Shenker Academy

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.”

NAC 425

“1. The director or a designated member of the staff of a nursery for infants and toddlers or other facility that enrolls infants and toddlers shall discuss policies concerning the health of an infant or toddler with the parents before enrollment of the child. Every parent must be given a description of and agree in writing to the following matters concerning the child: (a) Feeding; (b) Diapering; (c) Changes of clothing, which are to be provided by the parents; (d) Bathing, including, without limitation, the kind of soap to be used; (e) Precautions against infectious disease; (f) Sleeping; (g) Toilet training; (h) Daily reports to the parents; (i) Any special precautions regarding the health and safety of the child; and (j) Any other information deemed necessary by the facility or the Health Division. 2. A caregiver must be assigned to a specific group of infants on a continuing basis. 3. Except as otherwise provided in paragraph (n) of subsection 3 of NAC 432A.416, each infant and toddler must be under direct visual observation by a qualified caregiver at all times. 4. Each infant and toddler must be given undivided attention by the same caregiver for at least 30 minutes in the morning and 30 minutes in the afternoon, including periods of feeding and bathing. The caregiver shall, during this time: (a) Hold and talk to the child; (b) Encourage the development of the child ' s coordination by allowing him or her to reach for, grasp, creep, crawl or pull up; (c) Give toddlers the opportunity to develop the large muscles of the body by activities such as climbing and walking; and (d) Encourage the child to interact socially through playing, using language and solving problems using materials and equipment that are appropriate for the age of the child. Infants under 6 months of age must be provided an additional period of not less than 2 hours of activity each day out of the crib, for example, in a playpen or other suitable area. 5. Each licensee of a facility shall provide an indoor area which is covered by a soft or nonabrasive material and is protected from traveled walkways where crawling children can be on the floor for at least a part of the day. 6. A caregiver may take the infant or toddler assigned to him or her outside or to areas of the facility other than their usual room for a part of each day to provide a change in their physical environment and to increase opportunities for social interaction. 7. When weather permits, each toddler over 12 months of age must be taken outside for a portion of each day. If the weather is extremely hot, the toddler must be kept in a shaded area while outdoors. 8. An infant who is awake must not be left in a crib for long periods without direct adult care and never for more than 30 minutes at a time. 9. The staff of a nursery for infants and toddlers shall separate the infants from the toddlers while the toddlers are engaging in physical activities. 10. There must be a resilient surface under equipment that is used for playing and climbing at a nursery for infants and toddlers. Such equipment must be appropriate for the age of the children using the equipment. 11. The staff of a nursery for infants and toddlers shall promote the healthy development of toddlers by: (a) Expressing feelings with words; (b) Giving directions that are worded in a positive manner; (c) Modeling desirable behavior; and (d) Redirecting behavior. 12. The staff of a nursery for infants and toddlers shall not discipline or punish an infant or toddler by confining him or her to a crib, high chair, playpen or other such piece of furniture or equipment. 13. The staff of a nursery for infants and toddlers shall prepare a daily report for each infant less than 12 months of age for whom it provides care. The report must be posted in a conspicuous place in each room used to care for the infants and must include, without limitation, information concerning the feeding, diapering and sleeping of each infant.”

NAC 400

“1. A licensee of a facility shall enhance a child ' s behavior through positive guidance, redirection of the child ' s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child ' s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; or (g) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child ' s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. The facility failed to enhance the behavior of children through the use of positive guidance, redirection of the child 's behavior and the setting of clear-cut limits on behavior. Outdoor time shall not be withheld as form of discipline. Often children who are exhibiting challenging behaviors in the classroom will benefit from the movement and physical activity that outdoor time allows. Disciplinary measures used in a facility must be consistent with supportive, positive action”

NAC 390

“1. Every licensee of a facility shall develop a program to meet the basic needs of children for: (a) Good health and normal physical development; (b) Optimal mental growth; (c) Stimulating language and communicative experiences; (d) The attention, acceptance and affection of others; (e) Opportunities to experience success and to test mental, physical and social skills; (f) Self-identity and a sense of competence and worth; (g) The security provided by gentle discipline; (h) Relations with others which set forth the rights of adults and the rights of children; (i) Learning experiences planned with the aid of the child ' s parents which ensure harmony with the life style and cultural background of the child; (j) Activities which facilitate social growth and adjustment; and (k) The time and opportunity to learn independence and personal care. 2. A licensee of a facility shall teach each child personal hygiene. The licensee of a facility shall require all children to wash before meals and after using a toilet. 3. If the weather permits, all children must have a daily period of outdoor play. A licensee of a facility shall provide opportunities for active play which builds muscles such as climbing, jumping, running and playing with toys which have wheels. The quantity and quality of materials and equipment must be sufficient to avoid excessive competition between the children and long waiting periods to use the materials or equipment. 4. Every child who is in a facility for more than 5 hours per day must have a period for a nap during the day. A child who cannot sleep must rest during the period provided for a nap. The licensee of a facility shall provide a cot, mat or bed for each child. 5. The amount, variety and arrangement and use of materials and equipment used in a facility must be appropriate to the developmental needs of the children cared for in the facility. Materials must be stored in a manner that allows children to select, remove and replace the materials independently or with minimal assistance. 6. Furniture must be durable, safe and intended for use by children or appropriately adapted for use by children. 7. A licensee of a facility shall provide space for the storage of the children ' s clothing and the storage must be within easy reach of the children.”

