A child care center may have more than one location and may be treated as one center for purposes of this subtitle only if: The buildings: Function as one integrated center, are in close proximity such as across the street or on the same campus, and are connected by an intercom system; and Are under the supervision of one director; and Two or more locations: Are administered by one central administration with one ownership; and Share common administrative policies and procedures and contracts. An operator may not admit a child for care unless the operator has: Met the applicable requirements of this regulation; and Received the written records required by Regulation .04C—H of this chapter, unless the child is temporarily admitted or retained in care on a temporary basis pursuant to §F of this regulation. At or before the child's admission to care, the operator shall obtain written information from the parent about the child's individual needs. As part of the admission process, the operator shall: Give the parent, or advise the parent how to obtain, information that is supplied by the office concerning: Consumer education on child care; How to file a complaint against the child care center; and Provide documentation that the requirements of §C(1) of this regulation have been met. Upon admission of an infant or toddler, an operator shall determine with the parent: A schedule for feeding the child that includes: The amounts and kinds of food consumed daily; The sequence for introducing solid food when appropriate; and Any recommendations about feeding from the infant's physician; A written individual activity plan for the child; and If the child is a toddler or an infant who is 12 months old or older, the need for the child to use a crib for rest purposes. If a child is younger than 6 years old at the time of admission, the operator may not allow the child to remain in care if the parent does not, in accordance with COMAR 10.11.04, submit evidence to the operator on a form supplied or approved by the office that the child has received an appropriate lead screening or test. Temporary Admission to Care. An operator may temporarily admit or retain a child in care if: The child is homeless; or The child’s parent is unable to provide the health-related records specified in Regulation .04D, E, G, or H of this chapter. For a child to be temporarily admitted or retained in care, the parent shall present evidence of the child’s appointment with a health care provider or local health department to: Receive a medical evaluation to include, if applicable, a lead screening or test; Receive a required immunization; Acquire evidence of age-appropriate immunizations on a form approved by the office; or Reconstruct a lost health record. The date of the appointment required by §F(2) of this regulation may not be later than 20 calendar days after the date the child was temporarily admitted or retained. An operator shall exclude from care a child who has been temporarily admitted or retained in care if the parent fails to provide evidence of the required health-related information within 3 business days after the date of the appointment made pursuant to §F(2) of this regulation. The operator shall: Create and maintain, for at least 2 years after their creation, records of program: Enrollment, with each child's name, address, telephone number, date of birth, and dates and time periods for which enrolled; and Attendance, by groups of children, which indicate: The dates of attendance of each child in the center; and Verification by each child's parent of that child's recorded daily attendance in care; Maintain: Procedures to ensure that the whereabouts of each child in attendance is known at all times; A written child discipline policy as required in COMAR 13A.16.07.03C; Records of food actually served by the center for the most recent 4 weeks as required by COMAR 13A.16.12.01E; A written record of the dates and times at which emergency and disaster plan drills were conducted pursuant to COMAR 13A.16.10.01A(3)(c); Documentation that, at least once each calendar year, the parent of each child under the age of 3 years was given: Information about the Maryland Infant and Toddlers Program; and Contact information for the local lead agency responsible for the administration of the Maryland Infant and Toddlers Program; and A current copy of this subtitle at the center so that it is displayed and freely available for reference by parents and center staff; Display a copy of the consumer education pamphlet on child care supplied by the office so that it is freely available for reference to parents; and Negotiate and maintain a written agreement with the child's parent that specifies: The fees for and provision of care; The center’s child discipline policy; The presence at the center of any pet animals; If applicable, the use of volunteers in the child care center; and If overnight care is to be provided to the child, the sleeping arrangements approved by the parent. The operator may provide the information required under §B(5) of this regulation by: A personal message to the parent, including an e-mail; A document for which the parent acknowledges receipt; or A text message. For each child admitted to, or continuing in care, the operator shall maintain written records, on forms provided or approved by the office, that meet the requirements of this regulation. Each child's written records shall be: Readily accessible to all staff members providing care to the child; and Kept on file at the center during the period of a child's enrollment and for 2 years after the child's disenrollment. The operator shall obtain and maintain emergency information from the child's parent that: Includes the child's name and date of birth; Includes the parent's full name, current address, and home and work telephone numbers; Includes the name and telephone number of the individual who is authorized to pick up the child each day; Includes the name and telephone number of at least one individual who is authorized to pick up the child in an emergency; Includes the name, address, and telephone number of the child's physician or other health care provider; If the child has a special health condition, includes emergency medical instructions for that condition; Is signed and dated by the child's parent; Is updated as needed, but at least annually; and Is readily