Lulus Kids Care

NAC 250.4

“4. The play area of each facility must: (a) Be fenced or enclosed in a manner that prevents the unsupervised departure of children from the area; (b) Have an adequate drainage system; (c) Be free of hazards, debris and trash; (d) If it is an outdoor play area, provide, during the months of April through September, a shade area or shade areas that are at least equal in size to the product of 5 square feet multiplied by the total number of children in the outdoor play area; (e) Have appropriate, as determined by the Division, depths and perimeters of resilient surfacing underneath and surrounding any elevated play equipment; (f) Have adequate safety barriers around any elevated platforms; (g) Not have any dangerous or poisonous plants or other vegetative matter located within the boundaries of the play area or in an area that is accessible to children from the play area; (h) Not be in a location where any bodies of water are accessible to children; and (i) If it has playground equipment, have only equipment that is: (1) In good repair; (2) Designed and constructed to minimize injury; (3) Compatible with the age of the children in the care of the facility; (4) Spaced to reduce accidents; and (5) Securely anchored.”

NAC 280.5

“5. The director of the facility shall maintain a daily sign-in sheet that includes: (a) The first and last names of staff and children; and (b) The times of arrival and departure for staff and children”

NAC 390.6

“6. Furniture must be durable, safe and intended for use by children or appropriately adapted for use by children.”

NAC 385

“1. The staff of each facility shall: (a) Provide appropriate and adequate seating for the children at the facility during snacks and meals; (b) If a high chair is used, ensure that the chair: (1) Is in good condition; (2) Has a wide base; and (3) Has a safety belt for the child; (c) Wash with a detergent and disinfect before and after each use of any table that is used during a snack or meal; (d) Allow, encourage and assist each child to feed himself or herself, including, without limitation, encouraging a child to hold and drink from a cup, use a spoon and use his or her fingers to feed himself or herself; (e) Offer each child drinking water at times other than during his or her regular feedings; (f) Discard any food that is left in a dish after a meal; (g) Ensure that bottles and containers of food are not kept in water longer than 5 minutes, and stir, shake and test a bottle or container of food before using the bottle or container to feed an infant; (h) Not hold an infant while preparing food; (i) On a daily basis, empty, clean and sanitize any pot used to warm a bottle or food; (j) Store each bottle of formula and container of food in accordance with the instructions from the manufacturer of the formula or food; (k) Label each bottle of formula and container of food with the name of the child to whom it belongs and the date the formula or food was prepared by the facility or was prepared or purchased by the parent; (l) Immediately refrigerate and label each container of breast milk provided by a parent; (m) Return each bottle to the appropriate parent each day; (n) Return any unused, open container of food to the appropriate parent each day if the child was not fed directly from the container of food; and (o) Develop with the parents of a child a plan for feeding the child, which must include, without limitation: (1) Instructions for feeding; (2) Any special dietary restrictions, including, without limitation, any allergies to food; (3) A schedule of times for feeding; (4) Whether the child will be fed breast milk, formula or solid food; (5) If the child will be fed breast milk or formula, when to begin feeding solid food; and (6) Likes and dislikes of certain foods. 2. A child who is fed with a bottle and does not hold his or her own bottle must be held by a caregiver while being fed with a bottle. The bottle must not be propped for feeding. A child who demonstrates a preference for holding a bottle during feeding may hold his or her own bottle and need not be held by a caregiver if the caregiver is directly observing the child. 3. The staff of a facility may feed a child commercially prepared baby food directly from the jar in which it was packaged or from a separate dish. If the staff feeds the child from the jar, the staff shall discard the jar after it is used. The staff failed to label each bottle of formula and container of food with the name of the child to whom it belonged and the date the formula or food was prepared by the facility or was prepared or purchased by the parent. Ensure formula and food is labeled as required., The staff failed to return each bottle to the appropriate parent each day. Ensure bottles are returned daily to parents.”

NAC 280.5

“5. The director of the facility shall maintain a daily sign-in sheet that includes: (a) The first and last names of staff and children; and (b) The times of arrival and departure for staff and children The facility failed to maintain a daily sign-in sheet that included the times of arrival and departure for staff and children. To ensure times are consistently recorded, please provide instruction to staff and parents and monitor the daily sign-in sheets.”

NAC 308

“1. Whenever a child care facility is in operation, each caregiver on duty must have completed training for the recognition of signs and symptoms of illness and the administration of first aid. 2. The training for the recognition of signs and symptoms of illness must include, without limitation, the provision of information concerning health and the observation and evaluation of signs and symptoms of illness and responses to illness and emergencies and training in the prevention of exposure to bloodborne pathogens. The training for the administration of first aid must include, without limitation, the administration of first aid to victims of fire, serious injury or the ingestion of poison. Both types of training must be: (a) Provided by a licensed health care professional or a representative of a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an institution approved by The Nevada Registry or its successor organization; and (b) Approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve the training; or (2) If the training is not approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve the training, the Division or the local licensing agency. 3. A certificate or other evidence of compliance issued by a licensed health care professional, a licensed health care agency or clinic, a community college, a university, the American National Red Cross, an adult education program in home nursing or an approved provider of such training is adequate evidence of compliance. Documentation for training did not show that the trainer was qualified to provide the training. Obtain verification the trainer meets the requirements: or if this is not possible, new training must be completed”

