The provider shall: Monitor, and ensure that each staff member present monitors, each child in attendance for signs and symptoms of acute illness; Notify a child's parent or other designated person upon observing a sign or symptom of acute illness; and Provide temporary isolation for the affected child in a suitably equipped separate area within sight and hearing of an adult. A provider may not admit a child to care or allow a child to remain in care when the child is exhibiting symptoms of acute illness. A child may not be readmitted to care after an absence of 3 days or more due to illness without a written statement from the parent or physician that the child may return to a regular schedule. A provider shall immediately transmit to the health officer a report of the name and address of a child or a staff member who appears to be infected with a reportable communicable disease or who has been exposed to a reportable communicable disease as indicated in COMAR 10.06.01.03. A provider may not knowingly admit to care or retain in care a child with a transmissible infection or a communicable disease during the period of exclusion recommended for that infection or disease as shown in the Communicable Disease Summary, as published by the Maryland Department of Health, unless the health officer grants approval for the child to attend child care during that period. A written hand washing procedure approved by the office shall be posted at each sink used for washing hands. Hands shall be washed according to the posted approved procedure by the provider, each staff member, each volunteer, each substitute, and each child in care at least: After toileting or diapering; Before food preparation or eating; and After an outdoor activity or handling an animal. Diapering shall be performed in accordance with a written diapering procedure approved by the office. Medication Administration. Medication, whether prescription or nonprescription, may not be administered to a child in care unless: Parental permission to administer the medication is documented on a completed, signed, and dated medication authorization form, provided by the office, that is received at the child care home before the medication is administered; and A licensed health practitioner has approved the administration of the medication and the medication dosage. A prescription medication may not be administered to a child unless at least one dose of the medication has been given to the child at home. If medication is by prescription, it shall be labeled by the pharmacy or physician with: The child's name; The date of the prescription; The name of the medication; The medication dosage; The administration schedule; The administration route; If applicable, special instructions, such as “take with food”; The duration of the prescription; and An expiration date that states when the medication is no longer useable. Topical Applications. A diaper rash product, sunscreen, or insect repellent supplied by a child's parent may be applied without prior approval of a licensed health practitioner. Medication shall be administered according to the instructions on the label of the medication container or a registered health practitioner's written instructions, whichever are more recently dated. Recording Requirements. Each administration of a prescription or nonprescription medication to a child, including self-administration of a medication by the child, shall be noted in the child's record. Application of a diaper rash product, sunscreen, or insect repellent supplied by a child's parent shall be noted in the child's record. Medication Storage. Each medication shall be: Labeled with the child's name, the dosage, and the expiration date; Stored as directed by the manufacturer, the dispensing pharmacy, or the prescribing physician; and Discarded according to guidelines of the Office of National Drug Control Policy or the U.S. Environmental Protection Agency, or returned to the child's parent upon expiration or discontinuation. All medications shall be stored to make them inaccessible to children in care but readily accessible to each staff member designated by the provider to administer medication. Medication Administration Training. Whenever children in care are present, there shall be at least one child care home staff member present who has completed medication administration training approved by the office. Medication may be administered to a child in care only by a staff member who has completed approved medication administration training. The requirements of §F of this regulation shall not apply if: The child care home employs a registered nurse, registered practical nurse, or medication technician certified by the Maryland Board of Nursing to administer medication to children in care; or Responsibility for administering medication to children in care is delegated to a staff member by a delegating nurse in accordance with COMAR 10.27.11. Self-Administration of Medication. Before a child may self-administer medication while in care, a provider shall: Have a written order from the child's physician and the written request of the child's parent for the child's self-administration of medication; In consultation with the child's parent, establish a written procedure for self-administration of medication by the child based on the physician's written order; and Authorize the child to self-administer medication. Revocation of Authorization to Self-Administer. A provider may revoke a child's authorization to self-administer medication if the child fails to follow the written procedure required by §H(1)(b) of this regulation. Immediately upon revoking the child's authorization to self-administer medication, the provider shall notify the child's parent of that revocation. The provider shall document the revocation of authorization to self-administer and the notification to the child’s parent in the child’s record. Medical Cannabis. The administration of medical cannabis by a caregiver to a child who is a qualifying medical cannabis patient is governed by COMAR 10.62.01—10.62.37. The administration of medical cannabis that includes smoking or vaping is prohibited. If a resident smokes or vapes any substance, including but not limited to tobacco or cannabis, the provider shall make this known in advance to parents who are considering placing their children in the large family child care home’s care. A resident may not consume alcohol during the large family child care home’s approved hours of operation. A provider and any other individual may not consume alcohol during the large family child care home’s approved hours of operation. During the large family child care home’s hours of operation, if an enrolled child is or will be on the premises, the provider or any other individual may not smoke or vape or permit smoking or vaping in any indoor or outdoor area approved for child care use. A provider and any other individual may not consume or be under the influence of alcohol, cannabis, or an illegal or nonprescribed controlled dangerous substance while: Present at the large family child care home during the home’s hours of operation; or Providing or assisting with the care of children during an off-site program activity or during transport. The provider and any other individual shall ensure that all alcohol, tobacco, cannabis, cannabis edibles, and smoking and vaping paraphernalia and byproducts are kept out of the reach of the children in care. Whenever children are in care, a provider may not allow the consumption of alcoholic beverages or the use of illegal or nonprescribed controlled dangerous substances: By a person supervising, or helping to supervise, a child in care; In an area of the child care home approved for child care during the home's hours of operation; or By a staff member or a volunteer during an off-site program activity. Education Article, §§9.5-301—9.5-308, 9.5-310—9.5-312, 9.5-320, and 9.5-321; 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: February 6, 2012 (39:2 Md. R. 142) Regulation .02B amended effective January 13, 2020 (47:1 Md. R. 17) Regulation .03B amended effective January 13, 2020 (47:1 Md. R. 17) Regulation .04 amended effective June 24, 2013 (40:12 Md. R. 1043) Regulation .04F amended effective January 13, 2020 (47:1 Md. R. 17) Regulation .04I adopted as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); adopted permanently effective February 5, 2024 (51:2 Md. R. 76) Regulation .05 amended as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); amended permanently effective February 5, 2024 (51:2 Md. R. 76) Regulation .06 repealed as an emergency provision effective August 31, 2023 (50:20 Md. R. 885); repealed permanently effective February 5, 2024 (51:2 Md. R. 76)