accessible to each staff member supervising the child, including during an off-site activity. Unless a parent objects to a child's medical examination because of bona fide religious beliefs and practices, a health assessment of the child shall be provided by the child's parent that: Includes a parental statement of the child's health status; If applicable, includes a statement of allergies; and Includes a medical evaluation, signed and dated by a physician, that states the child is medically cleared to attend child care and is based on an examination completed by the physician within the last: 2 months before admission for a child younger than 9 months old; 3 months before admission for a child between 9 and 24 months old; or 12 months before admission for a child 2 years old or older. The operator shall maintain documentation that, as required by COMAR 10.11.04, each child admitted to, or continuing in, care has received: An appropriate lead screening, if the child is younger than 6 years old and was born before January 1, 2015; or A lead test when the child is 12 months old and again when the child is 24 months old, regardless of where the child resides, if the child was born on or after January 1, 2015. A medical evaluation and, if applicable, documentation of an appropriate lead screening or test that are transferred directly from a registered family child care home, another licensed child care center, or a public or nonpublic school in Maryland may be accepted as meeting the requirements of §§D(3) and E of this regulation. Unless a school-age child attends a school-age program located in the child’s school, the operator shall obtain, and maintain at the center, an immunization record showing that: The child has had immunizations appropriate for the child's age which meet the immunization guidelines set by the Maryland Department of Health; The child has had at least one dose of each vaccine appropriate for the child's age before entry and is scheduled to complete the required immunizations; A licensed physician or a health officer has determined that immunization is medically contraindicated according to accepted medical standards; or The parent objects to the child's immunization because it conflicts with the parent's bona fide religious beliefs and practices. If a parent objects to a child's immunization or medical examination, or both, because of the parent's bona fide religious beliefs and practices, an operator shall require the parent to provide a health history of the child and sign a statement indicating that to the best of the parent's knowledge and belief, the child is in satisfactory health and free from any communicable disease. The operator shall record or maintain on file: Each incidence of acute illness requiring exclusion of the child from care pursuant to COMAR 13A.16.11.01; Each injury or accident required by Regulation .06C and D of this chapter to be reported; Child medication records required by COMAR 13A.16.11.04A(1) and D; If the child requires a modified diet, the prescription from the child's health practitioner or the written instructions from the child's parent, pursuant to COMAR 13A.16.12.02; If program activities away from the center are provided, prior written permission from the child's parent to take the child to those activities; and If applicable, documentation that the parent of a toddler or an infant who is 12 months old or older has requested a crib for the child's rest periods. Written information about the child's individual needs that is supplied by the parent by the time of the child's admission to care shall be reviewed by the operator and the parent at least every 12 months after the child's admission to care. An operator shall maintain daily records of the amounts and kinds of liquids and solid food consumed by each infant and toddler. These records shall be: Dated and kept on file for at least 4 weeks; Available in the infant or toddler feeding area; and Made available to the child's parent. The operator shall: Maintain and, upon request by the office, submit a current and complete list of personnel, on a form supplied or approved by the office, that includes each individual, whether paid or unpaid, who works at the center on a routine basis; For review by the office and by parents who have enrolled their children or are considering enrolling their children, post in a conspicuous location a current and complete staffing pattern, on a form supplied or approved by the office, that specifies: The number and ages of children enrolled; The staff/child ratio in relation to the daily schedule; and By staff name, all child care assignments; During an individual’s employment at the center and for 2 years after the date of the individual’s last employment there, maintain a record for each individual that includes: The individual’s: Training, including initial and yearly basic health and safety training, if required under this subtitle; Experience, if required under this subtitle; and Function or position; Verification that the staff member's age complies with the minimum required for the position held; An employment medical evaluation; Criminal background check results, except that the operator shall destroy the record of those results immediately after the last day of the individual’s employment; and The date on which the staff member received the written information required by COMAR 13A.16.06.02; Maintain documentation required for: Substitutes, pursuant to COMAR 13A.16.06.13; and The adult available for emergencies, pursuant to COMAR 13A.16.08.02D(3); and Maintain a calendar or other written record of the: Days on which a substitute provides care; and Staff member in whose place the substitute worked. The operator shall: Within 5 working days of its occurrence, provide written notification to the office about the: Addition of a new employee or staff member that includes: The individual’s full name, date of birth, and date of hire; Information about the individual’s work assignment; Proof of compliance with the laws and regulations pertaining to criminal background checks; and Signed and notarized permission to examine records of abuse and neglect of children and adults for information about the individual; and Ending of employment, for whatever reason, of an individual that includes the: Individual’s full name; and Date of the individual’s last day of employment. Within 