NAC 200.3

“3. Documentation of completed and current investigations must be kept on file at the facility for all persons required to be investigated, for the period of their presence at the facility. Based on record”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children.”

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.”

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.”

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.”

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 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.”

NAC 425

“1. The director or a designated member of the staff of a nursery for infants and toddlers or other facility that enrolls infants and toddlers shall discuss policies concerning the health of an infant or toddler with the parents before enrollment of the child. Every parent must be given a description of and agree in writing to the following matters concerning the child: (a) Feeding; (b) Diapering; (c) Changes of clothing, which are to be provided by the parents; (d) Bathing, including, without limitation, the kind of soap to be used; (e) Precautions against infectious disease; (f) Sleeping; (g) Toilet training; (h) Daily reports to the parents; (i) Any special precautions regarding the health and safety of the child; and (j) Any other information deemed necessary by the facility or the Health Division. 2. A caregiver must be assigned to a specific group of infants on a continuing basis. 3. Except as otherwise provided in paragraph (n) of subsection 3 of NAC 432A.416, each infant and toddler must be under direct visual observation by a qualified caregiver at all times. 4. Each infant and toddler must be given undivided attention by the same caregiver for at least 30 minutes in the morning and 30 minutes in the afternoon, including periods of feeding and bathing. The caregiver shall, during this time: (a) Hold and talk to the child; (b) Encourage the development of the child ' s coordination by allowing him or her to reach for, grasp, creep, crawl or pull up; (c) Give toddlers the opportunity to develop the large muscles of the body by activities such as climbing and walking; and (d) Encourage the child to interact socially through playing, using language and solving problems using materials and equipment that are appropriate for the age of the child. Infants under 6 months of age must be provided an additional period of not less than 2 hours of activity each day out of the crib, for example, in a playpen or other suitable area. 5. Each licensee of a facility shall provide an indoor area which is covered by a soft or nonabrasive material and is protected from traveled walkways where crawling children can be on the floor for at least a part of the day. 6. A caregiver may take the infant or toddler assigned to him or her outside or to areas of the facility other than their usual room for a part of each day to provide a change in their physical environment and to increase opportunities for social interaction. 7. When weather permits, each toddler over 12 months of age must be taken outside for a portion of each day. If the weather is extremely hot, the toddler must be kept in a shaded area while outdoors. 8. An infant who is awake must not be left in a crib for long periods without direct adult care and never for more than 30 minutes at a time. 9. The staff of a nursery for infants and toddlers shall separate the infants from the toddlers while the toddlers are engaging in physical activities. 10. There must be a resilient surface under equipment that is used for playing and climbing at a nursery for infants and toddlers. Such equipment must be appropriate for the age of the children using the equipment. 11. The staff of a nursery for infants and toddlers shall promote the healthy development of toddlers by: (a) Expressing feelings with words; (b) Giving directions that are worded in a positive manner; (c) Modeling desirable behavior; and (d) Redirecting behavior. 12. The staff of a nursery for infants and toddlers shall not discipline or punish an infant or toddler by confining him or her to a crib, high chair, playpen or other such piece of furniture or equipment. 13. The staff of a nursery for infants and toddlers shall prepare a daily report for each infant less than 12 months of age for whom it provides care. The report must be posted in a conspicuous place in each room used to care for the infants and must include, without limitation, information concerning the feeding, diapering and sleeping of each infant.”

NAC 400

“1. A licensee of a facility shall enhance a child ' s behavior through positive guidance, redirection of the child ' s behavior and the setting of clear-cut limits on behavior. 2. A member, employee or other person associated with a facility shall not, for any reason: (a) Inflict physical punishment, in any manner or form, upon any child; (b) Verbally abuse or threaten a child; (c) Make derogatory remarks about the child or the child ' s family; (d) Threaten a child with the loss of love of any person; (e) Threaten a child with punishment by a deity; (f) Subject a child to any form of punishment which pertains to food or rest or restricts the use of a toilet or other bathroom fixture; or (g) Subject a child to any form of punishment by other children. Parental consent to allow any person within the facility to punish a child contrary to the provisions of this section is void. 3. Disciplinary measures used in a facility must be consistent with supportive, positive action, and may include: (a) Holding a child ' s arm to prevent hitting; (b) Bodily picking up the child and removing him or her from the group, and: (1) Sitting with the child until he or she is ready to play without hitting; or (2) Isolating the child under observation for no more than 10 minutes; (c) Informing the child in a simple, positive manner what conduct is expected while the child is in the facility; (d) Praising and recognizing a child who behaves in the expected manner; and (e) Directing a child who is in a situation that is creating problems to a new activity. The facility failed to enhance the behavior of children through the use of positive guidance, redirection of the child 's behavior and the setting of clear-cut limits on behavior. Outdoor time shall not be withheld as form of discipline. Often children who are exhibiting challenging behaviors in the classroom will benefit from the movement and physical activity that outdoor time allows. Disciplinary measures used in a facility must be consistent with supportive, positive action”