NAC 340

“1. Procedures for admission must provide the caregiver with sufficient information and instruction from the parents to enable the caregiver to prepare a record and to make decisions or act on behalf of the child. 2. Before the admission of a child to a facility, the parent shall give the following information to the caregiver: (a) The child ' s full legal name, date of birth, current address and preferred name; (b) The name, address and telephone number of each parent responsible for the child and any special instructions needed to reach the parent during the hours the child is in the facility; (c) The name, address and telephone number of any person who can assume responsibility for the child and is authorized to take the child from the facility if the parents cannot be reached; (d) Information concerning the health of the child, including any special needs of the child; and (e) A written authorization signed by a parent which allows emergency surgical and medical care. 3. The caregiver shall, unless the facility is an accommodation facility: (a) Make a record for each child that includes the date the record was prepared and the date the child is scheduled to attend the facility; and (b) Maintain each record in good order. The following children are missing signed transportation permission forms. Secure missing form for the children and submit to licensing., The facility did not ensure that information provided by the parent before admission included a written authorization signed by a parent which allows emergency and medical care. Secure missing authorization for the child(ren) as noted on the supplement.”

NAC 210

“1. Each license must contain the name of each person authorized to operate the facility, the location of the facility, the number of children for whom care may be provided pursuant to the license and the nature of child care services which may be provided. 2. The current license issued to an operator of a facility must be signed by the Administrator of the Division or a person designated by the Administrator and conspicuously posted in a public place within the facility. 3. The license is not transferable from one licensee to another licensee or from a licensee to a person who is not a licensee. A license is valid only for the premises described in the license. 4. Except as otherwise provided in this chapter, a licensee may not care for a greater number of children than the number set forth on the license issued to the licensee. The license issued to the operator of the facility failed to be conspicuously posted in a public place within the facility. Post the license in a conspicuous place.”

NAC.370

“1. Evidence of each child ' s health must be presented to the director of a facility, other than an accommodation facility or a facility that provides care for ill children, within 30 days after the child ' s initial admission. The evidence must include a written statement from a licensed physician or registered nurse attesting to the status of the child ' s health and stating that all known special conditions are under treatment and the child is capable of adjusting to the programs of the facility. 2. A licensee of each such facility shall keep a record of each child which includes any pertinent information on the status of the child ' s health and any special needs of the child.”

NAC 376

“Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child-proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213 . 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child ' s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child ' s parent. The facility failed to maintain a written record of medication administered to include information noted in letter(s) of the following: (a) the name of each medication administered; (b) the name of the child to whom it was administered; and (c) the date and time on which is was administered on a weekly basis. Take corrective action to ensure a complete record., The facility failed to destroy or return to the child ' s parent prescribed medication that was no longer being administered. Dispose of prescribed medication upon discontinuance of use.”

NAC 430

“1. Each facility, including, without limitation, a family home and a group home, shall have an early care and education program. 2. Each facility described in subsection 1 shall develop a written assessment plan which is designed to, without limitation: (a) Identify the interests and needs of each child enrolled in the facility; (b) Describe the developmental and educational progress of each child enrolled in the facility who is not attending public or private elementary school; (c) Identify the need for and referral of a child enrolled in the facility for developmental screening and the referral of the child for diagnostic assessment, if appropriate; (d) Describe the methodology for developing curriculum for the children enrolled in the facility; (e) Adapt teaching practices and the environment to the children enrolled in the facility; (f) Facilitate the early care and education program required pursuant to subsection 1; and (g) Promote communication with the family of a child enrolled in the facility. 3. In addition to the written assessment plan which is developed pursuant to subsection 2, each facility described in subsection 1 shall, within 3 months after a child enrolls in the facility, assess the child by use of, without limitation, portfolios, observations, checklists, rating scales and screening tools. Such an assessment must be repeated biannually thereafter to monitor and support the learning and development of each child enrolled in the facility. 4. Each facility described in subsection 1 shall develop a written plan of curriculum for the children enrolled in the facility. The plan must: (a) Be made available for parental review; (b) Be prepared before the early care and education program becomes effective; (c) Be kept on file at the facility for at least 1 year; (d) Include a program of speaking and listening to English; (e) Integrate age appropriate key areas of instruction, including, without limitation, literacy, mathematics, science, social studies, creative expression and the arts, and health and safety; (f) Incorporate instruction, concepts and activities that foster the social, emotional, physical, linguistic and cognitive development of children; and (g) Provide for the involvement of parents of the children enrolled in the facility in learning activities at the facility and at home. 5. Each facility described in subsection 1 shall provide materials and equipment to carry out the written plan of curriculum developed pursuant to subsection 4 that: (a) Reflect the lives of the children and the families of the children enrolled in the facility; (b) Reflect the diversity of the children in our society with regard to the gender, age, native language, ethnicity, culture and abilities of the children enrolled in the facility; (c) Provide for the safety of the children enrolled in the facility while being appropriately challenging for the children; (d) Encourage the children enrolled in the facility to explore, experiment and discover new information and ideas; (e) Promote action on the part of the children enrolled in the facility and interaction among the children enrolled in the facility; (f) Are organized in a manner which facilitates independent use of the materials and equipment by a child enrolled in the facility; (g) Are rotated to reflect changes in the curriculum and to accommodate the different interests and skill levels of the children enrolled in the facility; (h) Allow for a variety of uses; and (i) Accommodate the special needs of the children enrolled in the facility. The facility failed to ensure assessments were completed at least twice a year and within 3 months of enrollment. Please ensure assessments are completed for all children present, with the exception of school age children, at least twice a year and within 3 months of enrollment.”

