rules of department of health and senior...

CODE OF STATE REGULATIONS 1JASON KANDER (3/31/16)Secretary of State

Rules ofDepartment of Health and

Senior ServicesDivision 30—Division of Regulation and Licensure

Chapter 61—Licensing Rules for Family Day Care Homes

Title Page

19 CSR 30-61.010 Definitions .....................................................................................3

19 CSR 30-61.015 Exemption of Day Care Facilities ..........................................................4

19 CSR 30-61.025 Organization and Administration ...........................................................6

19 CSR 30-61.045 Initial Licensing Information ...............................................................6

19 CSR 30-61.055 License Renewal ..............................................................................7

19 CSR 30-61.085 Physical Requirements of the Family Day Care Home .................................8

19 CSR 30-61.086 Fire Safety.....................................................................................10

19 CSR 30-61.090 Disaster and Emergency Preparedness ...................................................13

19 CSR 30-61.095 Furniture, Equipment, and Materials ....................................................14

19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel ..............................15

19 CSR 30-61.115 Day Care Family and Household..........................................................17

19 CSR 30-61.125 Medical Examination Reports..............................................................17

19 CSR 30-61.135 Admission Policies and Procedures ......................................................21

19 CSR 30-61.145 Nighttime Care ..............................................................................24

19 CSR 30-61.155 Overlap Care of Children ..................................................................24

19 CSR 30-61.165 Emergency School Closings ...............................................................26

19 CSR 30-61.175 Child Care Program ........................................................................26

19 CSR 30-61.185 Health Care ..................................................................................27

19 CSR 30-61.190 Nutrition and Food Service ...............................................................32

19 CSR 30-61.200 Transportation and Field Trips ............................................................34

19 CSR 30-61.210 Records and Reports ........................................................................34

19 CSR 30-61.220 Variance Request ............................................................................35

Title 19—DEPARTMENT OFHEALTH AND SENIOR SERVICESDivision 30—Division of Regulation and

LicensureChapter 61—Licensing Rules for Family

Day Care Homes

19 CSR 30-61.010 Definitions

PURPOSE: This rule defines the terms usedin the licensing rules for family day carehomes.

PUBLISHER’S NOTE: The publication of thefull text of the material that the adoptingagency has incorporated by reference in thisrule would be unduly cumbersome or expen-sive. Therefore, the full text of that materialwill be made available to any interested per-son at both the Office of the Secretary of Stateand the office of the adopting agency, pur-suant to section 536.031.4, RSMo. Suchmaterial will be provided at the cost estab-lished by state law.

(1) Adult is any individual eighteen (18) yearsof age or older.

(2) The assistant is an adult who is employedor volunteers in the home to care for childrenin case of an emergency, to meet staff/childratios, to substitute for the provider duringabsences or to assist the provider with thecare of children.

(3) Caregiver is the child care provider or anassistant.

(4) Child care provider or provider is the per-son(s) licensed or required to be licensedunder section 210.221, RSMo in order toestablish, conduct or maintain a child carefacility. This person(s) shall have the follow-ing rights and responsibilities as determinedby the division:

(A) Ultimate responsibility for making andimplementing decisions regarding the opera-tion of the facility; and

(B) Ultimate financial control of the oper-ation of the facility.

(5) A child day care center or center, whetherknown or incorporated under another title orname, is a child care program conducted in alocation other than the provider’s permanentresidence, or separate from the provider’s liv-ing quarters, where care is provided for chil-dren not related to the child care provider forany part of the twenty-four (24)-hour day.

(6) Day care is care of a child away fromhis/her own home for any part of the twenty-four (24)-hour day for compensation or oth-

erwise. Day care is a voluntary supplement toparent responsibility for the child's protec-tion, development and supervision. Day caremay be given in a family day care home,group day care home or day care center.

(7) A day care facility or facility is a day carehome, day care center or group day carehome.

(8) Director is the director of the MissouriDepartment of Health.

(9) Department is the Missouri Departmentof Health.

(10) A family day care home or home,whether known or incorporated under anoth-er title or name, is a child care programwhere care is given by a person licensed as afamily day care home provider for no morethan ten (10) children not related to theprovider for any part of the twenty-four (24)-hour day. The provider may be licensed tooperate no more than one (1) family day carehome or group day care home.

(11) Graded boarding school is a public orprivate school which provides education in atleast the first through the sixth grade andwhich provides lodging and meals for thepupils for the standard school term.