NAC 390

“1. Every licensee of a facility shall develop a program to meet the basic needs of children for: (a) Good health and normal physical development; (b) Optimal mental growth; (c) Stimulating language and communicative experiences; (d) The attention, acceptance and affection of others; (e) Opportunities to experience success and to test mental, physical and social skills; (f) Self-identity and a sense of competence and worth; (g) The security provided by gentle discipline; (h) Relations with others which set forth the rights of adults and the rights of children; (i) Learning experiences planned with the aid of the child ' s parents which ensure harmony with the life style and cultural background of the child; (j) Activities which facilitate social growth and adjustment; and (k) The time and opportunity to learn independence and personal care. 2. A licensee of a facility shall teach each child personal hygiene. The licensee of a facility shall require all children to wash before meals and after using a toilet. 3. If the weather permits, all children must have a daily period of outdoor play. A licensee of a facility shall provide opportunities for active play which builds muscles such as climbing, jumping, running and playing with toys which have wheels. The quantity and quality of materials and equipment must be sufficient to avoid excessive competition between the children and long waiting periods to use the materials or equipment. 4. Every child who is in a facility for more than 5 hours per day must have a period for a nap during the day. A child who cannot sleep must rest during the period provided for a nap. The licensee of a facility shall provide a cot, mat or bed for each child. 5. The amount, variety and arrangement and use of materials and equipment used in a facility must be appropriate to the developmental needs of the children cared for in the facility. Materials must be stored in a manner that allows children to select, remove and replace the materials independently or with minimal assistance. 6. Furniture must be durable, safe and intended for use by children or appropriately adapted for use by children. 7. A licensee of a facility shall provide space for the storage of the children ' s clothing and the storage must be within easy reach of the children.”

NAC 200.3

“3. Documentation of completed and current investigations must be kept on file at the facility for all persons required to be investigated, for the period of their presence at the facility. Based on record”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children.”

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.”

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.”

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.”

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 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.”

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.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section.”

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.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section.”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section. The facility failed to have a completed complaint review (NRS-178) on file and signed by parents/guardians for the following children:”

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.”

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 250

“1. Except as otherwise provided in this subsection, subsection 3 and NRS 432A.078 in each facility there must be: (a) At least 35 square feet of indoor space for each child, exclusive of bathrooms, halls, kitchen, stairs, storage spaces, multipurpose rooms and gymnasiums that are not regularly used. (b) At least 37 1/2 square feet of outdoor play space for each child, as determined by the maximum number of children stated on the license for the facility. An accommodation facility need not provide outdoor play space. 2. Each facility shall: (a) Ensure that each room of the facility which is used by children is: (1) Maintained free of drafts and at a temperature that is not less than 65 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of October through March and at a temperature that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit during the months of April through September; and (2) Heated, cooled and ventilated to maintain the temperatures required in this paragraph and to avoid the accumulation of odors and fumes; (b) Ensure that electrical devices or electrical apparatuses which are accessible to children are not located near any type of water source, including, without limitation, any sink, tub, shower area or wading pool; and (c) Install nonflammable barriers, including, without limitation, permanent guards or shields to cover heating units, including, without limitation, hot water heating pipes and baseboard heaters with a surface temperature that is hotter than 100 degrees Fahrenheit, to ensure that those heating units are inaccessible to children. 3. A facility that provides care for ill children must have: (a) At least 50 square feet of indoor space for each child, as determined by the maximum number of children stated on the license for the facility, exclusive of bathrooms, halls, kitchen, stairs and storage spaces. (b) A separate ventilation system if the facility is attached to another building. 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. 5. If a facility that provides care for ill children is a component of a child care center and provides outdoor play space, the play space must: (a) Be separate from the play space for well children; (b) Meet the requirements of paragraph (b) of subsection 1; and (c) Meet the requirements of subsection 4. REVISER ' S NOTE. The regulation of the Board for Child Care filed with the Secretary of State on April 23, 2009 (LCB File No. R032-07), which amended this section, contains the following provision not included in NAC: " 1. A child care facility is exempt from the provisions of paragraph (e) of subsection 4 of NAC 432A.250, as amended by section 9 of this regulation, until the date for compliance with those provisions established by the Bureau of Services for Child Care of the Division of Child and Family Services of the Department of Health and Human Services [now the Division] or an agency for the licensing of child care facilities established by a county or city, as applicable. 2. As used in this section, " child care facility " has the meaning ascribed to it in NAC 432A.060. "”

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 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.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.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.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section.”