NAC 220

“1. Except as otherwise provided in NAC 432A.437, a licensee of a facility may apply for reissuance of a license by submitting an application for reissuance which must be received by the Division, or postmarked if mailed, not later than 45 days before the expiration of the license. The Division shall provide all forms and materials necessary for reissuance of a license. The Division shall charge a late fee of $50 for an application for reissuance of a license that is received or postmarked later than 30 days before the expiration of the license. 2. After receipt of an application for reissuance of a license and the receipt of a fee for reissuance computed in the same manner described in subsection 1 of NAC 432A.200, the Division shall conduct a survey to determine whether the licensee of a facility meets all of the requirements for issuance of a license set forth in NAC 432A.200. 3. If, after investigation, the Division determines that the facility complies with the requirements of NAC 432A.200, a license must be reissued for 1 year. A reissued license may be revoked or suspended on the same grounds as an initial license.”

NAC 306

“1. Every caregiver in a child care facility must: (a) Be at least 16 years of age; (b) Be able to summon help in an emergency; (c) Be emotionally and physically qualified to carry out a program which places emphasis on the development of children; and (d) Except as otherwise provided in subsection 5, within 90 days after the caregiver commences employment in the child care facility, apply with The Nevada Registry or its successor organization, and annually renew his or her registration before the date on which it expires. 2. Not more than 50 percent of the caregivers in a child care center, a child care institution or an early care and education program may be under 18 years of age. Any caregiver who is under 18 years of age and is employed in such a facility must: (a) Have completed a course in the development of children which is approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such courses; or (2) If the course has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency; or (b) Be currently enrolled in such a course. 3. A child care facility may not be operated unless a person who is 18 years of age or older is on the premises of the facility. 4. A volunteer for a child care facility, regardless of his or her age, and a member of the staff of the facility who is under 18 years of age may not provide direct care to a child at the facility unless the care is provided under the supervision of an employee of the facility who is 18 years of age or older. 5. A caregiver in a child care institution is not required to initially apply with or annually renew his or her registration with The Nevada Registry or its successor organization. The facility failed to ensure within 90 days after each caregiver commences his employment in the child care facility; they have applied with the Nevada Registry or its successor organization, and/or annually renewed his registration before the date on which it expires. Provide verification the staff members as noted have submitted initial or renewal application.”

NAC 304

“1. The director of a child care facility is responsible for screening, scheduling and supervising the staff of the facility and for the conduct of each member of the staff at the facility. 2. The director shall: (a) Provide a program for child care for the facility which meets the requirements of this chapter. (b) Be physically present in the facility for a sufficient amount of time to ensure compliance with the provisions of this chapter and chapter 432A of NRS. (c) Provide space for an office, the storage of records, conferences with parents, meetings of the staff and all other needs of the program for child care. (d) Maintain organized separate records for each employee that include, without limitation, documents related to training. Such records must include, without limitation: (1) Documents verifying that the employee has, if applicable: (I) Completed the training required pursuant to NRS 432A.177; (II) Received the orientation and basic training required pursuant to NAC 432A.320; (III) Completed the training required pursuant to NAC 432A.323; and (IV) Completed the training required pursuant to NAC 432A.326; and (2) A copy of the documentation concerning, and the results of, the investigation of the employee’s background and personal history which is conducted pursuant to NRS 432A.170, including, without limitation, a clearance letter from the Division or a current child care work card, and a release form for this information completed by the employee. (e) Ensure that each member of the staff of the facility who is not a caregiver, but whose job duties may directly impact children cared for in the facility, has the training necessary to protect the health and safety of the children and the health and safety of the other members of the staff, including, without limitation, training concerning proper nutrition, methods of sanitation and procedures for maintaining a safe environment in the facility. (f) Work with parents and include them, whenever possible, in the programming and functioning of activities. (g) Cooperate with the Division and other agencies of government to improve the quality of child care and the competence of caregivers. (h) Designate a member of the staff who is responsible for the operation of the facility when the director is not present at the facility. 3. If the facility is in operation 25 hours or less per week, the director must be present in the facility during at least half the hours of operation. The director failed to maintain organized, separate records for each employee that include, without limitation , documents related to training and background investigations. Maintain employee records as required.”

