) Children shall not exit through a kitchen, bathroom, storage room, furnace room, garage, or any other rooms or areas deemed hazardous by the fire inspector.

(G) Dead-ends as defined by 19 CSR 30-62.087(l)(B) Fire Safety shall not exceed twenty feet (20').

(5) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall meet the following requirements. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space

(A) Stairs in facilities with fifty (50) or more occupants shall be at least forty-four inches (44") wide. Stairs in facilities with less than fifty (50) occupants shall be at least thirty-six inches (36") wide.

1. The maximum height of risers shall be seven inches (7") with a minimum height of four inches (4").

2. The minimum tread depth shall be ten inches (1011).

3. The minimum height from any tread to the finished ceiling shall be six feet, eight inches (6' 8").

4. The maximum height between landings shall be no more than twelve feet (12').

5. Landings shall be as wide as the clear width of the stairs.

(B) Handrails shall not project into the stairway more than three and one-half inches (3 1/2") on each side.

1. Handrails shall be mounted at least thirty-four inches (34"), and no more than thirty-eight inches (38"), above the surface of the treads. They shall have a clearance of at least one and one-half inches (1 1/2") from the wall. Handrails shall be at least one and one half inches (1 1/2"), but no greater than two inches (2") in diameter.

2. Stairs with no walls on either side shall have balusters placed on the sides. There shall be no more than four inches (4") between each baluster. They shall be attached to the stairs in a sturdy manner.

(C) Ramps used in an exit discharge shall be at least forty-four inches (44") wide if the facility has fifty (50) or more occupants. They shall be at least thirty-six inches (36") wide if the facility has less than fifty (50) occupants.

1. Ramps greater than six inches (6") in height shall have a maximum slope of one inch (1") drop for twelve inches (12") of run. Ramps less than six inches (6") in height shall have a maximum slope of one inch (1") drop for ten inches (10") of run.

2. Ramps greater than Six inches (6") in height shall have handrails and balusters placed on each side.

3. Ramps shall have a slip-resistant surface.

(D) The elevation of interior floor surfaces through doorways shall not present a tripping hazard.

(6) Facilities caring for children under the age of twenty-four (24) months shall have two (2) means of egress out of each room that is dedicated for their use. One (1) means of egress shall lead directly outside at level exit discharge. Both exit doors shall be a minimum of thirty-six inches (36") wide or wider to accommodate the largest crib in the room. Doors shall swing in the direction of egress travel. The direct exit outside is not required if the entire facility is protected throughout by an approved supervised automatic sprinkler system.

(A) Children shall not pass through more than one (1) adjoining room to gain access to an exit door that leads directly outside.

(7) Level of Exit Discharge.

(A) Areas used for day care shall not be located more than one (1) level below ground level.

(B) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall meet the following requirements. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space:

1. Where children are occupying a level below or above the level of exit discharge (basement or second floor), at least one (1) means of egress shall be an exit discharging directly to the outside. The vertical travel to ground level shall not exceed eight feet (8') for the basement and twelve feet (12') for the second floor; and

2. Where children are occupying a level below or above the level of exit discharge (basement or second floor), arrangement of means of egress shall be remote from each other.

(8) Travel Distance to Exits.

(A) The travel distance between any room door intended as an exit access or an exit shall not exceed one hundred feet (100'). This travel distance may be increased by fifty feet (50') in buildings protected throughout by a supervised automatic sprinkler system that is approved by the fire inspector based on the National Fire Protection Association's Standards for Sprinkler Systems.

(B) The travel distance between any point in a room and an exit shall not exceed one hundred fifty feet (150'). This travel distance may be increased by fifty feet (50') in buildings protected throughout by a supervised automatic sprinkler system that is approved by the fire inspector based on the National Fire Protection Association's Standards for Sprinkler Systems.

(C) The travel distance between any point in a sleeping room and an exit access to that room shall not exceed fifty feet (50').

(9) Windows for Rescue and Ventilation.

1. Every room or space greater than three hundred (300) square feet used by children shall have at least one (1) outside window for emergency rescue and ventilation. The window shall be operable from the inside without the use of tools and shall provide a clear opening of at least twenty inches (20") wide, twenty four inches (24") in height. The total clear opening space shall be no less than 5.7 square feet in size. The bottom of the opening shall be no more than forty-four inches (44") above the floor and any latching device shall be operated easily. The clear opening shall be a rectangular solid, with a minimum width and height that provides the required 5.7 square feet opening and a minimum depth of twenty inches (20") to allow passage through the opening. The windows shall be accessible by the fire department and shall open into an area having access to a public way. This does not apply in the following situations:

A. In buildings protected throughout by an approved, supervised automatic sprinkler system; and

B. When the room or space has a door leading directly to the outside of the building;

2. In rooms located higher than three (3) stories above the level of exit discharge, the operable clear height, width, and area of the window shall be permitted to be modified to the dimensions necessary for ventilation as determined by the fire inspector; and

3. No windows shall have bars or any other items placed over them in a stationary manner that would impede a rescue or evacuation attempt.

(10) Protection.

(A) The door between the main level and any level below or above it shall be equipped with a one (1)-hour fire rated self-closing door.

(B) Vertical openings shall be enclosed and protected with a one (1) hour fire barrier.

(C) The following rooms and areas used for the storage, processing, or use of materials shall be separated from the remainder of the building by fire barriers having a fire resistance rating of at least one (1) hour of protection:

1. Boiler, furnace rooms, and rooms containing water heaters. This does not apply to rooms enclosing only air-handling equipment;

2. Rooms or areas used for the storage of combustible supplies in quantities deemed hazardous by the fire inspector;

3. Rooms or areas used for the storage of hazardous materials, or flammable or combustible liquids in quantities deemed hazardous by the fire inspector;

4. Laundries and laundry rooms, maintenance shops, including woodworking and painting areas; and

5. The doors to janitorial closets shall be equipped with a self-closing device and a fire alarm initiating device in the room.

(D) The rooms or areas listed in 19 CSR 3062.087(10)(C)1.-5. Fire Safety shall be inaccessible to children by use of a locked doorknob or latch.

(E) The one (1) hour fire resistance rating required for rooms or areas listed in 19 CSR 30-62.087(10)(C)1.5. Fire Safety is not required if the facility installs a sprinkler head off the domestic water supply or has an approved automatic sprinkler system. A fire alarm initiating device shall be installed in the rooms or areas listed in 19 CSR 30-62.087(10)(C)1.-5. Fire Safety as instructed by the fire inspector.

(11) Interior Finish.

(A) Interior wall and ceiling finishes throughout shall meet the requirements of the latest edition of the National Fire Protection Association, Chapter 101, Life Safety Code. Textile materials having a napped, tufted, looped, woven, nonwoven, or similar surface shall not be applied to walls or ceilings. Foam plastic materials or other highly flammable or toxic material shall not be used as an interior wall, ceiling, or floor finish.

(B) Interior floor finishes within corridors and exits shall be Class I or II in accordance with Chapter 6 of the latest edition of the Life Safety Code.

(C) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall have wall studs, ceiling joists, and floor joists that are covered with a minimum of Class C finish with no exposed studs or joists. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space.