NAC 350

“1. Every licensee of a facility shall adopt a written statement which: (a) Sets forth the general services to be offered to the children; (b) Provides for the special needs of each child; (c) States the requirements for admission and procedures for enrollment; (d) Sets forth fees and any plan for payment of fees; (e) Provides rules relating to personal belongings brought to the facility; (f) Covers arrangements for transportation; (g) Requires written parental permission for trips and activities outside the facility; (h) Provides for parental involvement in the general functions of the facility; (i) Gives either or both parents the right to observe the program of the licensee before enrollment and at any time after enrollment of the child; (j) For a child care facility as defined in paragraph (a) of subsection 7 of NRS 202.2491 <../NRS/NRS-202.html>, notifies either or both parents that smoking of tobacco in any form is prohibited in the facility at all times; (k) For a facility other than a child care facility as defined in paragraph (a) of subsection 7 of NRS 202.2491 <../NRS/NRS-202.html>, notifies either or both parents if smoking of tobacco is permitted on the premises of the facility in a designated area approved by the fire authority; (l) Notifies either or both parents if and when a member of the staff who is trained and certified in cardiopulmonary resuscitation is on duty at the facility; and (m) Notifies either or both parents of the contents of any plan created pursuant to NAC 432A.280 to ensure that the staff of the facility is prepared to respond to an emergency. 2. In addition to the information required by subsection 1, a licensee for a facility that provides care for ill children shall adopt criteria for admission that set forth: (a) The illnesses and disabilities that are accepted; (b) The illnesses and disabilities that are not accepted; (c) The ages of children served by the facility; (d) The information required from a parent before a child may be admitted to the facility; and (e) The procedures to be followed by the staff of the facility in the event of an emergency. 3. Every licensee shall provide a copy of the statement described in subsection 1 to each paid or volunteer member of its staff, to each parent of a child enrolled in the facility and to the Health Division. 4. The name, business address and business telephone number of any person who has legal or administrative responsibility for the facility must be provided to each parent of a child enrolled in the facility and to the Health Division. 5. The licensee of a facility shall notify each parent of a child enrolled in the facility and the Health Division of significant changes in the services offered by the facility.”

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.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section.”

NAC 360

“1. The licensee of a facility shall not disclose to any person who is not a member of the staff of the facility or a member of the licensing staff of the Health Division information pertaining to any child, unless: (a) The parent has given written permission for the disclosure; or (b) There is an emergency as determined by the director or the member of the staff who is in charge at the time of the emergency. 2. The licensee of a facility shall have available forms which allow a parent to release information pertaining to his or her child.”

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 430.2

“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.”

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.”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children.”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children. Facility failed to recognize and eliminate the following hazards for the safety of children as evidenced by the following:”

NAC 5205

“1. Except as otherwise provided in NAC 432A.290 and 432A.546, a licensee of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility shall, between the hours of 6:30 a.m. and 9:00 p.m., abide by the following staffing levels in each classroom: Age of Child Required Staff to Child Ratio Group Size Less than 9 months of age 1 caregiver for every 4 children 8 9 months of age or older but less than 2 years of age 1 caregiver for every 6 children 12 2 years of age or older but less than 3 years of age 1 caregiver for every 9 children 18 3 years of age or older but less than 4 years of age 1 caregiver for every 12 children 24 4 years of age or older but less than 5 years of age 1 caregiver for every 13 children 26 5 years of age or older 1 caregiver for every 18 children 36 2. Except as otherwise provided in NAC 432A.546, a licensee of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility which is operated between the hours of 9:00 p.m. and 6:30 a.m. shall abide by the following staffing levels in each classroom: Age of Child Required Staff to Child Ratio Group Size Less than 3 years of age 1 caregiver for every 6 children 12 3 years of age or older 1 caregiver for every 10 children 20 3. Every member of the staff of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility who is on duty at night shall remain awake during duty hours. 4. A licensee of a child care facility is allowed to utilize all useable and measured square footage within a classroom to meet the requirements of NAC 432A.250 if the requirements for ratios and groups described in subsections 1 and 2 are maintained within such classrooms. 5. If a licensee of a child care facility care for children of different age groups as described in subsections 1 and 2, the licensee shall abide by the required staff to child ratio and group size based on the age of the youngest child in the group. The facility failed to provide an adequate # of staff for the number of infants/toddlers in care. Take corrective action to ensure sufficient staffing in order to provide for children ' s needs.”

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 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 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 200.3

“3. Documentation of completed and current investigations must be kept on file at the facility for all persons required to be investigated, for the period of their presence at the facility. Documentation of completed and current investigations were not on file at the facility for required persons. The following items were not observed for individuals as noted below:”

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 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 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 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 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 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 326