(12) A group day care home, whether knownor incorporated under another title or name,is a child care program where care is given bya person licensed as a group day care homeprovider for eleven (11), but not more thantwenty (20), children not related to the childcare provider, for any part of the twenty-four(24)-hour day. A group day care home shallbe in a location other than the provider’s per-manent residence or separate from theprovider’s living quarters. The provider maybe licensed to operate no more than one (1)group day care home or family day carehome.

(13) Infant is any child under twelve (12)months of age.

(14) Night is the part of the twenty-four (24)-hour day between 9:00 p.m. and 6:00 a.m.

(15) Nursery school is a program operated bya person or organization with the primaryfunction of providing an educational programfor preschool-age children for no more thanfour (4) hours per child per day.

(16) Preschool child is any child two throughfive (2—5) years of age who is not in kinder-garten for five (5)-year-old children.

(17) Premises is a house(s), dwelling(s) orbuilding(s) and its adjoining land.

(18) Related is any of the following relation-ships by marriage, blood or adoption betweenthe provider and the children in care: parent,grandparent, great-grandparent, brother, sis-ter, stepparent, stepbrother, stepsister, uncle,aunt, niece, nephew or first cousin.

(19) Review board is the Child CareLicensing Review Board.

(20) School-age child is any child five (5)years of age or older who is in kindergartenor elementary school.

(21) School system is a program establishedprimarily for education and which meets thefollowing criteria:

(A) Provides education in at least the firstthrough the sixth grade; and

(B) Provides evidence that the school sys-tem's records will be accepted by a public orprivate school for the transfer of any student.

(22) Staff/child ratio is the number of care-givers required in relation to the number ofchildren in care.

(23) Summer camp is a program operatedfrom May to September by a person or orga-nization with the primary function of provid-ing a summer recreational program for chil-dren no younger than five (5) years of age andproviding no day care for children youngerthan five (5) years of age in the same build-ing or in the same outdoor play area.

(24) Toddler is any child between twelve totwenty-four (12–24) months of age.

(25) A well-known religious order is definedas—

(A) An entity that qualifies for federal taxexemption status as a not-for-profit religiousorganization under Section 501(c)(3) of theInternal Revenue Code of 1954; and

(B) An entity whose real estate on whichthe child care facility is located is exemptfrom taxation because it is used for religiouspurposes.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 13CSR 40-61.010 and 19 CSR 40-61.010.Original rule filed in 1956. Amended: FiledDec. 19, 1975, effective Jan. 1, 1976.Rescinded: Filed April 13, 1982, effectiveAug. 31, 1982. Readopted: Filed April 13,1982, effective Sept. 1, 1982. Amended:Filed March 14, 1985, effective Aug. 11,1985. Amended: Filed Oct. 7, 1987, effective

CODE OF STATE REGULATIONS 3ROBIN CARNAHAN (6/30/11)Secretary of State

Chapter 61—Licensing Rules for Family Day Care Homes 19 CSR 30-61

March 25, 1988. Rescinded and readopted:Filed March 29, 1991, effective Oct. 31,1991. Changed to 19 CSR 40-61.010, effectiveDec. 9, 1993. Emergency amendment filedAug. 18, 1993, effective Aug. 28, 1993,expired Dec. 25, 1993. Emergency amend-ment filed Jan. 4, 1994, effective Jan. 14,1994, expired May 13, 1994. Amended: FiledAug. 18, 1993, effective April 9, 1994.Changed to 19 CSR 30-61.010 July 30, 1998.

*Original authority: 210.221.1(3), RSMo 1949, amended1955, 1987, 1993.

19 CSR 30-61.015 Exemption of Day CareFacilities

PURPOSE: This rule defines the basis onwhich a family day care home may qualify forexemption from licensure.

(1) A day care facility does not qualify forexemption from licensure unless it is underthe exclusive control of an entity qualifyingfor exemption under section 210.211, RSMo.

(2) When a nonreligious organization havingas its principal purpose the provision of childcare services enters into an arrangement witha well-known religious order to provide con-tinuing assistance in the maintenance or oper-ation of a day care facility, the facility is notunder the exclusive control of the well-knownreligious order and does not qualify forexemption from licensure under section210.211(5), RSMo.

(3) If the person(s) operating the facilityclaims exemption from licensure, s/he shallfile all information requested by the depart-ment to make a determination of exemptionprior to opening. Facilities may waive theright to apply for exemption and request vol-untary licensure. These facilities shall com-ply with all licensing rules.

