National Children's Center

Failure of the Licensee to ensure that medication is administered according to the instructions on the label of the medication container or a licensed health care practitioner's written instructions, whichever is most recently dated.

Failure of a Licensee to comply with the following requirements concerning infant formula and feeding:</br>(a) Each feeding bottle for an infant or toddler shall be labeled with the name of the child to whom it belongs;</br>(b) Each bottle of milk or formula shall be labeled with the date of preparation, and refrigerated at thirty-five to forty degrees Fahrenheit (35ºF - 40ºF);</br>(c) Each open container of ready-to-feed or concentrated formula shall be used for only one (1) child, and shall be labeled with that child’s first and last name and the date on which the container is opened;</br>(d) All infant formula given to a child shall be prepared according to written instructions obtained from the parent(s) or guardian(s) of that child or from the child’s licensed health care practitioner;</br>(e) All bottles and formula preparation equipment shall be washed with hot water and detergent in sinks which are not designated for hand washing only;</br>(f) Bottles, bottle caps, nipples, and other equipment used for bottle feeding shall not be reused without first being cleaned and sanitized by washing in a dishwasher or by washing, rinsing, and boiling them for one (1) minute;</br>(g) Each bottle of reconstituted concentrated or powdered formula shall be refrigerated immediately after its preparation, or immediately upon its arrival at the Facility if it is prepared and brought to the Facility by the child’s parent(s) or guardian(s), and may be held for feeding for no longer than twenty-four (24) hours;</br>(h) Each bottle of commercially prepared ready-to-feed formula shall be refrigerated promptly after it is opened;</br>(i) After each feeding, discard any unused:</br>(1) Formula within one hour of feeding; and</br>(2) Breast milk, if less than one ounce, otherwise return remaining breast milk to the mother;</br>(j) Each bottle or container of breast milk provided for a child by the parent(s) or guardian(s) of that child shall be labeled with the child’s first and last name and the date of receipt, and refrigerated immediately upon its arrival at the Facility;</br>(k) Fluid breast milk may be held for a feeding for no more than twenty-four (24) hours, and frozen breast milk may be held in a frozen state for no more than two (2) months;</br> (l) Bottles shall be warmed under running, warm tap water or by placing them in a container of water that is no warmer than one hundred and twenty degrees Fahrenheit (120°F). Bottles shall not be left in a pot of water to warm for more than five (5) minutes;</br>(m) Microwaving of breast milk is prohibited. If the Facility plans to use this method of heating formula or other liquids and foods, the Licensee shall notify a child’s parent(s) or guardian(s) in writing;</br>(n) All warmed bottles shall be shaken and temperature tested before feeding to a child. Warmed solid foods shall be stirred and temperature tested before feeding to a child. Liquid and food shall be room temperature;</br>(o) A Licensee shall provide, or require the parent(s) or guardian(s) of each infant to provide, a sufficient supply of commercially prepared formula so that the child will be adequately fed in the event of emergency;</br>(p) Each child who is too young or otherwise developmentally unable to use a feeding chair or other appropriate seating apparatus shall be held while being fed;</br>(q) Each child who is too young, too small, or otherwise developmentally unable to hold his or her bottle while feeding shall be held while being fed; and</br>(r) A Licensee shall provide a comfortable and secluded location where mothers may breast-feed their children on-site.

Failure of a Licensee to ensure that positive behavior support or discipline shall not include any of the following</br>methods of discipline and the use of any of them by the Licensee, and the staff members, is prohibited:</br>(a) Physical harm, including but not limited to, punching, pinching, shaking, shoving, pushing, spanking, striking, kicking, biting, yanking, strangling, kneeing, poking, or plucking;</br>(b) Fear, shaming, intimidation, or humiliation;</br>(c) Derogatory remarks or profane language;</br>(d) Confinement in a locked room or an enclosed area where a child cannot be seen or supervised by Facility staff;</br>(e) Force feeding against a child’s will;</br>(f) Withholding of food, water, rest, toilet use, outdoor activities, or outdoor play; or</br>(g) Physical or chemical restraints.

Failure of a Licensee to establish and maintain respectful and professional communication with the parent(s) or guardian(s) of children enrolled.

Failure of a Licensee to maintain hot and cold running water under pressure. Hot running water shall be maintained at one hundred degrees Fahrenheit (100°F).

Failure to ensure minimum adult-to-child ratios shall be met at all times, including non-peak hours, during nap or rest periods, and in vehicles during transport