Section 250.2720  Day Care for Mildly Ill Children

 

a)         General Description

 

1)         A hospital may provide a program for the temporary custodial care of mildly ill children in accordance with the requirements of this Section. (Section 6.13 of the Act)

 

2)         The purpose of a day care program for mildly ill children is to provide a short-term day care alternative for children who, because of mild illness, cannot participate in their usual daily routine and whose parent or guardian cannot stay home with them.

 

3)         Children who participate in a day care program for mildly ill children are not considered hospital patients and are not required to be under the professional care of a member of the hospital's medical staff except in those cases where emergency medical treatment is needed during the time the child is on the program premises. (Section 6.13(b) of the Act)

 

b)         For the purposes of this Section, "mildly ill" or "mild illness" means a temporary medical condition which does not require in-patient hospital treatment, but which makes a child unable to attend school, renders participation in normal day care arrangements impracticable, or excludes a child from attendance at a day care center or home licensed by the Department of Children and Family Services [see 89 Ill. Adm. Code 406.14(d), 407.18(e), 408.60(e), and 408.70(b)].  (Section 6.13 of the Act)

 

c)         Policies and Procedures

 

1)         Each hospital offering a day care program for mildly ill children shall develop written policies and procedures to govern the operation of the program. The hospital shall consider the rules of the Department of Children and Family Services on day care programs (89 Ill. Adm. Code 407) in the development of the policies and procedures.

 

2)         Policies and procedures governing the registration of children into the program, the conditions under which children will be referred for medical treatment, and the provision of emergency medical treatment shall be reviewed and approved by the medical director of the program or by another physician licensed to practice medicine in all its branches.

 

d)         Program Administration

 

1)         The program shall designate a physician licensed to practice medicine in all its branches, experienced in caring for children, who will serve as the medical director of the program.

 

2)         The program shall be supervised by a registered nurse or a physician experienced in caring for children.

 

e)         Registration and Initial Evaluation

 

1)         The program shall have a policy for the registration of mildly ill children into the program.  The policy shall include at least the following requirements:

 

A)        The program shall collect background information concerning the child prior to accepting a sick child into the program, including the information required under subsections (k)(1) and (2) of this Section.

 

B)        The registration procedures shall be designed to provide the program with sufficient information to enable the parent or guardian and the program staff to make decisions or act on behalf of the child while at the program.

 

2)         A preliminary evaluation of the condition of the mildly ill child shall be made by a registered nurse or physician affiliated with the program before the child is brought to the program.  The preliminary evaluation shall consist of the parent's or guardian's reporting the child's symptoms to the program's designated personnel by telephone.  A determination shall be made at that time as to whether the parent or guardian may bring the child to the program for on-site evaluation.

 

3)         An on-site evaluation must be performed by a physician or registered nurse affiliated with the program.  The evaluation which takes place at the program premises shall include the following;

 

A)        An assessment of the child's physical condition, including current medications.

 

B)        An assessment of the probable contagion and risk to the health of other individuals present.

 

C)        An assessment of the ability of the program to provide the services that the child requires.

 

4)         The program personnel evaluating the child shall determine whether a mildly ill child may be registered.

 

5)         The registration and evaluation process must be followed each day the parent or guardian wishes to register a child into the program.

 

6)         Program staff must report cases of suspected child abuse and communicable disease cases in accordance with current reporting requirements of the Department of Children and Family Services (89 Ill. Adm. Code 300) and the Department (77 Ill. Adm. Code 690).

 

f)         Facility and Equipment Requirements

 

1)         A day care program for mildly ill children shall be located on the hospital's licensed premises. (Section 6.13 of the Act)

 

2)         Programs which are located in an area where patients are also present shall meet the following requirements:

 

A)        Children in the program shall not simultaneously occupy the same room as a hospital patient.  (Section 6.13(a)(1) of the Act)

 

B)        Policies and procedures shall be developed to assess individual children's needs and potential infection control implications prior to placing a program participant in a particular room.

 

3)         Toilets and handwashing sinks must be within or immediately adjacent to the room or rooms used for day care for mildly ill children.

 

g)         Infection Control

 

1)         The program shall have written infection control and isolation policies and procedures.  The policies and procedures shall specify medical conditions which will exclude children from participation in the program.  The policies and procedures shall include the use of universal precautions, comply with the hospital's infection control policies and be reviewed and approved by the individual responsible for the hospital's infection control program.

 

2)         Children in the program who are recovering from non-contagious conditions shall be cared for in a room separate from children registered in the program who have contagious conditions. (Section 6.13(a)(2) of the Act)

 

3)         Programs which accept children with contagious conditions must separate children with different contagious conditions in accordance with the hospital's infection control policies.