“1. During each 12-month licensing period immediately succeeding the completion of the initial training required pursuant to NAC 432A.323, each director of a child care facility and each caregiver who is employed at the facility shall complete: (a) If the facility provides care for ill children, at least 24 hours of training, of which not more than 3 hours may be training in the administration of cardiopulmonary resuscitation. (b) If the facility does not provide care for ill children, the number of hours of training required pursuant to NRS 432A.1775, of which not more than 3 hours may be training in the administration of cardiopulmonary resuscitation. 2. The hours of training described in subsection 1 may consist of: (a) Informal training, including, without limitation, on-site training at a facility, community workshops or conferences; (b) Formal training; or (c) An early child care and education course offered by a community college or university. 3. Any training relating to the administration of cardiopulmonary resuscitation must be taught by a certified instructor who meets the standards of a nationally or internationally recognized provider of training in cardiopulmonary resuscitation, including, without limitation, the American Heart Association, the American Red Cross, MEDIC First Aid, EMS Safety Services, Inc. or the American Safety and Health Institute. 4. 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. 5. A director or caregiver described in subsection 1 may not receive credit toward the training required pursuant to subsection 1 for hours of training received concerning the administration of first aid or concerning the recognition of signs and symptoms of illness more than once every 36 months. Documentation of annual training completed by staff listed on the supplement did not show the completion of (21, 24) hours. Additional training must be completed for staff listed.”

NRS 178

“Child care facility required to maintain certain information; reporting of information to parents and guardians; notice of right to information. 1. A child care facility shall maintain a copy of: (a) The license issued to the facility by the Health Division or an agency for the licensing of child care facilities established by a county or incorporated city; (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 432A.190; (c) The report of any investigation conducted with respect to the complaints; and (d) The report of any disciplinary action taken against the facility pursuant to NRS 432A.190. 2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3: (a) To the parent or guardian of a child who enrolls the child in the facility, at or before the time of enrollment. (b) To the parent or guardian of a child, upon request, who is considering enrolling the child in the facility. (c) In the case of disciplinary action taken pursuant to NRS 432A.190, to the parents or guardians of all children admitted to the facility. Notice of disciplinary action must be provided to the parents or guardians of the children admitted to the facility within 3 working days after receipt by the licensed child care facility. 3. The Health Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided. 4. The Health Division and every agency for the licensing of child care facilities established by a county or incorporated city shall inform persons seeking information concerning child care facilities of their right to information pursuant to this section. The facility failed to have a completed complaint review (NRS-178) on file and signed by parents/guardians for the following children:”

NAC 5205

“1. Except as otherwise provided in NAC 432A.290 and 432A.546, a licensee of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility shall, between the hours of 6:30 a.m. and 9:00 p.m., abide by the following staffing levels in each classroom: Age of Child Required Staff to Child Ratio Group Size Less than 9 months of age 1 caregiver for every 4 children 8 9 months of age or older but less than 2 years of age 1 caregiver for every 6 children 12 2 years of age or older but less than 3 years of age 1 caregiver for every 9 children 18 3 years of age or older but less than 4 years of age 1 caregiver for every 12 children 24 4 years of age or older but less than 5 years of age 1 caregiver for every 13 children 26 5 years of age or older 1 caregiver for every 18 children 36 2. Except as otherwise provided in NAC 432A.546, a licensee of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility which is operated between the hours of 9:00 p.m. and 6:30 a.m. shall abide by the following staffing levels in each classroom: Age of Child Required Staff to Child Ratio Group Size Less than 3 years of age 1 caregiver for every 6 children 12 3 years of age or older 1 caregiver for every 10 children 20 3. Every member of the staff of a child care center, child care institution, accommodation facility, facility for special events, nursery for infants and toddlers or special needs facility who is on duty at night shall remain awake during duty hours. 4. A licensee of a child care facility is allowed to utilize all useable and measured square footage within a classroom to meet the requirements of NAC 432A.250 if the requirements for ratios and groups described in subsections 1 and 2 are maintained within such classrooms. 5. If a licensee of a child care facility care for children of different age groups as described in subsections 1 and 2, the licensee shall abide by the required staff to child ratio and group size based on the age of the youngest child in the group. The facility failed to provide an adequate # of staff for the number of infants/toddlers in care. Take corrective action to ensure sufficient staffing in order to provide for children ' s needs.”

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. The below listed children did not have a current immunization record or approved exemption on file at the facility. Obtain and file a current immunization record for the children listed. Director is recommended to sign up for WebIZ training in order to have access to the most up-to-date immunization records on-line. Discard old immunization records upon obtaining most current.”

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 200.3

“3. Documentation of completed and current investigations must be kept on file at the facility for all persons required to be investigated, for the period of their presence at the facility. Documentation of completed and current investigations were not on file at the facility for required persons. The following items were not observed for individuals as noted below:”

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. The facility was found to have hazards as listed below. Ensure that the play area is free of hazards, debris and trash.”