(12) Detection, Alarms, and Extinguishment.

(A) Facilities using equipment or appliances that pose a potential carbon monoxide risk, including facilities with attached garages, shall install a carbon monoxide detector(s). The detector(s) shall be installed according to the manufacturer's instructions. The fire inspector may require additional carbon monoxide detectors if the fire inspector determines that the safety of the occupants is endangered.

1. Carbon monoxide detectors shall be in good operating condition. If a battery operated detector is not operational, the provider shall install a detector that is powered by the home's electrical system with a battery backup.

2. If an elevated carbon monoxide level is detected during a fire inspection, the provider shall have all gas-fired appliances checked by a heating and air conditioning company to identify the source of the carbon monoxide. Until the provider has documentation on file at the facility verifying that all gas-fired appliances were checked by a heating and air conditioning company and are in safe working order, and the facility is determined safe by the fire inspector, the fire inspection shall not be approved.

3. If a level of carbon monoxide is determined that endangers the children in care, the fire inspector shall take measures necessary to protect the children. This may include evacuation of the building or closing the facility. The provider shall obtain and have on file at the facility, documentation verifying that all gas-fired appliances were checked by a heating and air conditioning company and are in safe working order. The facility shall be reinspected by the fire inspector and determined safe before the children can return to the building or the facility can reopen.

(B) At least one portable, 5 lb., 2A-10 BC, fire extinguisher shall be required in all facilities. One (1) fire extinguisher shall be located in or near the kitchen or a location required by the fire inspector. The fire inspector may require additional fire extinguishers based on the floor plan, arrangement of space, and the number of levels used.

(C) Fire extinguishers shall be installed and maintained according to the instructions of the fire inspector and shall be inspected and approved annually by a fire extinguisher company. Documentation of the inspection and approval shall be on file at the facility and available for review by the fire inspector.

(D) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall meet the following requirements. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space

1. All facilities shall have a manual fire alarm system. Pull stations shall be mounted at each exit door and at least one (1) horn or strobe light shall be installed in a central location on each floor. Additional horns or strobe lights may be required by the fire inspector dependent upon the floor plan and arrangement of space. The battery backup control panel shall be Underwriter's Laboratory (UL) or Factory Mutual (FM) listed and installed on a circuit used only for this system in the breaker box. The fire alarm system shall be installed and maintained in good working order. The fire inspector shall base the inspection of this system on the National Fire Protection Association Standards, National Fire Alarm Code. This does not apply to facilities housed in one (1) room only where all exit doors lead directly outside at level exit discharge;

2. Group day care homes and day care centers caring for fifty (50) or fewer children at one (1) time shall have smoke detectors installed in each room used by the children and in other locations as deemed necessary by the fire inspector. All smoke detectors shall be powered by the building's electrical system and have a battery backup. When more than one (1) smoke detector is required in a facility, they shall be arranged so that the activation of any detector causes the operation of an alarm in all detectors. This system may work independently from the manual fire alarm system;

3. Day care centers caring for more than fifty (50) children at one time shall have a full coverage fire alarm system. Smoke detectors shall be installed in each room, throughout hallways, and in other locations as deemed necessary by the fire inspector. Heat detectors shall be installed in the attic, kitchen, mechanical rooms, and other locations as deemed necessary by the fire inspector. The fire alarm system shall be installed and maintained in good working order. The fire inspector shall base the inspection of this system on the National Fire Protection Association Standards, National Fire Alarm Code; and

4. Facilities using a commercial stove, deep fryer, two (2) home-type ranges placed side by side, or a home-type range that produces grease laden vapor, shall be equipped with a range hood and extinguishing system with an automatic cut-off of fuel supply and exhaust system in case of fire. The fire inspector shall inspect these systems to ensure that they are in good working condition and are installed and maintained correctly. The inspector shall base this inspection on the National Fire Protection Association, Chapter 96, Standard for Fire Protection of Commercial Cooking Operations.

A. Home-type stoves separated by an eighteen inch (18")-cabinet shall not be required to have an extinguishing system installed above them.

B. Facilities that cook on a home-type range and have a menu that does not include frying or emitting a grease-laden vapor, shall not be required to install a fire extinguishment system above the range.

C. The range hood fire extinguishment system shall be interconnected with the control panel of the fire alarm system. The activation of the range hood fire extinguishment system shall cause the fire alarm to activate throughout the building.

(E) Day care centers caring for more than one hundred (100) children at one time shall have a fire alarm system that notifies a monitoring company or the fire department. A copy of the contract with the monitoring company shall be on file at the facility and available for review by the fire inspector. The contract with the monitoring company shall not be terminated without approval of the fire inspector.

(F) Facilities that have a supervised automatic fire sprinkler system installed shall have the system tested and approved annually by a fire sprinkler company A copy of the test report and approval of the system shall be kept on file at the facility and available for review by the fire inspector.

(G) When child care space is located above the second floor, the entire building shall be protected by a supervised automatic sprinkler system.

(13) Heating, Ventilating, and Air Conditioning Equipment.

(A) Unvented fuel-fired room heaters, portable electrical space heaters, or floor furnaces shall not be used during child care hours. The provider shall sign a compliance letter verifying that such equipment will not be used.

(B) Heating equipment and radiators in areas occupied by children shall have partitions, screens, or other means to protect children from hot surfaces and open flames. If solid partitions are used, provisions shall be made to ensure adequate air for combustion and ventilation for heating equipment. Partitions shall be constructed of noncombustible material and shall not obstruct exit access.

(D) Facilities with a water heater over two hundred thousand (200,000) British thermal units (Btus) per hour input or larger, or that is heating with a boiler, shall have a valid permit from the Division of Fire Safety posted on the premises. A copy of the permit shall be kept on file at the Division of Fire Safety

(E) Gas and electric heating equipment shall be equipped with thermostatic controls. Gas water heaters shall have a properly sized pressure relief valve and be vented properly by a galvanized flue pipe with screws at every joint in the pipe or by material recommended by the manufacturer, The drip leg pipe on the pressure relief valve shall extend to approximately six inches (6") above the floor.

(F) Furnaces shall be vented properly. Furnace flue pipes shall be constructed of galvanized pipe or material recommended by the manufacturer. Galvanized pipe shall be secured by screws at every joint in the pipe.

(G) Joints in gas supply pipes shall be located outside the furnace cabinet housing.

(H) Furnaces shall be equipped with an electrical fused switch to protect the unit from electrical overloading and to disconnect the electrical supply.

(I) Furnace rooms and rooms containing water heaters shall have adequate combustion air for the units. The vent size openings for the combustion air shall be measured at one (1) square inch per one thousand (1,000) Btu input, if the combustion air is drawn from inside the structure, and one (1) square inch per four thousand (4,000) Btu input if the air is drawn from outside the structure. There shall be two (2) combustion air vent openings in each furnace room. One (1) opening shall be located at the lower level and the other at the upper level. One (1) combustion air vent opening shall be permitted if the vent opening extends directly to the outside of the structure. This opening shall be one (1) square inch per three thousand (3,000) Btu input of the total gas appliances located in the room. The gas appliances shall have a clearance around them of one inch (1") from the sides and back and six inches (6") from the front of the unit.