 

4)         If a hospital also operates a day care center licensed by the Department of Children and Family Services, children registered in the day care program for mildly ill children shall not simultaneously occupy the same rooms used by well children.

 

h)         Activities

 

1)         Each program shall provide activities which are available to children registered in the program.  The activities shall take into account the educational and developmental needs of program registrants.

 

2)         Children in the program shall be permitted to participate in activities which are appropriate to the level of illness and age of each child.

 

i)          Food Services.  Well-balanced meals and snacks must be offered at appropriate times throughout the day.  Menus shall be modified to meet the individual needs of each child as necessary.

 

j)          Medication Administration

 

1)         Medication which is brought to the program for a child by the child's parent or guardian may be administered to the child in the program in accordance with the following requirements.

 

A)        The program shall maintain a record of the dates, hours, dosages, and the name of the person administering the medication.

 

B)        Prescription medications shall be labeled with the child's name, directions for administering the medication, the date, the physician's name, the prescription number, and the dispensing drug store or pharmacy. (Section 6.13(c)(1) of the Act)

 

C)        Only current prescription medications shall be administered by the program. (Section 6.13(c)(1) of the Act)

 

D)        The medications shall be administered as required by the child's physician, subject to the receipt of appropriate releases from the parent or guardian, which shall be on file for each child for the administration of any and all prescribed medications.

 

E)        Written parental permission shall be obtained before non-prescription medication is administered.  Such medication shall be administered in accordance with package instructions.  (Section 6.13(c)(2) of the Act)

 

F)         Medications shall be kept in locked cabinets or containers which are in an area well-lighted and out of reach of children even if medications must be refrigerated.

 

G)        Medications shall only be administered by individuals who are authorized by the hospital's policies to administer medications as required by Section 250.2140(c)(6).

 

2)         The requirement that no medication shall be administered except on the written order of a member of the medical staff (Section 250.330(a)) shall not apply to day care programs for mildly ill children. Program staff may administer medication prescribed by any licensed professional who is permitted by law to do so, whether or not the professional is a member of the hospital's medical staff.  (Section 6.13(c)(1) of the Act)

 

k)         Records.  A record shall be maintained for each child registered in the program and shall include each of the following items:

 

1)         Parent or guardian information:

 

A)        Names, home addresses, and home telephone numbers.

 

B)        Employers, work addresses, and work telephone numbers.

 

C)        Telephone numbers where the parent or guardian can be reached.

 

D)        Name, address, and telephone number of a person to be notified in an emergency, if the parent or guardian cannot be reached.

 

E)        Names of persons authorized to remove the child from the program, if other than the parent or guardian.

 

2)         Child information:

 

A)        Name, address and telephone number.

 

B)        Birth date.

 

C)        Medical history, including any known allergies, any diet restrictions or special dietary needs, and proof of immunizations.

 

D)        Current health status.

 

E)        Any prescription and non-prescription medications taken by the child during the previous 24 hours.

 

F)         Any special instructions.

 

G)        The name and telephone number of the child's pediatrician or family practitioner.

 

3)         Signed consent forms from the parent or guardian, authorizing the program to take the following actions:

 

A)        Care for the child in accordance with the program's policies and procedures.

 

B)        Care for the child in accordance with any special instructions given by the parent or guardian which do not conflict with the program's policies and procedures.

 

C)        Administer medication, including prescription and non-prescription drugs.

 

D)        Provide emergency medical treatment.

 

4)         Daily record for each day the child actually spends in the program, including:

 

A)        A description of the evaluation of the child at the time the child is brought to the program premises.

 

B)        A record of the services the child received while at the program, including any medications administered.

 

C)        Periodic assessment of the child's health status while at the program.

 

l)          Staffing

 

1)         The program shall develop a staffing plan which assures the safety, comfort and effective care of children during all times the program is in operation.  Both the numbers and training of staff shall be included in the staffing plan. In programs located on inpatient pediatric units where staff are shared, a staffing plan must be developed and implemented that provides a patient/staff ratio that ensures appropriate staffing levels to meet the needs of both inpatients and day care participants.

 

2)         A registered nurse must be available at all times the program is in operation.

 

3)         Written job qualifications and descriptions must be prepared for all personnel involved with the program.

 

4)         Program staff must have training in the care of ill children and in normal child development.  Such training may be provided by the hospital.

 

m)        Emergency Medical Treatment

 

1)         The program shall have written policies and procedures governing the provision of emergency medical treatment to children registered in the program who become seriously ill.

 

2)         Emergency medical treatment shall be available at all times the program is open for operation.

 

(Source:  Added at 17 Ill. Reg. 1614, effective January 25, 1993)