NAC 320

“1. Except as otherwise provided in NRS 432A.177 , within the first 2 weeks after commencing employment, newly employed members of the staff of a facility must be given a written and oral orientation program and be trained in the policies, procedures and programs of the facility by the director or a designee trained by the director. The orientation must address, at a minimum: (a) Any regulatory requirements that govern the facility; (b) The goals and philosophy and the policies and procedures of the facility; (c) Any planned programs or activities of the facility; (d) The policies and practices of the facility for relating to parents; (e) Meal patterns and food-handling policies and practices of the facility; (f) Dealing with occupational health hazards for caregivers, including, without limitation, paying attention to the physical health and emotional demands of the job and being aware of any special considerations required by a caregiver who is pregnant; (g) The emergency health and safety procedures of the facility; and (h) The general health and safety policies and procedures of the facility, including, without limitation, policies and procedures concerning: (1) Hand-washing techniques and requirements; (2) Techniques for diapering and for assisting in the use of a toilet if care is provided to children in diapers or children needing help with using a toilet, including, without limitation, techniques for the disposal of diapers and for changing diapers; (3) Identifying hazards and methods for preventing injuries; (4) Techniques for preparing, serving and storing food for employees who are involved in any of the activities concerning food for children at the facility; (5) Excluding a child from the facility because the child has an illness, and the manner in which illnesses are transmitted between persons; (6) Methods for preparing formula if formula is prepared at the facility; (7) Any precautions and other measures that should be taken to prevent exposure to blood and other bodily fluids, and policies and procedures to follow in the event of exposure to blood or other bodily fluids; and (8) The administration of medication. 2. If required by the director or owner of the facility, a member of the staff of a facility shall participate in any specialized training related to child care which is offered in the community where the facility is located. 3. A volunteer who works at least 15 hours per week in a facility and participates in specialized child care training, as defined by the director: (a) Is a member of the staff of the facility for the purposes of this section; and (b) Must satisfy the training and certification requirements set forth in NAC 432A.323 and 432A.326. 4. Any training received by an employee of a facility or a volunteer who works in a facility as part of the orientation required by this section may not be applied toward meeting the training requirements set forth in NAC 432A.323 and 432A.326.”

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 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 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 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 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 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 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 280.3

“"3. The licensee of a facility shall hold: (a) A fire drill at least once every month; and (b) A drill for natural disasters at least once every 3 months." The facility had no record that a drill for natural disasters was held at least once every three months. Hold drills for natural disasters as required and complete a record of the drills.”

NAC 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children. Facility failed to recognize and eliminate the following hazards for the safety of children as evidenced by the following:”

NAC 414

“1. A carpeted floor or rug on a floor that is too large to wash in a washing machine must be vacuumed not less than one time each day or more often if necessary and cleaned not less than one time every 3 months or more often if necessary. If the carpeted floor or rug is cleaned by a member of the staff of the facility using a carpet cleaning machine, the Health Division may require the carpeted floor or rug to be professionally cleaned if the carpeted floor or rug does not appear to be clean. 2. Each floor of a facility that is not carpeted must be swept and mopped not less than one time each day or more often if necessary. 3. When cleaning a nonporous surface in a facility, including, without limitation, cleaning toys, cribs, tables, high chairs and surfaces used to change diapers, the staff of the facility shall: (a) Clean the surface first with soap and water to remove any dirt or debris; and (b) Disinfect the surface with a disinfecting agent. 4. The disinfecting agent used pursuant to subsection 3 must consist of: (a) One-fourth of a cup of liquid chlorine bleach added to 1 gallon of water that is prepared fresh daily and kept in a closed container; (b) One tablespoon of liquid chlorine bleach added to 1 quart of water that is prepared fresh daily; or (c) A solution that is approved by the appropriate state or local agency and is at least as effective as the solutions described in paragraphs (a) and (b). Carpeted floors/rugs too large for washing were not cleaned once every three months or more often if necessary. Please ensure cleaning of carpets and rugs occurs as required and document dates of cleaning., Based on”

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 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 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., An over the counter medication was present in a cubby and was not plainly labeled with the name of the child. Ensure that medication is labeled as required and any over the counter medication has a doctor's note.”

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.”

NAC 390

“1. Every licensee of a facility shall develop a program to meet the basic needs of children for: (a) Good health and normal physical development; (b) Optimal mental growth; (c) Stimulating language and communicative experiences; (d) The attention, acceptance and affection of others; (e) Opportunities to experience success and to test mental, physical and social skills; (f) Self-identity and a sense of competence and worth; (g) The security provided by gentle discipline; (h) Relations with others which set forth the rights of adults and the rights of children; (i) Learning experiences planned with the aid of the child ' s parents which ensure harmony with the life style and cultural background of the child; (j) Activities which facilitate social growth and adjustment; and (k) The time and opportunity to learn independence and personal care. 2. A licensee of a facility shall teach each child personal hygiene. The licensee of a facility shall require all children to wash before meals and after using a toilet. 3. If the weather permits, all children must have a daily period of outdoor play. A licensee of a facility shall provide opportunities for active play which builds muscles such as climbing, jumping, running and playing with toys which have wheels. The quantity and quality of materials and equipment must be sufficient to avoid excessive competition between the children and long waiting periods to use the materials or equipment. 4. Every child who is in a facility for more than 5 hours per day must have a period for a nap during the day. A child who cannot sleep must rest during the period provided for a nap. The licensee of a facility shall provide a cot, mat or bed for each child. 5. The amount, variety and arrangement and use of materials and equipment used in a facility must be appropriate to the developmental needs of the children cared for in the facility. Materials must be stored in a manner that allows children to select, remove and replace the materials independently or with minimal assistance. 6. Furniture must be durable, safe and intended for use by children or appropriately adapted for use by children. 7. A licensee of a facility shall provide space for the storage of the children ' s clothing and the storage must be within easy reach of the children. Based on”

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 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 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. The facility was found to have hazards as listed below. Ensure that the play area is free of hazards, debris and trash., Playground equipment was not in good repair as evidenced by:”

NAC 200.3

“3. Documentation of completed and current investigations must be kept on file at the facility for all persons required to be investigated, for the period of their presence at the facility. Facility failed to ensure that the backgrounds Clearance Memo and Consent and Release Form were kept on file. Ensure both documents are kept on file at the facility for all staff and volunteers.”