(J) Furnace or air-handling equipment that has an air flow of two thousand (2,000) cubic feet of air per minute or more shall have a fan shut-down switch and duct smoke detectors that are interconnected with the fire alarm system.

(K) Air conditioning, heating, ventilating duct work, and related equipment shall be installed safely and be in good operating condition as determined by the fire inspector. The fire inspector shall base this on the National Fire Protection Association, Chapter 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, or National Fire Protection Association, Chapter 90B, Standard for the Installation of Warm Air Heating and Air Conditioning Systems, as applicable.

(L) In addition to meeting all the requirements of this rule, facilities initially licensed and areas initially approved for child care on or after the effective date of this rule, shall meet the following requirements. If alterations are made in facilities licensed prior to the effective date of this rule, those facilities shall meet these requirements in the altered space

1. Gas shut-off valves shall be located next to all gas appliances, furnaces, and water heaters; and

2. If a furnace or water heater is located inside a garage, it shall be at least eighteen inches (18") above the finished floor and enclosed inside a fire resistant room as provided in 19 CSR 30-62.087(10) Fire Safety.

(14) Electrical Services.

(A) Electrical wiring shall be installed and maintained in good working order. If the fire inspector considers the wiring to be unsafe for the occupants or it is installed improperly, an inspection by a licensed electrician may be required prior to fire safety approval. The inspection by the licensed electrician shall be based on National Fire Protection Association, Chapter 70, National Electrical Code.

(B) Protective covers or inserts for electrical receptacles shall be installed in all areas occupied by children.

(15) Equivalency Concepts.

(A) Nothing in this rule is intended to prevent the use of systems, methods, or devices of equivalent or superior quality, strength, fire resistance, effectiveness, durability, and safety as alternatives required by this rule. These alternatives may be used only if technical documentation to demonstrate equivalency and the system, method, or device is submitted and approved by the Missouri Division of Fire Safety.

PURPOSE: This rule sets forth the requirements for the furniture, equipment and materials needed in a group day care home or child day care center.

(1) Indoor Furniture and Equipment.

(A) General Requirements.

1. All furniture and equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.

2. Furniture and equipment shall be arranged to provide a clear passage to all exits.

(B) Sleeping Equipment.

1. General requirements.

A. An individual cot or bed with an individually assigned sheet and blanket shall be provided for each child who naps or sleeps. Upper levels of bunk beds shall not be used.

B. All bedding shall be clean with sheets laundered at least once a week. Once bedding has been used by a child, it shall not be used by another child until it has been laundered.

C. If two (2)-year olds are in care, they shall be napped in an area separate from the other children so they can sleep undisturbed longer than the older children.

D. Sleeping equipment shall be arranged to provide at least a two foot (2') aisle on one (1) long side of the equipment.

2. Infants and toddlers.

A. An individually assigned crib, portable crib or playpen shall be provided for each infant and toddler. Stack cribs shall not be used.

B. With written parental consent on file, cots may be used for napping or sleeping for toddlers twelve (12) months and older.

C. Cribs and playpens shall have side rail spokes not more than two and three-eighths inches (2 3/8") apart. Cribs or playpens previously approved for licensed centers and which do not meet this requirement shall have bumper pads in place for children under twelve (12) months of age.

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

E. Cribs and playpens shall be left consistently in place for infants and toddlers who use them for napping.

1. Preschool and school-age children.

A. Individual chairs and table space for the licensed capacity of the facility shall be available for children twelve (12) months of age and older. Chairs shall be proportioned so children's feet are firm on the floor when they are sitting back as far as possible on the chair.

B. Provision shall be made for seating during meals and for table space for eating and table activities.

2. Infants and toddlers. Infants and toddlers who are unable to sit at a table shall have one (1) piece of mealtime feeding equipment for every four (4) infant/toddlers which may include feeding tables, high chairs, infant seats or other safely designed infant seating equipment. Equipment shall be provided which will allow the child to sit comfortably and securely while being fed. Appropriate restraints shall be used.

(2) Indoor Play Equipment and Materials.

(A) General Requirements.

1. Play equipment and materials shall be clean, in good condition with all parts intact and accessible to children.

2. Play equipment and materials shall be replaced as needed to maintain the number of items required for the licensed capacity of the facility

3. Toys or materials that come in sets shall be considered one (1) item.

(B) Preschool and School-Age Children.

1. Children twenty-four (24) months of age and older shall have an ample variety of age-appropriate toys, books, creative materials and activities which provide fun, stimulation, development and opportunities for individual choices.

2. A minimum of forty (40) approved items shall be required for every ten (10) children in the licensed capacity of the facility. The forty (40) items shall include at least four (4) items from each of the following categories:

A. Blocks, construction and transportation toys;

B. Manipulatives;

C. Creative arts;

D. Large muscle activities;

E. Library and language activities;

F. Music and rhythm activities;

G. Dramatic and housekeeping play; and

H. Science activities or sensory experiences.

1. Infants and toddlers shall have safe toys which shall be washed when soiled. Toys, parts of toys or other materials shall not be small enough to be swallowed. Toys and materials shall include a minimum of one (1) approved item from each of the following categories for each infant and toddler in the licensed capacity of the facility:

A. Push-pull toys;

B. Balls or other large muscle equipment;

C. Blocks, stacking toys or other manipulatives; and

D. Cloth or plastic coated books.

(3) Outdoor Equipment.

(A) All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.

(B) Outdoor equipment shall be provided for the ages and number of children in care to meet their physical and developmental needs.

(D) Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

(E) For facilities initially licensed after the effective date of these rules or for facilities installing new equipment, any part of the equipment from which children might fall shall not be more than six feet W) in height.

(F) Equipment with moving parts which might pinch or crush children's hands or fingers shall not be used unless the moving parts which pose a threat to children have guards or covers. "S" hooks shall be pinched together to avoid catching children's skin or clothing.

(G) Swings shall have lightweight seats of rubber, plastic, canvas or nylon.

(H) Exposed bolts and screws shall be recessed into the frame, covered or filed to avoid sharp edges.

(I) Ropes, loops or any hanging apparatus that might entrap, close or tighten upon a child shall not be permitted.

(J) Trampolines shall not be used. Mini-trampolines, aerobic bouncers or other similar small jumping equipment may be used with close supervision.

PURPOSE: This rule sets forth the general, educational and training requirements for staff

(1) General Staff Requirements.

(A) Day care personnel shall be of good character and intent and shall be qualified to provide care conducive to the welfare of children.

(B) Day care personnel shall cooperate with the department.

(D) Caregivers shall be capable of carrying out assigned responsibilities and shall be willing and able to accept training and supervision.

(E) Caregivers shall have knowledge of the needs of children and shall be sensitive to the capabilities, interests and problems of children in care.

(F) Caregivers shall be capable of handling emergencies promptly and intelligently.

(G) Caregivers, other personnel or volunteers shall not be under the influence of alcohol or illegal drugs while on the premises. These individuals shall not be in a state of impaired ability due to use of medication while on the premises.

(H) The provider shall have available a copy of the Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri. All caregivers and volunteers working directly with children shall be required to review and be knowledgeable of the rules at the time they begin work and shall be able to understand and apply those rules which relate to their respective responsibilities.