NAC 520

“1. A licensee of a child care facility shall have a staff which is sufficient in number to provide physical care, supervision and individual attention to each child and allow time for interaction between the staff and the children to promote the children ' s social competence, emotional well-being and intellectual development. 2. Except as otherwise provided in subsection 3, in addition to the number of caregivers that are required to satisfy the applicable ratio of caregivers to children set forth in NAC 432A.524, one additional caregiver or an adult volunteer per each group of children must be present on all field trips away from the child care facility to assist in providing direct supervision to the children and to increase the safety of the children. 3. The provisions of subsection 2 do not apply: (a) If the purpose for leaving the child care facility is to transport the children from the child care facility to another location and, upon reaching that location, the responsibility for caring for the children is assumed by another adult. (b) To a group of children that is composed entirely of children of school age, including children who are attending kindergarten. 4. A member of the staff of a facility who is supervising a child pursuant to subsection 1 must: (a) Be physically present in the room where the child being supervised is present; (b) Observe, oversee and guide the child; (c) Be aware of the needs of the child and accountable for the care of the child; and (d) Maintain a proximity to the child that allows the member of the staff to be capable of intervening if assistance or direction is needed by the child. The facility failed to have staff present which is sufficient in number to provide physical care, supervision and individual attention to each child and allow time for interaction between the staff and the children to promote the children ' s social competence, emotional well-being and intellectual development.”

NAC 200.4

“4. Fingerprints must be taken and applications for investigations must be made by: (a) Every employee or a resident of the facility who is 18 years of age or older, other than a resident who remains under the jurisdiction of a court pursuant to NRS 432B.594, and every volunteer of the facility who is 18 years of age and or older, other than a parent of a child who attends the facility, within 24 hours after the date of hiring or his or her presence in the facility, and every 5 years thereafter. (b) Every participant in an outdoor youth program who is 18 years of age or older within 24 hours after the participant begins participating in the program and every 5 years thereafter. (b) An applicant at the time that his or her application is submitted for licensure, and then at least once every 5 years after the license is issued. (d) A licensee every 5 years after the date his or her license is originally issued. Fingerprints were not taken and a release form was not completed by an employee of the facility or a volunteer who is at least 18 years of age within 24 hours after the date of hire or his presence in the facility. Have the employee/volunteer secure required fingerprints and submit with a release form.”

NAC 323

“1. Except as otherwise provided in NAC 432A.521 and NRS 432A.177, within 120 days after commencing his or her employment or position in a child care facility, each person who is employed in a child care facility, other than a person employed in a facility that provides care for ill children, and each director of a child care facility shall complete: (a) Any training required by the facility in which the director serves or in which the person is employed for the purposes of obtaining certification in the administration of cardiopulmonary resuscitation as required pursuant to NAC 432A.322; (b) Three or more hours of training in child development or guidance and discipline specific to the age group served by the facility in which the director serves or in which the person is employed; (c) Two or more hours of training in the administration of first aid; (d) Two or more hours of training in the recognition of signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodborne pathogens; (e) Two or more hours of training in the recognition and reporting of child abuse and neglect; (f) If the person or director works with infants under 12 months of age, at least: (1) Two hours of training concerning Sudden Infant Death Syndrome; and (2) One hour of training in the prevention of shaken baby syndrome and abusive head trauma; (g) Two or more hours of training in the administration of medication, which must include, without limitation, training in the prevention of and response to food and other allergies; (h) Two or more hours of training in building and physical premises safety, which must include, without limitation, training in the storage of biocontaminants and other hazardous materials; (i) Two or more hours of training in emergency preparedness and response planning for emergencies resulting from a natural or man-made event; (j) If the facility provides transportation, 1 or more hours of training in precautions to be taken when transporting children for each person who will provide such transportation; and (k) Two or more hours of training in lifelong wellness, health and safety of children, which must include, without limitation, training relating to childhood obesity, nutrition and moderate or vigorous physical activity. 2. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment, each person described in subsection 1 shall, in addition to completing any training required pursuant to subsection 1 and completing any course in the development of children required pursuant to NAC 432A.306, complete at least the number of hours of training described in NAC 432A.326. A person may use training completed pursuant to subsection 1 to satisfy the training requirements set forth in NAC 432A.326. 3. Except as otherwise provided in NAC 432A.521, within 12 months after commencing employment as a member of the staff of a facility, each member of the staff of a facility shall complete a course in the development of children required pursuant to NAC 432A.306. 4. The training concerning the administration of first aid and the recognition of signs and symptoms of illness that is required to be completed pursuant to subsection 1 must be provided by one of the persons, agencies or institutions listed in NAC 432A.308 as qualified to provide such training. 5. The training required pursuant to subsections 1, 2 and 3 must be designed to: (a) Ensure the protection of the health and safety of each child enrolled in the facility; and (b) Promote the physical, moral and mental well-being of each child enrolled in the facility. 6. If the facility is a special needs facility, the training required pursuant to subsections 1, 2 and 3 must also be designed to provide information on the characteristics of handicapping conditions and appropriate programs for children with special needs. The training must be approved by: (a) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such training; or (b) If the training has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency. 7. Evidence that an employee has completed the training required pursuant to subsections 1, 2 and 3 must be included in his or her personnel file and must be kept at the facility. With regard to training concerning the administration of first aid and the recognition of signs and symptoms of illness, the evidence listed in NAC 432A.308 as adequate evidence of compliance is adequate evidence of compliance for the purposes of this section. The facility failed to ensure that within 90 days of hire each employee completed the required hours of training in child care which includes: any training required by the facility for the purposes of obtaining certification in CPR, three or more hours of training in child development , two or more hours of training in first aid, two or more hours of training in the signs and symptoms of illness, which must include, without limitation, training in the prevention of exposure to bloodbourne pathogens, and two or more hours of training in the recognition and reporting of child abuse. In addition, if a person works with infants under 12 months of age, at least 2 hours of training concerning SIDS. Staff as listed on the supplement need to secure child care training.”