15 working days of adding the new employee or staff member, provide to the office documentation that the individual meets the requirements of this chapter for the assignment, unless documentation already is on file in the office; Notify or require that a staff member notify the office within 24 hours of: The death of a child if the child died while at the center; The death of a child enrolled at the center if the child died of a contagious disease; and An injury to a child that occurs while the child is at the center or on a field trip which results in the child's being: Treated by a medical professional; or Admitted to a hospital; If a child has an injury or accident while in attendance, notify the child's parent: Immediately, if the child's injury is serious; or Within the same day, about any other injury and each accident which may result in injury; Immediately notify the office of: An employee or individual living on the child care premises who is under investigation for: A criminal charge; or An allegation of child abuse or neglect; or A change at the center which may affect the status of the license, including but not limited to: Individuals living on the premises; Operation of the center; or Telephone number; Within 5 working days after there is a new individual living on the child care premises who is 18 years old or older: Submit to the office a signed and notarized release form giving the office permission to examine records of abuse and neglect of children and adults for information about an individual living on the child care premises; and Direct the individual living on the child care premises to apply for a federal and State criminal background check pursuant to COMAR 13A.16.02.02A(4) and C; and Within 10 business days of receiving notice from the center’s supplier of water that the drinking water is contaminated, send a written notice of the contamination to the parent of each child enrolled that: Identifies the contaminants and their levels; and Describes the plan for dealing with the water contamination problem until the water is determined by the appropriate authority to be safe for consumption. Except when converting the child care center to a summer youth camp, if an operator wishes to make any changes from the current license, such as use of rooms not previously approved for child care, capacity, hours of operation, age groups served, or the introduction of food service, the operator shall request and receive written approval of the change from the office before implementing the change. After determining whether the proposed change meets the requirements of this subtitle, the office shall approve or disapprove the proposed change. If the change is approved, the office shall issue a revised license indicating the change. If an operator wishes to convert to a summer youth camp, the operator shall: Notify the office before implementing the change to a summer youth camp; Upon request by the office, provide proof to the office of the center's certification as a summer youth camp under Health-General Article, Title 14, Subtitle 4, Annotated Code of Maryland; Remove the child care center license from display on the premises used for operating a summer youth camp during the period of summer youth camp operation; and Notify parents of children in care and those applying for care that: A child care center is not being operated during summer months; and State regulations for camps differ from those for child care centers. An office may grant a variance to a regulation under this subtitle: If the safeguards to a child's health, safety, or well-being are not diminished; When the operator presents clear and convincing evidence that the regulation is met by an alternative which complies with the intent of the regulation; and For a limited period of time as specified by the office, or for as long as the license remains in effect and the operator continues to comply with the terms of the variance. Within 30 calendar days of receiving a completed request for a variance, the office shall notify the operator that the variance has been granted or denied. If a variance request is denied by a regional office of the Agency: The operator may appeal the denial to the Agency's central office; and The Agency's central office has the final determination of whether or not a variance is granted. A variance to sanitary facility requirements that is granted pursuant to COMAR 13A.16.05.08C does not apply to any subsequent additions or enlargements to the center. An operator may not advertise child care services unless the center holds a current license issued by the office. An advertisement of the center shall: Specify that the center is licensed; and Include the license number issued to the center by the office. Education Article, §§9.5-115, 9.5-401, 9.5-404—9.5-411, and 9.5-413—9.5-418; General Provisions Article, §4-333;Human Services Article, §1-202; Annotated Code of MarylandAgency Note: Federal Statutory Reference — Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.);Pro-Children Act of 1994 (20 U.S.C. §6081 et seq.);Child Care Development Block Grant (45 CFR Parts 98 and 99 and 42 U.S.C. 9858 et seq.);Social Security Act §418 (42 U.S.C. 618) Effective date: October 20, 2008 (35:21 Md. R. 1826) Regulation .01 amended effective January 13, 2020 (47:1 Md. R. 14) Regulation .02A, C amended effective July 20, 2015 (42:14 Md. R. 883) Regulation .02E, F amended effective January 13, 2020 (47:1 Md. R. 14) Regulation .02F adopted effective July 20, 2015 (42:14 Md. R. 883) Regulation .03 amended effective June 24, 2013 (40:12 Md. R. 1043) Regulation .03A, B amended effective April 19, 2010 (37:8 Md. R. 618) Regulation .03B amended effective January 13, 2020 (47:1 Md. R. 14); March 17, 2025 (52:5 Md. R. 238) Regulation .03E adopted effective March 17, 2025 (52:5 Md. R. 238) Regulation .04 amended effective July 20, 2015 (42:14 Md. R. 883) Regulation .04E, F amended effective January 13, 2020 (47:1 Md. R. 14) Regulation .05C amended effective July 20, 2015 (42:14 Md. R. 883); January 13, 2020 (47:1 Md. R. 14) Regulation .06 amended effective July 20, 2015 (42:14 Md. R. 883); January 13, 2020 (47:1 Md. R. 14) Regulation .06E, F amended effective April 19, 2010 (37:8 Md. R. 618) Regulation .06G adopted effective April 19, 2010 (37:8 Md. R. 618) Regulation .09 adopted effective January 13, 2020 (47:1 Md. R. 14)