(I) Caregivers shall not be engaged in major housekeeping, cleaning or maintenance activities during the hours of child care, but may do routine cleanup to maintain order and sanitation in the facility.

(J) All staff shall acquaint themselves with the child abuse and neglect law and shall make a report of any suspected child abuse or neglect to the Division of Family Services at the toll free number, 1-800-3923738.

(K) Volunteers counted in staff/child ratios, caregivers and other personnel shall be screened for child abuse/neglect. The screening shall be requested by the provider within ten (10) days of any individual beginning employment or volunteering in the facility Any investigated allegation of child abuse or neglect involving these persons in which the investigator finds reasonable cause to believe that the individual is the alleged perpetrator of child abuse or neglect, shall be evaluated by the department. After review, the department may prohibit the person from being present in the facility during child care hours. A copy of the screening request and the response shall be filed in the employee's record.

(L) The child care provider shall request and have on file the results of a criminal record review from the Missouri State Highway Patrol as defined by 19 CSR 30-62.042 Initial Licensing Information and 19 CSR 30-62.052 License Renewal. The child care provider shall request a criminal record review within ten (10) days following a change of the facility owner(s), board president or chairperson, the center director or group day care home provider, employees of the provider, or volunteers counted in staff/child ratios. The department may request a criminal record review from the Missouri State Highway Patrol for any adult present in the facility when child care children are present. The criminal record reviews shall include records of criminal convictions, pending criminal charges, and suspended imposition of sentence during the term of probation. Requests for criminal record reviews shall be made on a form provided by the highway patrol.

1. When the department determines that a nationwide check is warranted, the department may request a criminal record review from the Missouri State Highway Patrol for classification and search of fingerprints for any person seeking employment with the provider as provided in sections 43.530 and 43.543, RSMO. Requests for criminal record reviews shall be made on a form provided by the highway patrol that shall be signed by the subject of the request. The provider shall submit the signed form to the department with two (2) sets of fingerprints for each person who is the subject of a criminal record review.

2. Any information received by the department that indicates that the subject of the criminal record review poses a threat to the safety or welfare of children shall be evaluated by the department, After review, the department may prohibit such person from being present on the premises of the facility during child care hours.

3. Information received by the provider shall be retained in the individual's file in a confidential manner.

(M) Any person present at the facility during the hours in which child care is provided shall not present a threat to the health, safety or welfare of the children.

(N) If an employee reports licensing deficiencies in the facility, the child care provider shall not take any action against the employee because of the report that would adversely affect his/her employment, or terms or conditions of employment.

(2) Center Director or Group Day Care Home Provider.

(A) General Requirements.

1. The group day care home provider or the individual designated as the center director shall be responsible for planning, monitoring and managing the facility's daily program.

2. Center directors and group day care home providers routinely shall be on duty during the hours of highest attendance a minimum of forty (40) hours per week. If the facility operates less than forty (40) hours per week, the center director or group day care home provider shall be on duty at least fifty percent (50%) of the operating hours.

3. The duties and responsibilities of the center director or group day care home provider shall be defined clearly in writing.

4. In the absence of the center director or group day care home provider, another responsible individual shall be designated to be in charge of the facility.

5. The center owner(s), or the board president or chairperson shall notify the department immediately when there is a change of directors and shall submit child abuse/neglect screening information as required by 19 CSR 30-62.042 Initial Licensing Information.

(B) Education and Experience Requirements.

1. General requirements.

A. A child development associate (CDA) credential shall be considered the equivalent of twelve (12) months' experience and six (6) college semester hours in child-related courses toward meeting the educational and experience requirements for director of any size facility.

B. All experience must have been responsible, supervised, full-time (a minimum of thirty-five (35) hours per week) paid experience in working with children in a child care setting. Part-time experience may be prorated to a full-time equivalent.

C. Each month of full-time experience may be substituted for two (2) college semester hours in unspecified courses, but not for the required child related courses.

D. All college semester hours must have been received from an accredited college or university.

E. The required courses may include child related courses in early childhood education, elementary education, child development, child psychology, nutrition, first aid, recreation, nursing, health, marriage and family, social work, sociology or other related areas as approved by the department.

F. Official verification of the education and experience of the group day care home provider or center director shall be on file with the Child Care Licensing Unit prior to beginning employment.

G. Any college transcript used for verification of education must be an official transcript bearing the seal of the college or university.

2. Group day care home provider. The group day care home provider shall have at least thirty (30) college semester hours, with six (6) of the thirty (30) hours in child-related courses; or twelve (12) months' experience and six (6) college semester hours in child related courses; or a CDA credential.

3. Center director.

A. Any individual approved as a qualified center director under the previous licensing rules and employed in a center in that position as of the effective date of these rules shall be exempt from these requirements for continued employment in the same center, or for employment in another center of the same or smaller licensed capacity category. If the same individual is to be employed in another center in a larger licensed capacity category, s/he shall meet the educational and experience requirements of that category.

B. Day care center directors employed after the effective date of these rules shall meet the following education or experience requirements, or both, as determined by the licensed capacity of the center in which they are to serve:

Licensed Capacity of the Center	Education and Experience Requirements for Center Director
Up to 20 Children	Thirty (30) college semester hours, with six (6) of the thirty (30) hours in child related courses; or twelve (12) months' experience with six(6) college semester hours in child-related courses; or a CDA credential.
21-60 Children	Sixty (60) college semester hours. Twelve (12) of the hours must be in child-related courses; or twenty-four (24) months' experience and twelve (12) college semester hours in child-related courses.
61-99 Children	Ninety (90) college semester hours. Eighteen (18) of the ninety (90) hours must be in child-related courses; or thirty-six (36) months' experience and eighteen (18) college semester hours in child-related courses.
100 or More Children	One hundred twenty (120) college semester hours. Twenty-four (24) of the one hundred twenty (120) hours must be in child-related courses. Six (6) of the twenty four (24) college semester hours may include courses in business or management; or four (4) years' experience and twenty-four (24) college semester hours in child related courses. Six (6) of the twenty-four (24) college semester hours may include courses in business or management.

(3) Child Care Training.

(A) The center director, group day care home provider, all other caregivers and those volunteers who are 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 which is 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.

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

PURPOSE: This rule provides the number of staff required for specific ages and numbers of children in care.

(1) The following staff/child ratios shall be maintained on the premises at all times:

(A) Birth Through Two (2) Years. Groups composed of mixed ages through two (2)-years shall have no less than one (1) adult to four (4) children, with no more than eight (8) children in a group;

(B) Age Two (2) Years. Groups composed solely of two (2)-year olds shall have no less than one (1) adult to eight (8) children, with no more than sixteen (16) children in a group;

(C) Ages Three Through Four (3 4) Years. Groups composed solely of three (3)- and four (4)-year olds shall have no less than one (1) adult to ten (10) children;

(D) Ages Five (5) and Up. Groups composed solely of five (5)-year olds and older shall have no less than one (1) adult to every sixteen (16) children; and

(E) Mixed Age Groups Two Years (2) and Up. Groups composed of mixed ages of children two (2) years of age and older shall have no less than one (1) adult to ten (10) children with a maximum of four (4) two (2)-year olds. When there are more than four (4) two (2)-year olds in a mixed group, the staff/child ratio shall be no less than one (1) adult to eight (8) children.