NAC 380

“1. To the extent set forth in subsections 3 and 4, a licensee of a facility shall meet the daily nutritional needs of each child. Meals and snacks must be of a quality and quantity which supplement the food served at home. Cultural and ethnic foods which are appropriate for children must be considered in planning meals. To the extent possible, information provided by parents concerning their child’s eating habits and preferences or special needs regarding food must be considered in planning for meals. 2. A licensee of a facility shall follow the current nutrition standards for meals and snacks which are applicable to children of ages receiving care at the facility as issued by the Child and Adult Care Food Program of the United States Department of Agriculture. 3. A child who stays in a facility: (a) For 10 hours or less in 1 day must be offered at least one meal and two snacks or two meals and one snack; and (b) For more than 10 hours in 1 day must be offered at least two meals and two snacks or one meal and three snacks. 4. A nutritious snack must be offered to all children in the midmorning and the midafternoon. Each child must be offered food at intervals that are at least 2 hours apart and, unless the child is asleep during that time, are not more than 3 hours apart. 5. Foods and beverages which are sweet or have little nutritional value must not be served to children except as an addition to the meals or snacks served to comply with the requirements of subsections 3 and 4. 6. Every menu must be in writing, dated, planned a week in advance, and kept on file in the facility for at least 90 days after the corresponding meal is served. The licensee of a facility shall post the current menu, including any changes, in the kitchen and in a public place within the facility convenient for parental inspection. Family homes and group homes are exempt from the requirements of this subsection. 7. Meals may be brought from home to a facility for a child to consume at the facility. The bag or other container used to bring the meal to the facility must be labeled with the child’s first and last name. A facility shall inform the parents of each child who is cared for in the facility that perishable items must be stored or packed in a manner that maintains the temperature of the contents. 8. A child is not allowed in the kitchen of any facility unless he or she is supervised. 9. Members of the staff of the facility must encourage the children to eat a variety of food and observe table manners. 10. Drinking water must be freely available to all children at all times. 11. Food must not be used as a basis for discipline or reward. Children should be encouraged, but must not be forced, to eat.”

NAC 430

“1. Each facility, including, without limitation, a family home and a group home, shall have an early care and education program. 2. Each facility described in subsection 1 shall develop a written assessment plan which is designed to, without limitation: (a) Identify the interests and needs of each child enrolled in the facility; (b) Describe the developmental and educational progress of each child enrolled in the facility who is not attending public or private elementary school; (c) Identify the need for and referral of a child enrolled in the facility for developmental screening and the referral of the child for diagnostic assessment, if appropriate; (d) Describe the methodology for developing curriculum for the children enrolled in the facility; (e) Adapt teaching practices and the environment to the children enrolled in the facility; (f) Facilitate the early care and education program required pursuant to subsection 1; and (g) Promote communication with the family of a child enrolled in the facility. 3. In addition to the written assessment plan which is developed pursuant to subsection 2, each facility described in subsection 1 shall, within 3 months after a child enrolls in the facility, assess the child by use of, without limitation, portfolios, observations, checklists, rating scales and screening tools. Such an assessment must be repeated biannually thereafter to monitor and support the learning and development of each child enrolled in the facility. 4. Each facility described in subsection 1 shall develop a written plan of curriculum for the children enrolled in the facility. The plan must: (a) Be made available for parental review; (b) Be prepared before the early care and education program becomes effective; (c) Be kept on file at the facility for at least 1 year; (d) Include a program of speaking and listening to English; (e) Integrate age appropriate key areas of instruction, including, without limitation, literacy, mathematics, science, social studies, creative expression and the arts, and health and safety; (f) Incorporate instruction, concepts and activities that foster the social, emotional, physical, linguistic and cognitive development of children; and (g) Provide for the involvement of parents of the children enrolled in the facility in learning activities at the facility and at home. 5. Each facility described in subsection 1 shall provide materials and equipment to carry out the written plan of curriculum developed pursuant to subsection 4 that: (a) Reflect the lives of the children and the families of the children enrolled in the facility; (b) Reflect the diversity of the children in our society with regard to the gender, age, native language, ethnicity, culture and abilities of the children enrolled in the facility; (c) Provide for the safety of the children enrolled in the facility while being appropriately challenging for the children; (d) Encourage the children enrolled in the facility to explore, experiment and discover new information and ideas; (e) Promote action on the part of the children enrolled in the facility and interaction among the children enrolled in the facility; (f) Are organized in a manner which facilitates independent use of the materials and equipment by a child enrolled in the facility; (g) Are rotated to reflect changes in the curriculum and to accommodate the different interests and skill levels of the children enrolled in the facility; (h) Allow for a variety of uses; and (i) Accommodate the special needs of the children enrolled in the facility. The facility failed to ensure assessments were completed at least twice a year and within 3 months of enrollment. Please ensure assessments are completed for all children present, with the exception of school age children, at least twice a year and within 3 months of enrollment.”