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 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 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 323

“1. Except as otherwise provided in subsection 4 and NAC 432A.521 and NRS 432A.177 , within 90 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; and (f) If the person or director works with infants under 12 months of age, at least 2 hours of training concerning Sudden Infant Death Syndrome. 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 15 hours of training in professional development as required pursuant to 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 who works in a nursery for infants and toddlers shall, in addition to completing any training required pursuant to subsections 1 and 2, and completing any course in the development of children required pursuant to NAC 432A.306, complete at least 2 hours of training concerning Sudden Infant Death Syndrome. 4. A new employee of a child care facility is not required to complete the training required pursuant to subsection 1 if he or she has completed that training within the previous 24 months. 5. 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. 6. 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. 7. 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 Health Division or the local licensing agency. 8. 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 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) 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. (c) 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. (d) 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. (e) Work with parents and include them, whenever possible, in the programming and functioning of activities. (f) Cooperate with the Division and other agencies of government to improve the quality of child care and the competence of caregivers. (g) 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, 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 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 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children. Facility failed to recognize and eliminate the following hazards for the safety of children as evidenced by the following:”

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 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 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 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 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 310

“1. Every member of the staff of a facility, including a volunteer, shall present to the director of the facility, to be placed in the employee ' s file, written evidence that the employee is free from communicable tuberculosis. The evidence must be in the form of a report which states that the employee is free from active tuberculosis as required pursuant to subsection 2 or 3. 2. Before a person, including a person who has received a bacillus Calmette-Guerin (BCG) vaccination, begins employment at a facility, he or she must have submitted to a: (a) Mantoux tuberculin skin 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 at the facility. 3. Every member of the staff of a facility, including a volunteer, shall submit to: (a) A Mantoux tuberculin skin 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 skin 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 323

“1. Except as otherwise provided in subsection 4 and NAC 432A.521 and NRS 432A.177 , within 90 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; and (f) If the person or director works with infants under 12 months of age, at least 2 hours of training concerning Sudden Infant Death Syndrome. 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 15 hours of training in professional development as required pursuant to 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 who works in a nursery for infants and toddlers shall, in addition to completing any training required pursuant to subsections 1 and 2, and completing any course in the development of children required pursuant to NAC 432A.306, complete at least 2 hours of training concerning Sudden Infant Death Syndrome. 4. A new employee of a child care facility is not required to complete the training required pursuant to subsection 1 if he or she has completed that training within the previous 24 months. 5. 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. 6. 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. 7. 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 Health Division or the local licensing agency. 8. 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.”

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. The below listed children did not have a current immunization record or approved exemption on file at the facility. Obtain and file a current immunization record for the children listed. Director is recommended to sign up for WebIZ training in order to have access to the most up-to-date immunization records on-line. Discard old immunization records upon obtaining most current., 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. The below listed children did not have a current immunization record or approved exemption on file at the facility. Obtain and file a current immunization record for the children listed. Director is recommended to sign up for WebIZ training in order to have access to the most up-to-date immunization records on-line. Discard old immunization records upon obtaining most current., 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.”

NAC 310

“1. Every member of the staff of a facility, including a volunteer, shall present to the director of the facility, to be placed in the employee ' s file, written evidence that the employee is free from communicable tuberculosis. The evidence must be in the form of a report which states that the employee is free from active tuberculosis as required pursuant to subsection 2 or 3. 2. Before a person, including a person who has received a bacillus Calmette-Guerin (BCG) vaccination, begins employment at a facility, he or she must have submitted to a: (a) Mantoux tuberculin skin 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 at the facility. 3. Every member of the staff of a facility, including a volunteer, shall submit to: (a) A Mantoux tuberculin skin 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 skin 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 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 302

“1. A licensee of a child care facility shall not knowingly appoint a person as director of the facility or appoint or permit the appointment of a person as an employee or volunteer at the facility if the person has been convicted of child abuse or neglect or any other crime involving physical harm to a person or if a criminal action for such a crime is pending against the person. 2. The staff of a child care facility must be able to: (a) Work with children without recourse to physical punishment or psychological abuse; (b) Communicate with children and their parents; (c) Praise and encourage children and provide them with a variety of opportunities for learning and social experiences; and (d) Recognize and eliminate hazards to the safety of children. Facility failed to recognize and eliminate the following hazards for the safety of children as evidenced by the following:”