(2) If a center has an attendance of more than fifty (50) children, the center director or individual in charge shall not be included in staff/child ratios except during naptime or on an emergency substitute basis.

(3) If a center has an attendance of more than thirty (30) children at lunch or dinner time, staff shall be provided for meal preparation, serving and clean-up. The staff shall not be included in staff/child ratios during this time.

(4) Individuals employed for clerical, housekeeping, cleaning and maintenance shall not be included in staff/child ratios while performing those duties.

PURPOSE: This rule sets forth the requirements for medical examinations for caregivers and children in care.

(1) Staff and Volunteers.

(A) All adults working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.

(B) Medical examination reports shall include a tuberculin skin test, a chest X ray or appropriate follow up of a previous examination that indicates the individual is free of contagion.

(C) Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another day care facility for subsequent employment.

(D) The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.

(E) After the initial medical examination, all adults working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall have an annual tuberculin skin test, a chest X ray or appropriate follow-up of a previous examination that indicates the individual is free of contagion.

(F) If at any time the department has reason to question the physical or emotional health of any adult working or volunteering in the facility, the department shall require a physical or mental examination of these persons.

(G) Staff or volunteers shall not work when ill if the health or well-being of children is endangered.

(2) Children.

(A) The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve (12) months prior to admission.

(B) The examination report shall determine if a child's medical history and current state of health is satisfactory for participation in a day care program.

(C) Medical examination requirements shall not apply to any child if the parent(s) files a signed statement of objection based on religious beliefs.

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

(E) The medical examination report form and the health history report for school-age children shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form,

PURPOSE: This rule defines admission policies and procedures for children in care.

(1) The provider shall establish written policies pertaining to the program goals, admission, care and discharge of children and shall provide a copy to the parent(s) at the time of enrollment.

(2) The provider shall have available a copy of the Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri and shall advise the parent(s) at the time of enrollment of his/her child of the availability of the rules for review.

(3) Only children two (2) years of age and older shall be accepted for care unless the facility has been specifically licensed to include infant/toddler care.

(4) If infant/toddler care is provided in a unit auxiliary to a licensed facility for older children, the following shall apply:

(A) Placement of a two (2) year old in either the infant/toddler unit or the unit for older children shall be determined in consultation with the parent(s); and

(B) The infant/toddler unit shall not care for children older than two (2) years unless the total number of children in attendance at the time is four (4) or fewer.

(5) A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professional y qualified source.

(6) The provider shall assess his/her ability to provide care for the special needs child while also meeting the needs of the other children.

(7) The provider shall develop and implement a procedure for admitting children which shall include:

(A) A personal interview with the parent(s) and child to exchange information and arrive at a mutual decision about admitting a child;

(B) A plan for continuing communication between the child care provider and the parent(s);

(D) Discussion of the parental plan for providing for the care of the school-age child on scheduled days of school closings; and

(E) Completion by the parent(s) of the following written information, which shall be on file before the child is accepted for care:

1. All information required by 19 CSR 30-62.222 Records and Reports;

2. Information regarding a child's personal development, behavior patterns, habits and individual needs;

3. A diet plan for each infant/toddler signed by the parent(s);

4. Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;

5. Information indicating that the child has completed age-appropriate immunizations, is in the process of completing immunizations or is exempt from immunization requirements as defined by 19 CSR 30-62.192 Health Care;

6. Permission for field trips, transportation to and from school and other transportation;

7. Permission for school-age children to leave the facility to participate in classes, clubs or other activities, naming the activity, time of leaving and returning and the method of transportation to and from the activity (Permission for regular activities such as scouting may be given for the entire school term.); and

8. Acknowledgement by the parent(s) that

A. They have received a copy of the provider's policies pertaining to the admission, care and discharge of children;

B. They have been informed that the Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri are available in the facility for their review;

C. They and the provider have agreed on a plan for continuing communication regarding the child's development, behavior and individual needs; and

D. They understand and agree that the child may not be accepted for care when ill.

(8) If care is provided for children related to the center owner(s) or group day care home provider, the parent(s) shall complete and sign a form which is supplied by the department. The form shall be on file at the facility before children related to the center owner(s) or group day care home provider are accepted for care, and shall contain the following identifying information:

(A) Each child's name, address, birthdate and date of admission;

(B) Each child's relationship to the center owner(s) or group day care home provider; and

(9) If a provider enrolls children for irregular or intermittent care, all procedures for admitting children shall be followed. Children enrolled on an irregular or intermittent basis shall be accepted only by appointment and shall not cause the facility to exceed its licensed capacity.

(10) After attempts have been made to meet a child's individual needs, any child who demonstrates an inability to benefit from the care offered by the child care provider or whose presence is detrimental to other children may be discharged from the facility.

(11) Care of a child may be discontinued if the provider and the parent(s) cannot establish a mutually satisfactory working relationship.

(12) Parents shall have access to the facility at any time during child care hours.

PURPOSE: This rule sets forth requirements for facilities providing nighttime care for children.

(1) If nighttime care is to be offered on a regular basis, rules shall be met as set forth for nighttime care and the facility shall be specifically licensed to include nighttime care.

(2) Facilities licensed for nighttime care shall meet the requirements of the following additional rules:

(A) Special effort shall be made by caregivers to individualize care at children's bedtime and awakening. The parent(s) shall be consulted concerning his/her child's particular behavior patterns at bedtime and awakening;

(B) As parents will be calling for children at various hours during nighttime care, room arrangements shall take into consideration the child's need for undisturbed sleep;

(D) Night-lights shall be located in areas as required by individual children's needs;

(E) Separate sleeping and dressing areas shall be provided for school-age boys and girls;

(F) During sleeping hours, caregivers shall be in close proximity to sleeping areas in order to respond to children needing attention. Close proximity means that caregivers shall be close enough to the children to be able to hear any sounds they might make that would indicate a need for assistance. One (1) caregiver shall be awake at all times; and

(G) Adults on the premises shall be limited to staff, parents or authorized individuals.

PURPOSE: This rule sets forth requirements for facilities providing irregular, intermittent, hourly care for children.

(1) An hourly care facility is a facility licensed exclusively for irregular, intermittent, hourly care.

(2) Hourly care shall be limited to a maximum of fifty (50) hours per month per child. If a child is in care more than fifty (50) hours per month, other child care arrangements shall be made.

(3) Hourly care facilities shall meet all licensing rules for group day care homes and day care centers with the following exceptions:

(A) An outdoor play area is not required;

(B) Children may bring sack lunches; and

PURPOSE: This rule defines overlap care and sets forth the requirements for overlap care.

(1) There may be situations (for example, to accommodate parents' work shifts, before- and after school care or before- and after-summer camp care) when the number of children in care may exceed the licensed capacity of the facility at the time of overlap. The number in care shall never be more than one-third (1/3) over the licensed capacity of the facility. The overlap period(s) shall not exceed two (2) hours total in any twenty-our (24)-hour child-care day. The two (2) hours of available overlap time may be utilized in smaller time periods.