NAC 310

“1. Every member of the staff of a facility, including a volunteer, and each resident of the facility shall present to the director of the facility, to be placed in the person’s file, written evidence that the person is free from communicable tuberculosis. The evidence must be in the form of a report which states that the person is free from active tuberculosis as required pursuant to subsection 2 or 3. This subsection does not apply to a child who is receiving child care services from the facility or a child who resides at the facility who is not employed by or volunteering at the facility. 2. Before a person, including a person who has received a bacillus Calmette- Guerin (BCG) vaccination, begins employment, volunteering or residing at a facility, he or she must have submitted to a: (a) Tuberculin test; or (b) Chest radiograph and examination by a provider of health care who is authorized to diagnose active tuberculosis, Ê within the 12 months immediately preceding the first day of employment, volunteering or residing at the facility. 3. Every member of the staff of a facility, including a volunteer, and each resident of the facility shall submit to: (a) A tuberculin test; or (b) An examination by a provider of health care who is authorized to diagnose active tuberculosis, Ê at least once every 24 months after the date the tuberculin test or chest radiograph and examination were conducted pursuant to subsection 2. 4. Each caregiver or member of the staff of a facility who has an identified health problem that may affect his or her ability to provide adequate care to children in a facility shall: (a) Report the problem to the director of the facility or, if self-employed, to his or her licensing agency; and (b) Submit to the director or, if self- employed, to his or her licensing agency, a written statement from a licensed physician attesting to the fact that the health of the caregiver does not endanger the children who are under his or her care in the facility. 5. Each director shall report to his or her licensing agency any health problem reported to him or her pursuant to subsection 4. 6. Each director or caregiver, if self- employed, shall immediately report to his or her licensing agency any person residing at his or her facility who contracts a serious communicable disease. 7. Each caregiver or member of the staff of a facility who has herpetic gingivostomatitis, a cold sore or herpes labialis shall: (a) Refrain from engaging in close contact with children cared for in the facility; (b) Refrain from sharing food or drink with children cared for in the facility or with other caregivers or members of the staff of the facility; (c) Avoid touching the lesions; (d) Wash his or her hands frequently; and (e) Cover any skin lesion with a bandage, clothing or other appropriate dressing. Negative TB tests are needed for all caregivers. These staff may not return to work until a negative TB is provided to CCL.”

NAC 310

“1. Every member of the staff of a facility, including a volunteer, and each resident of the facility shall present to the director of the facility, to be placed in the person’s file, written evidence that the person is free from communicable tuberculosis. The evidence must be in the form of a report which states that the person is free from active tuberculosis as required pursuant to subsection 2 or 3. This subsection does not apply to a child who is receiving child care services from the facility or a child who resides at the facility who is not employed by or volunteering at the facility. 2. Before a person, including a person who has received a bacillus Calmette- Guerin (BCG) vaccination, begins employment, volunteering or residing at a facility, he or she must have submitted to a: (a) Tuberculin test; or (b) Chest radiograph and examination by a provider of health care who is authorized to diagnose active tuberculosis, Ê within the 12 months immediately preceding the first day of employment, volunteering or residing at the facility. 3. Every member of the staff of a facility, including a volunteer, and each resident of the facility shall submit to: (a) A tuberculin test; or (b) An examination by a provider of health care who is authorized to diagnose active tuberculosis, Ê at least once every 24 months after the date the tuberculin test or chest radiograph and examination were conducted pursuant to subsection 2. 4. Each caregiver or member of the staff of a facility who has an identified health problem that may affect his or her ability to provide adequate care to children in a facility shall: (a) Report the problem to the director of the facility or, if self-employed, to his or her licensing agency; and (b) Submit to the director or, if self- employed, to his or her licensing agency, a written statement from a licensed physician attesting to the fact that the health of the caregiver does not endanger the children who are under his or her care in the facility. 5. Each director shall report to his or her licensing agency any health problem reported to him or her pursuant to subsection 4. 6. Each director or caregiver, if self- employed, shall immediately report to his or her licensing agency any person residing at his or her facility who contracts a serious communicable disease. 7. Each caregiver or member of the staff of a facility who has herpetic gingivostomatitis, a cold sore or herpes labialis shall: (a) Refrain from engaging in close contact with children cared for in the facility; (b) Refrain from sharing food or drink with children cared for in the facility or with other caregivers or members of the staff of the facility; (c) Avoid touching the lesions; (d) Wash his or her hands frequently; and (e) Cover any skin lesion with a bandage, clothing or other appropriate dressing. Negative TB tests are needed for all caregivers. These staff may not return to work until a negative TB is provided to CCL.”

NRS 230

“Certificate of immunization prerequisite to admission to child care facility; conditional admission; report to Health Division. Except as otherwise provided in NRS 432A.235 for accommodation facilities: 1. Except as otherwise provided in subsection 3 and unless excused because of religious belief or medical condition, a child may not be admitted to any child care facility within this State, including a facility licensed by a county or city, unless the parents or guardian of the child submit to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 <NRS-439.html> for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the State Board of Health may determine. 2. The certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his or her designee or a registered nurse or his or her designee, attesting that the certificate accurately reflects the child ' s record of immunization. 3. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunization cannot be immediately confirmed by a physician in this State or a local health officer, may enter the child care facility conditionally if the parent or guardian: (a) Agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (b) Submits proof that the parent or guardian has not established a permanent residence in the county in which the facility is located. 4. If a certificate from the physician or local health officer showing that the child has received or is receiving the required immunizations is not submitted to the operator of the child care facility within 15 days after the child was conditionally admitted, the child must be excluded from the facility. 5. Before December 31 of each year, each child care facility shall report to the Health Division of the Department, on a form furnished by the Division, the exact number of children who have: (a) Been admitted conditionally to the child care facility; and (b) Completed the immunizations required by this section. A certificate of immunization prerequisite to admission to child care facility; Child(ren) as noted below failed to have current immunization records on file at time of inspection.”