NAC 323

“1. Except as otherwise provided in subsection 4 and NAC 432A.521 and NRS 432A.177 , within 90 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; and (f) If the person or director works with infants under 12 months of age, at least 2 hours of training concerning Sudden Infant Death Syndrome. 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 15 hours of training in professional development as required pursuant to 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 who works in a nursery for infants and toddlers shall, in addition to completing any training required pursuant to subsections 1 and 2, and completing any course in the development of children required pursuant to NAC 432A.306, complete at least 2 hours of training concerning Sudden Infant Death Syndrome. 4. A new employee of a child care facility is not required to complete the training required pursuant to subsection 1 if he or she has completed that training within the previous 24 months. 5. 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. 6. 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. 7. 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 Health Division or the local licensing agency. 8. 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 323

“1. Except as otherwise provided in subsection 4 and NAC 432A.521 and NRS 432A.177 , within 90 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; and (f) If the person or director works with infants under 12 months of age, at least 2 hours of training concerning Sudden Infant Death Syndrome. 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 15 hours of training in professional development as required pursuant to 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 who works in a nursery for infants and toddlers shall, in addition to completing any training required pursuant to subsections 1 and 2, and completing any course in the development of children required pursuant to NAC 432A.306, complete at least 2 hours of training concerning Sudden Infant Death Syndrome. 4. A new employee of a child care facility is not required to complete the training required pursuant to subsection 1 if he or she has completed that training within the previous 24 months. 5. 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. 6. 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. 7. 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 Health Division or the local licensing agency. 8. 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 280.7

“7. The State Fire Marshal or a designee thereof shall, at least annually: (a) Enter and inspect every building or the premises of each facility; and (b) Observe and make recommendations regarding the drills conducted pursuant to subsection 3.”

NAC 280.6

“6. To maintain his or her license, the licensee must ensure that his or her facility meets all standards for fire safety which are established by the State Fire Marshal. The facility 's fire extinguisher was not tagged to show a current date of inspection and maintenance. Please make the necessary contact for inspection and maintenance.”

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 a caregiver at the facility who is at least 18 years of age 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 caregiver secure required fingerprints and submit with a release form.”

NAC 310.1

“1. Every member of the staff of a facility, including a volunteer, shall present to the director of the facility, to be placed in the employee ' s file, written evidence that the employee is free from communicable tuberculosis. The evidence must be in the form of a report which states that the employee is free from active tuberculosis as required pursuant to subsection 2 or 3. Staff members and /or volunteers of the facility did not have written evidence that they were free from communicable tuberculosis issued within the preceding 24 months. Staff listed on identifier supplement noted below require current TB test verification:, Staff/volunteer as listed on the supplement did not have written evidence of a Mantoux tuberculin skin test or an examination by a provider authorized to diagnose active tuberculosis at least once every 24 months. A report stating the employee/volunteer is free from TB must be secured for any person whose test/examination is more than two years old.”

NAC 310

“1. Every member of the staff of a facility, including a volunteer, shall present to the director of the facility, to be placed in the employee ' s file, written evidence that the employee is free from communicable tuberculosis. The evidence must be in the form of a report which states that the employee is free from active tuberculosis as required pursuant to subsection 2 or 3. 2. Before a person, including a person who has received a bacillus Calmette-Guerin (BCG) vaccination, begins employment at a facility, he or she must have submitted to a: (a) Mantoux tuberculin skin 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 at the facility. 3. Every member of the staff of a facility, including a volunteer, shall submit to: (a) A Mantoux tuberculin skin 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 skin 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 323

“1. Except as otherwise provided in subsection 4 and NAC 432A.521 and NRS 432A.177 , within 90 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; and (f) If the person or director works with infants under 12 months of age, at least 2 hours of training concerning Sudden Infant Death Syndrome. 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 15 hours of training in professional development as required pursuant to 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 who works in a nursery for infants and toddlers shall, in addition to completing any training required pursuant to subsections 1 and 2, and completing any course in the development of children required pursuant to NAC 432A.306, complete at least 2 hours of training concerning Sudden Infant Death Syndrome. 4. A new employee of a child care facility is not required to complete the training required pursuant to subsection 1 if he or she has completed that training within the previous 24 months. 5. 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. 6. 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. 7. 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 Health Division or the local licensing agency. 8. 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 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 310

“1. Every member of the staff of a facility, including a volunteer, shall present to the director of the facility, to be placed in the employee ' s file, written evidence that the employee is free from communicable tuberculosis. The evidence must be in the form of a report which states that the employee is free from active tuberculosis as required pursuant to subsection 2 or 3. 2. Before a person, including a person who has received a bacillus Calmette-Guerin (BCG) vaccination, begins employment at a facility, he or she must have submitted to a: (a) Mantoux tuberculin skin 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 at the facility. 3. Every member of the staff of a facility, including a volunteer, shall submit to: (a) A Mantoux tuberculin skin 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 skin 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 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 a caregiver at the facility who is at least 18 years of age 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 caregiver secure required fingerprints and submit with a release form.”