(2) Overlap care shall not be provided until an overlap request has been submitted, including the hours overlap care will be provided and written approval has been received from the department. Any changes in the hours of overlap care shall require that a new overlap request form be submitted and approved.

(3) All procedures for admitting children shall be followed if a provider chooses to enroll children for overlap care.

(4) Staff/child ratios shall be maintained during overlap periods.

(5) When before- and after-summer camp care for children is provided, the provider shall require that the parent(s) sign a statement of consent for the child to be taken from the facility to the summer camp location.

(6) Overlap shall be granted to an infant/toddler unit or to a preschool/school-age unit based on the licensed capacity of each unit. A provider may not use the time period for one (1) unit to increase the overlap period for the other unit.

(7) Overlap approval shall not be granted to facilities licensed exclusively for before- and after-school child care programs.

PURPOSE: This rule allows one-third additional attendance of school-age children on unscheduled days of school closings.

(1) On days when schools are closed due to emergencies such as inclement weather or physical plant failure, the facility may accommodate enrolled school-age children who need care. The provider shall be permitted to exceed for the day the licensed capacity of the facility by one-third (1/3). The one-third (1/3) excess attendance for emergency school closings shall not be in addition to the one-third (1/3) excess attendance allowed for overlap care. At no time may the total number in care be more than one-third (1/3) over the licensed capacity of the facility.

(2) Staff/child ratios shall be maintained during emergency school closings.

(3) The provider shall maintain a written record including the date of the emergency school closing, the reason for the closing and the number of children in care on that date.

(4) Emergency school closing overlap shall not be permitted for scheduled days of school closing.

PURPOSE: This rule sets forth the requirements for the care of children, including supervision, emergency drills, discipline, diapering and toileting, and daily activities.

(1) Care of the Child.

(A) General Requirements.

1. Caregivers shall not leave any child without competent adult supervision.

2. A caregiver personally shall admit each child upon arrival and personally shall dismiss each child upon departure. Children shall be dismissed only to the parent(s), guardian, legal custodian or to individuals approved by the parent(s), guardian or legal custodian.

3. Caregivers shall provide frequent, direct contact so children are not left unobserved on the premises.

4. Children under three (3) shall be supervised and assisted while in the bathroom.

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

6. Preschool children who do not sleep shall rest on cots or beds at least thirty (30) minutes, but shall not be forced to remain on cots or beds for longer than one (1) hour. They shall then be permitted to leave the napping area to engage in quiet play.

7. Caregivers shall provide special attention on an individual basis for new children having problems adjusting, distressed children, etc. Children shall be encouraged, but not forced to participate in group activities.

8. Children shall not be subjected to child abuse/neglect as defined by section 210.110, RSMO.

(B) Fire and Tornado Drills.

1. Fire, tornado, and other disaster drills shall meet the requirements of 19 CSR 30-62.087 Fire Safety

1. The provider shall establish simple, understandable rules for children's behavior and shall explain them to the children.

2. Expectations for a child's behavior shall be appropriate for the developmental level of that child.

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

4. Praise and encouragement of good behavior shall be used instead of focusing only upon unacceptable behavior.

5. Brief, supervised separation from the group may be used based on a guideline of one (1) minute of separation for each year of the child's age.

6. Firm, positive statements or redirection of behavior shall be used with infants and toddlers.

7. Physical punishment including, but not limited to, spanking, slapping, shaking, biting or pulling hair shall be prohibited.

8. No discipline technique which is humiliating, threatening or frightening to children shall be used. Children shall not be shamed, ridiculed or spoken to harshly, abusively or with profanity.

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

10. Children shall not be placed in a closet, a locked or unlit room or any other place which is frightening.

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

(D) Care of Infants and Toddlers.

1. Infants and toddlers shall have constant care and supervision.

2. Children shall be cared for by the same caregiver on a regular basis.

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

(E) Diapering and Toilet Training.

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

2. The diapering table shall be cleaned thoroughly with a disinfectant after each use.

3. The child shall not be left unattended at any time while on the diapering table.

4. Diapers and wet clothing shall be changed promptly.

5. Wet or soiled diapers shall be placed in an airtight disposal container located in the diaper change area. If cloth diapers are provided by the parent(s), individual airtight plastic bags shall be used to store each soiled diaper for return each day to the parent(s).

6. Caregivers changing diapers shall wash their hands with soap and running water each time after changing a child's diaper.

7. The diapering area and handwashing area shall be separate from any food service area and any food related materials.

8. No effort shall be made to toilet train a child until the parent(s) and provider agree on when to begin.

9. The routine for toilet training shall be discussed with the parent(s) so the same method will be used at the facility and the child's home.

10. Children shall not be punished, berated or shamed in any way for soiling their clothes. The parent(s) shall provide extra clothing for his/her child in case the child accidentally soils him/herself.

(2) Daily Activities for Children.

(A) A daily schedule shall be established in written form which shall include activities for all ages of children in care.

(B) Daily activities for preschool and school-age children shall include:

1. Developmentally appropriate play experiences and activities planned to meet the interests, needs and desires of the children;

2. Individual attention and conversation with adults;

3. Indoor and outdoor play periods which provide a balance of quiet and active play, and individual and small group activities. Activities shall provide some free choice experiences;

4. A total of at least one (1) hour of outdoor play for children in attendance a full day unless prevented by weather or special medical reasons. (Based on wind chill factor or heat index, children shall not be exposed to either extreme element.);

5. Toileting and handwashing times;

6. Regular snack and meal times;

7. A supervised nap or rest period for preschool children after the noon meal;

8. A quiet time for school-age children after the noon meal with a cot or bed available for those who wish to nap or rest; and

9. A study time for school-age children who choose to do homework, with a separate, quiet work space.

1. Developmental and exploratory play experiences and free choices of play appropriate to the interests, needs and desires of infants and toddlers;

2. Regular snack and meal times according to each infant's individual feeding schedule as stated by the parent(s);

3. A supervised nap period. After awakening, an infant may remain in the crib as long as s/he is content, but never for periods longer than thirty (30) minutes. Toddlers shall be taken out of bed for other activities when they awaken;

4. Individual attention and play with adults, including holding, cuddling, talking and singing;

5. Opportunities for sensory stimulation which includes visual stimulation through pictures, books, toys, nonverbal communication, games, and the like; auditory stimulation through verbal communication, music, toys, games, and the like; tactile stimulation through surfaces, fabrics, toys, games, and the like;

6. Encouragement in the development of motor skills by providing opportunities for reaching, grasping, pulling up, creeping, crawling and walking; and

7. Opportunity for outdoor play when weather permits.

PURPOSE: This rule sets forth the requirements for reporting communicable diseases, caring for a child when ill, medication, emergency care and handwashing.

(1) General Requirements. The provider shall report to the local health department if any child in the facility is suspected of having a reportable disease as defined by section 210.003, RSMO. In the event of an outbreak of communicable disease in the facility, caregivers shall implement control measures recommended by a local state health authority as required by the department.

(2) The Ill Child.

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

(B) Each child's parent(s) shall be notified immediately when any contagious disease occurs in the facility.