NRS 230

“Certificate of immunization prerequisite to admission to child care facility; conditional admission; report to Health Division. Except as otherwise provided in NRS 432A.235 for accommodation facilities: 1. Except as otherwise provided in subsection 3 and unless excused because of religious belief or medical condition, a child may not be admitted to any child care facility within this State, including a facility licensed by a county or city, unless the parents or guardian of the child submit to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 <NRS-439.html> for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the State Board of Health may determine. 2. The certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his or her designee or a registered nurse or his or her designee, attesting that the certificate accurately reflects the child ' s record of immunization. 3. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunization cannot be immediately confirmed by a physician in this State or a local health officer, may enter the child care facility conditionally if the parent or guardian: (a) Agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (b) Submits proof that the parent or guardian has not established a permanent residence in the county in which the facility is located. 4. If a certificate from the physician or local health officer showing that the child has received or is receiving the required immunizations is not submitted to the operator of the child care facility within 15 days after the child was conditionally admitted, the child must be excluded from the facility. 5. Before December 31 of each year, each child care facility shall report to the Health Division of the Department, on a form furnished by the Division, the exact number of children who have: (a) Been admitted conditionally to the child care facility; and (b) Completed the immunizations required by this section.”

NAC 306

“1. Every caregiver in a child care facility must: (a) Be at least 16 years of age; (b) Be able to summon help in an emergency; (c) Be emotionally and physically qualified to carry out a program which places emphasis on the development of children; and (d) Except as otherwise provided in subsection 5, within 90 days after the caregiver commences employment in the child care facility, apply with The Nevada Registry or its successor organization, and annually renew his or her registration before the date on which it expires. 2. Not more than 50 percent of the caregivers in a child care center, a child care institution or an early care and education program may be under 18 years of age. Any caregiver who is under 18 years of age and is employed in such a facility must: (a) Have completed a course in the development of children which is approved by: (1) The Nevada Registry or its successor organization, or any other agency designated by the Director of the Department to approve such courses; or (2) If the course has not been approved by The Nevada Registry or its successor organization, and the Director of the Department has not designated another agency to approve such courses, the Division or the local licensing agency; or (b) Be currently enrolled in such a course. 3. A child care facility may not be operated unless a person who is 18 years of age or older is on the premises of the facility. 4. A volunteer for a child care facility, regardless of his or her age, and a member of the staff of the facility who is under 18 years of age may not provide direct care to a child at the facility unless the care is provided under the supervision of an employee of the facility who is 18 years of age or older. 5. A caregiver in a child care institution is not required to initially apply with or annually renew his or her registration with The Nevada Registry or its successor organization.”

NRS 230

“Certificate of immunization prerequisite to admission to child care facility; conditional admission; report to Health Division. Except as otherwise provided in NRS 432A.235 for accommodation facilities: 1. Except as otherwise provided in subsection 3 and unless excused because of religious belief or medical condition, a child may not be admitted to any child care facility within this State, including a facility licensed by a county or city, unless the parents or guardian of the child submit to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 <NRS-439.html> for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the State Board of Health may determine. 2. The certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his or her designee or a registered nurse or his or her designee, attesting that the certificate accurately reflects the child ' s record of immunization. 3. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunization cannot be immediately confirmed by a physician in this State or a local health officer, may enter the child care facility conditionally if the parent or guardian: (a) Agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (b) Submits proof that the parent or guardian has not established a permanent residence in the county in which the facility is located. 4. If a certificate from the physician or local health officer showing that the child has received or is receiving the required immunizations is not submitted to the operator of the child care facility within 15 days after the child was conditionally admitted, the child must be excluded from the facility. 5. Before December 31 of each year, each child care facility shall report to the Health Division of the Department, on a form furnished by the Division, the exact number of children who have: (a) Been admitted conditionally to the child care facility; and (b) Completed the immunizations required by this section.”

NAC 200.4

“4. Fingerprints must be taken and applications for investigations must be made by: (a) Every employee or a resident of the facility who is 18 years of age or older, other than a resident who remains under the jurisdiction of a court pursuant to NRS 432B.594, and every volunteer of the facility who is 18 years of age and or older, other than a parent of a child who attends the facility, within 24 hours after the date of hiring or his or her presence in the facility, and every 5 years thereafter. (b) Every participant in an outdoor youth program who is 18 years of age or older within 24 hours after the participant begins participating in the program and every 5 years thereafter. (b) An applicant at the time that his or her application is submitted for licensure, and then at least once every 5 years after the license is issued. (d) A licensee every 5 years after the date his or her license is originally issued.”