(C) Unusual behavior shall be monitored closely and parent(s) shall be contacted if the behavior continues or if other symptoms develop. These behaviors include, but shall not be limited to:

1. Is cranky or less active than usual;

2. Cries more than usual;

3. Feels general discomfort or seems unwell; or

4. Has loss of appetite.

(D) The parent(s) or his/her designee shall be contacted when signs of illness are observed. Unless determined otherwise by the parent(s) or provider, a child with no more than one (1) of the following symptoms may remain in care:

1. A child with a temperature of up to one hundred degrees Fahrenheit (100' F) by mouth or ninety-nine degrees Fahrenheit (990 F) under the arm;

2. After an illness has been evaluated by a physician, medication has been prescribed and any period of contagion has passed as determined by a licensed physician;

3. When it has been determined that a child has a common cold unless the director and the parent(s) agree that isolation precautions should be taken;

4. When a child has vomited once with no further vomiting episodes, other symptoms, or both; or

5. When a child has experienced loose stools only one (1) time with no further problems or symptoms.

(E) If children exhibit any of the following symptoms, they must be sent home:

1. Diarrhea-more than one (1) abnormally loose stool. If a child has one (1) loose stool, s/he shall be observed for additional loose stools or other symptoms;

2. Severe coughing-if the child gets red or blue in the face or makes high-pitched croupy or whooping sounds after coughing;

3. Difficult or rapid breathing (especially important in infants under six (6) months);

4. Yellowish skin or eyes;

5. Pinkeye-tears, redness of eyelid lining, irritation, followed by swelling or discharge of pus;

6. Unusual spots or rashes;

7. Sore throat or trouble swallowing;

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

9. Unusually dark, tea-colored urine;

10. Grey or white stool;

11. Fever over one hundred degrees Fahrenheit (1000 F) by mouth or ninety-nine degrees Fahrenheit (99' F) under the arm;

12. Headache and stiff neck;

13. Vomiting more than once; and

14. Severe itching of the body or scalp, or scratching of the scalp. These may be symptoms of lice or scabies.

(F) Parental contact and the decision made shall be recorded and filed in the child's record.

(G) The ill child shall be kept isolated from the other children until the parent(s) arrives.

(H) The caregiver shall be in close proximity to the child until the parent(s) arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that would indicate a need for assistance.

(3) Medication.

(A) The provider is not required to administer medication but may choose to do so.

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

(C) Prescription medication shall be in the original container and labeled with the child's name, instructions for administration, including the times and amounts for dosages and the physician's name. This may include sample medication provided by a physician.

(D) All nonprescription medication shall be in the original container and labeled by the parent(s) with the child's name, and instructions for administration, including the times and amounts for dosages.

(E) All medication shall be stored out of reach of children or in a locked container.

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

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

(H) Medication shall be returned to the parent(s) or disposed of immediately when no longer needed.

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

(4) Immunizations.

(A) No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine-preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.

(B) A child who has not completed all immunizations appropriate for his/her age may enroll, if

1. Satisfactory evidence is produced that the child has begun the process of immunization (see form at 19 CSR 30-61.185). The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/Missouri Department of Health recommended schedule; or

2. The parent(s) or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following:

A. A medical exemption (see form at 19 CSR 3061.185), by which the child shall be exempted from immunization requirements, upon certification by a licensed physician that the immunization would seriously endanger the child's health or life; or

B. A parent or guardian exemption, by which a child shall be exempted from immunization requirements if one (1) parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. Exemption forms shall be provided by the department (see 19 CSR 3061.185).

(C) In the event of an outbreak or suspected outbreak of a vaccine-preventable disease in the facility, the administrator of the facility shall follow the control measures instituted by the local health authority or the department, or both the local health authority and the department.

(D) The administrator of each day care facility shall prepare a record of immunization of each child enrolled in or attending the facility. An annual summary report shall be made by January 15 showing the immunization status of each child enrolled, using forms provided by the department (see 19 CSR 3061.185). The immunization records shall be available for review by department personnel upon request.

(5) Accidents, Injuries and Emergency Medical Care.

(A) In case of accident or injury to a child, the provider shall notify the parent(s) immediately. If the child requires emergency medical care, the provider shall follow the parent's(s') written instructions.

(B) Information regarding the date and circumstance of any accident or injury shall be noted in the child's record.

(C) When planning for activities away from the facility, the provider shall establish a procedure for handling emergencies.

(6) Handwashing.

(A) Caregivers shall wash their hands with soap and running water after toileting or assisting a child with toileting, after diapering a child, before food preparation or serving of food and at other times as needed.

(B) Caregivers shall teach children to wash their hands before eating and after toileting.

PURPOSE: This rule provides the requirements for nutritious meals, snacks and methods of food service.

(1) General Requirements.

(A) The provider shall supply and serve nourishing food according to the Meal and Snack Food Chart provided in this rule.

(B) The required meal schedule shall include breakfast or a midmorning snack, lunch and a mid-afternoon snack for children in care during daytime hours, with a maximum time of four (4) hours between any meal or snack. School-age children shall be served a snack after school.

(C) Children in care during evening hours shall be served a snack. Upon parental request, children in care during evening hours shall be served supper and children spending the night shall be served breakfast.

(D) Snacks of fruit juice, raw fruit or vegetable, milk, crackers, cheese, peanut butter or similar nutritious food shall be served.

(E) One (1) serving of fluid milk shall be served with each meal.

(F) If the facility is licensed exclusively for schoolage care, the child may be permitted to bring sack meals. The provider shall supply one (1) serving of fluid milk with each sack meal and shall supply nutritious snacks.

(G) The acceptable food components and serving sizes for meals and snacks are outlined in the following chart for each age group. Menus and amounts served shall be based on this chart.

(H) The water and milk supply, and the method of dispensing, shall be approved by local or state health authorities, or both. Powdered milk shall not be used except for cooking purposes. Milk substitutes shall not be used for drinking or cooking.

(I) State or local rules, or both, governing food service sanitation shall be maintained in the storage, preparation and service of foods.

(J) Mealtime atmosphere shall be enjoyable and relaxed. No child shall be forced to eat, but shall be encouraged to set his/her own pace according to personal preferences.

(K) Menus shall be available to parents upon request.

(L) Drinking water shall be located conveniently near playrooms and the playground so children may be free to drink as they wish. Water fountains or individual cups shall be used.