NAC 376

“Except as otherwise provided in NAC 432A.585: 1. Each prescribed medication must: (a) Be kept in the original container which must have a child-proof lid; (b) Be plainly labeled; (c) Contain the name of the child or adult for whom it is prescribed; and (d) Be stored in a locked cabinet or be made inaccessible to children. 2. Medications for external use must be kept in a separate section of the locked cabinet. Medications stored in a refrigerator must be made inaccessible to children. Nonprescription medications must be kept in a container with a child-proof lid. 3. Except in an emergency, only one person designated by the licensee of a facility may administer medications to children. A person designated by the licensee of a facility pursuant to this subsection must be trained in the administration of medication by a health care professional or the parent of a child cared for in the facility and authorized to administer the medication pursuant to NRS 453.375 or 454.213 . 4. The licensee of a facility shall maintain a written record containing: (a) The name of each medication administered; (b) The name of the child to whom it was administered; and (c) The date and time on which it was administered on a weekly basis. The record must be kept in the child ' s file. 5. A prescribed medication must, upon discontinuance of use, be promptly destroyed or returned to the child ' s parent.”

NAC.370

“1. Evidence of each child ' s health must be presented to the director of a facility, other than an accommodation facility or a facility that provides care for ill children, within 30 days after the child ' s initial admission. The evidence must include a written statement from a licensed physician or registered nurse attesting to the status of the child ' s health and stating that all known special conditions are under treatment and the child is capable of adjusting to the programs of the facility. 2. A licensee of each such facility shall keep a record of each child which includes any pertinent information on the status of the child ' s health and any special needs of the child.”

NAC 200.4

“4. Fingerprints must be taken and applications for investigations must be made by: (a) Every employee or a resident of the facility who is 18 years of age or older, other than a resident who remains under the jurisdiction of a court pursuant to NRS 432B.594, and every volunteer of the facility who is 18 years of age and or older, other than a parent of a child who attends the facility, within 24 hours after the date of hiring or his or her presence in the facility, and every 5 years thereafter. (b) Every participant in an outdoor youth program who is 18 years of age or older within 24 hours after the participant begins participating in the program and every 5 years thereafter. (b) An applicant at the time that his or her application is submitted for licensure, and then at least once every 5 years after the license is issued. (d) A licensee every 5 years after the date his or her license is originally issued.”

NAC.370

“1. Evidence of each child ' s health must be presented to the director of a facility, other than an accommodation facility or a facility that provides care for ill children, within 30 days after the child ' s initial admission. The evidence must include a written statement from a licensed physician or registered nurse attesting to the status of the child ' s health and stating that all known special conditions are under treatment and the child is capable of adjusting to the programs of the facility. 2. A licensee of each such facility shall keep a record of each child which includes any pertinent information on the status of the child ' s health and any special needs of the child.”

NAC 430

“1. Each facility, including, without limitation, a family home and a group home, shall have an early care and education program. 2. Each facility described in subsection 1 shall develop a written assessment plan which is designed to, without limitation: (a) Identify the interests and needs of each child enrolled in the facility; (b) Describe the developmental and educational progress of each child enrolled in the facility who is not attending public or private elementary school; (c) Identify the need for and referral of a child enrolled in the facility for developmental screening and the referral of the child for diagnostic assessment, if appropriate; (d) Describe the methodology for developing curriculum for the children enrolled in the facility; (e) Adapt teaching practices and the environment to the children enrolled in the facility; (f) Facilitate the early care and education program required pursuant to subsection 1; and (g) Promote communication with the family of a child enrolled in the facility. 3. In addition to the written assessment plan which is developed pursuant to subsection 2, each facility described in subsection 1 shall, within 3 months after a child enrolls in the facility, assess the child by use of, without limitation, portfolios, observations, checklists, rating scales and screening tools. Such an assessment must be repeated biannually thereafter to monitor and support the learning and development of each child enrolled in the facility. 4. Each facility described in subsection 1 shall develop a written plan of curriculum for the children enrolled in the facility. The plan must: (a) Be made available for parental review; (b) Be prepared before the early care and education program becomes effective; (c) Be kept on file at the facility for at least 1 year; (d) Include a program of speaking and listening to English; (e) Integrate age appropriate key areas of instruction, including, without limitation, literacy, mathematics, science, social studies, creative expression and the arts, and health and safety; (f) Incorporate instruction, concepts and activities that foster the social, emotional, physical, linguistic and cognitive development of children; and (g) Provide for the involvement of parents of the children enrolled in the facility in learning activities at the facility and at home. 5. Each facility described in subsection 1 shall provide materials and equipment to carry out the written plan of curriculum developed pursuant to subsection 4 that: (a) Reflect the lives of the children and the families of the children enrolled in the facility; (b) Reflect the diversity of the children in our society with regard to the gender, age, native language, ethnicity, culture and abilities of the children enrolled in the facility; (c) Provide for the safety of the children enrolled in the facility while being appropriately challenging for the children; (d) Encourage the children enrolled in the facility to explore, experiment and discover new information and ideas; (e) Promote action on the part of the children enrolled in the facility and interaction among the children enrolled in the facility; (f) Are organized in a manner which facilitates independent use of the materials and equipment by a child enrolled in the facility; (g) Are rotated to reflect changes in the curriculum and to accommodate the different interests and skill levels of the children enrolled in the facility; (h) Allow for a variety of uses; and (i) Accommodate the special needs of the children enrolled in the facility.”