Food Components	Age 1 and 2	Age 3 through 5	Age 6 through 12
BREAKFAST Requirement-1 serving from each of the 3 food components
Fluid Milk***	1/2 cup	3/4 cup	1 cup
Juice** or Fruit or Vegetable	1/4 cup	1/2 cup	1/2 cup
Bread or Bread Alternate*	1/2 slice*	1/2 slice*	1 slice*
SNACK Requirement-2 servings selected from 2 of the 4 food components, 1 serving from the bread component
Fluid Milk***	1/2 cup	1/2 cup	1 cup
Juice** or Fruit or Vegetable	1/2 cup	1/2 cup	3/4 cup
Meat or Meat Alternate	1/2 ounce	1/2 ounce	1ounce
Bread or Bread Alternate*	1/2 slice*	1/2 slice*	1 slice*
LUNCH/SUPPER Requirement-1 serving of milk component, 1 serving from the meat/meat alternate component, 2 servings from the fruit/vegetable component, 1 serving from the bread component
Fluid Milk***	1/2 cup	3/4 cup	1 cup
Meat/Meat Alternate, poultry	1 ounce	1&1/2 ounce	2 ounce
Fish or Cheese or	1 ounce	1&1/2 ounce	2 ounce
Egg or	1	1	1
Cooked Dry Beans and Peas	1/4 cup	3/8 cup	1/2 cup
Peanut Butter	2 tablespoons	3 tablespoons	4 tablespoons
FRUIT/VEGETABLE, 1 Vegetable and 1 Fruit or 2 Different Vegetables or 2 Different Fruits	1/4 cup total	1/2 cup total	3/4 cup total
BREAD OR BREAD ALTERNATE*	1/2 slice*	1/2 slice*	1 slice*

*Or an equivalent serving of an acceptable bread alternate such as cornbread, biscuits, rolls, muffins, cereal, rice, pasta, and the like.

**All fruit juices shall be one hundred percent (100%) fruit juice.

***See subsection (1)(H) for acceptable milk supply.

(2) Nutrition and Food Service for Infants Up to Twelve (12) Months of Age.

(A) The provider shall serve nourishing foods appropriate for the infant's nutritional requirements and developmental stages as specified by his/her parent(s) in a written diet plan.

(B) The written diet plan for each infant/toddler shall be followed. The parent(s) shall update the plan according to the individual needs of the child until they grant permission in writing for the child to eat table foods.

(C) If preferred, formulas and special baby foods may be provided by the parent(s) with individual identification on each container.

(D) Until infants can hold a bottle comfortably, they shall be held by a caregiver during bottle feeding. Bottles shall not be propped.

(E) When an infant/toddler shows evidence of wanting to feed him/herself, the child shall be encouraged and permitted to do so.

PURPOSE: This rule sets forth the requirements of a day care provider when transporting children and on field trips.

(1) General Requirements.

(A) The provider shall be responsible for the care, safety and supervision of children on field trips or at any time they transport children away from the facility.

(B) Written parental consent shall be on file at the facility for field trips and transportation.

(D) Short, unscheduled walks may be taken without parent notification. These unscheduled outings shall be discussed with the parent(s) at the time of enrollment.

(2) Vehicle and Vehicle Operator.

(A) The driver of any vehicle used to transport children shall be no less than eighteen (181) years of age and shall have a valid driver's license as required by Missouri law.

(B) All vehicles used to transport children shall be licensed in accordance with Missouri law.

(3) Safety and Supervision.

(A) All children shall be seated in a permanent seat and restrained by seat belts or child restraint devices as required by Missouri law.

(B) Identifying information regarding the name of the provider, the names of the children and the names, addresses and telephone numbers of each child's parent(s) shall be carried in the vehicle.

(D) Children shall be required to remain seated while the vehicle is in motion.

(E) Doors shall be locked when the vehicle is moving.

(F) Order shall be maintained in the vehicle at all times.

(G) Children shall not be left unattended in a vehicle at any time.

(H) Children shall enter and leave the vehicle from the curbside unless the vehicle is in a protected area or driveway,

(I) Children shall be assisted, when necessary, while entering or leaving the vehicle.

(J) Children shall be released only to the parent(s) or individual(s) authorized by the parent(s).

(K) The operator of the vehicle shall wait until the child is in the custody of the parent(s) or individual(s) authorized by the parent(s) to receive the child.

(L) Head counts shall be taken before leaving the facility, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the facility.

(M) When children leave the vehicle, the vehicle shall be inspected to ensure that no children are left on or under seats.

PURPOSE: This rule lists records and reports which must be on file at the facility.

(1) The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.

(2) An individual file shall be kept to identify each child and enable the provider to communicate with the parent(s), guardian or legal custodian of the child in an emergency Records shall include:

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

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

(C) Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;

(D) Name and phone number of the family physician, hospital, or both, to be used in an emergency;

(E) Name of the individual(s) authorized to take the child from the facility; and

(F) Field trip and transportation authorization.

(3) Records on related children, as required by 19 CSR 30-62.132 Admission Policies and Procedures, shall be on file.

(4) Health information shall be retained in each child's individual file and shall include:

(A) A medical examination report for each infant, toddler or preschool child or a health report for each school-age child as required by 19 CSR 30-62.122 Medical Examination Reports;

(B) Parental authorization for medications and a record of medications administered;

(D) Any significant information learned from observing the child.

(5) Individual children's records shall be retained a minimum of one (1) year after the child discontinues attendance.

(6) Daily child attendance records shall be maintained and kept on file a minimum of one (1) year.

(7) Daily staff and volunteer attendance records shall be maintained and kept on -file a minimum of one (1) year.

(8) All enrollment records, medical examination records and attendance records shall be filed in a place known to caregivers and shall be accessible at all times. Records shall not be in a locked area or removed from the facility during the hours the facility is open and operating,

(9) Emergency school closing records, as required by 19 CSR 30-62.172 Emergency School Closings, shall be on file.

(10) The provider shall maintain the following information on file as provided in 19 CSR 30-62.087 Fire Safety:

(A) A written record at the facility for fire and disaster drills;

(B) Documentation verifying that fresh-cut Christmas trees are treated with a flame resistant material;

(C) Documentation verifying that all gas-fired appliances were checked by a repair company and are in safe working order after an elevated carbon monoxide level was determined during a fire inspection;

(D) Documentation verifying the inspection and approval of fire extinguishers;

(E) Documentation verifying the inspection and approval of automatic fire sprinkler systems; and

(F) A copy of the membership or receipt for membership documenting that facilities served by a volunteer or membership fire department are a member in good standing with the fire department.

(11) Medical examination reports for staff, as required by 19 CSR 30-62.122 Medical Examination Reports, shall be on file.

(12) A copy of the child abuse/neglect screening request form and response, as required by 19 CSR 3062.102 Personnel, shall be on file in each employee's record.

(13) The child care provider shall have the results of criminal record reviews as provided in 19 CSR 3062.042 Initial Licensing Information, 19 CSR 3062.052 License Renewal, and 19 CSR 30-62.102 Personnel on file at the facility.

(14) Staff training records, as required by 19 CSR 3062.102 Personnel, shall be on file.

(15) All records of children shall be confidential, protected from unauthorized examination and available to the parent(s) upon request.

(16) All records shall be available in the facility for inspection by the department upon request.

(17) Reports to the department shall be submitted as required.

PURPOSE: This rule explains how a provider may request a variance from the rules of this chapter

(1) Any provider may request a variance from a rule. The request for a variance shall be written to the Child Care Unit and shall include the item(s) for which a variance is requested and the reason(s) the provider requests the variance. Local inspectors may request a variance on behalf of the provider.

(2) If a variance request is not approved by the Child Care Unit, the provider shall be advised in writing of the basis for the denial. The provider may request a review of the decision by the director within thirty (30) days of receipt. The director or designee shall have fifteen (15) days to make the final determination on the variance request. That determination is subject to Chapter 536, RSMO review for licensed facilities.