AUTHORITY: sections 210.221.1(3), RSMo,Supp. 1993.* This rule previously filed as 13CSR 40-61.035, 13 CSR 40-61.035, 13 CSR40-61.015. Original rule filed March 29,1991, effective Oct. 31, 1991. Changed to 19CSR 40-61.015, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,effective April 9, 1994. Changed to 19 CSR30-61.015 July 30, 1998.


4 CODE OF STATE REGULATIONS (6/30/11) ROBIN CARNAHAN

Secretary of State

19 CSR 30-61—DEPARTMENT OF HEALTH ANDSENIOR SERVICES Division 30—Division of Regulation and Licensure

19 CSR 30-61.025 Organization andAdministration

PURPOSE: This rule defines the require-ments for the organization and administrationof family day care homes.

(1) Each family day care home shall be orga-nized according to policies and procedureswhich clearly establish job responsibilitiesand lines of administrative authority.

(2) If a family day care home is incorporated,the corporation shall designate one (1) of theofficers of the corporation to be responsiblefor the daily operation of the facility and tomeet the requirements of the child careprovider. When the responsibility for theoperation of a family day care home restswith a board of directors, the Child CareLicensing Unit shall be notified immediatelyif there is a change of the officer designatedto be responsible for the daily operation ofthe facility and to meet the requirements ofthe child care provider. References and childabuse/neglect screening information shall beprovided as required by 19 CSR 40-61.045Initial Licensing Information.

(3) The person(s) operating a family day carehome shall be responsible for meeting alldebts and obligations incurred by the facilityand for maintaining compliance with alllicensing rules for family day care homes.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 13CSR 40-61.060, 13 CSR 40-61.025 and 19CSR 40-61.025. Original rule filed March29, 1991, effective Oct. 31, 1991. Changed to19 CSR 40-61.025, effective Dec. 9, 1993.Changed to 19 CSR 30-61.025 July 30, 1998.


19 CSR 30-61.045 Initial LicensingInformation

PURPOSE: This rule describes the proce-dures for application for licensure, the licens-ing investigation and provisions for continuedlicensing investigations after the initiallicense is granted.

(1) Licensing Authority. (A) According to section 210.221(3),

RSMo, the department has the authority toissue uniform rules deemed necessary andproper to establish standards of service andcare to be rendered by the provider. To imple-ment the rules, the department shall be

responsible for inspecting, evaluating andlicensing all family day care homes.

(B) The department or any other agency ofMissouri that the department asks to assist it,is authorized to make an inspection andinvestigation of any proposed or operatingfamily day care home, and of any personnelconnected with that home to the extent thatthis inspection and investigation is required todetermine if the family day care home willbe, or is being, operated in accordance withstate statutes and licensing rules for familyday care homes.

(2) Persons Subject to Licensure. (A) Any person(s) planning to offer day

care for more than four (4) unrelated childrenat any one (1) time, except those comingunder the exceptions of the law, shall applyfor licensure and meet the requirements of thelicensing rules before accepting more thanfour (4) unrelated children for care.

(B) Licensing rules shall not apply to chil-dren related to the provider as defined in 19CSR 40-61.010(18). In order to documentthe exemption for related children, identify-ing information shall be on file at the homeon related children as required by 19 CSR 40-61.135 Admission Policies and Procedures.

(C) In an incorporated family day carehome, the exemption for related children doesnot apply as a corporation cannot have rela-tives.

(3) Licensing Process. (A) Upon receipt of an inquiry regarding

day care licensing, an interview shall be heldto discuss the licensing rules and the licens-ing process.

(B) Upon receipt of a completed applica-tion for license, on the form provided by thedepartment, a licensing investigation shall bemade. If licensing rules are not met withinsix (6) months, the application shall be voidand another application shall be filed.

(C) The licensing investigation shallinclude an inspection of the entire premises ofthe day care home by the licensing represen-tative.

(D) Prior to the granting of a license, thefollowing shall be submitted by the applicant:

1. A sketch or diagram of the homeshowing the arrangement of the rooms,including the location of toilet and handwash-ing facilities, the kitchen and the doors. Thelicensing representative and the applicantshall measure the home jointly;

2. A sketch or diagram of the outdoorplay area and placement of equipment, indi-cating if the area is fenced. The licensing rep-resentative and the applicant shall measurethe area jointly;

3. Written policies pertaining to the pro-gram goals, admission, care and discharge ofchildren;

4. A schedule of daily activities for chil-dren;

5. A sample weekly menu; 6. An itemized list of available materials

and equipment to be used by children; 7. A statement of discipline and guid-

ance policies; 8. The names and addresses of two (2)

references not related to the applicant whohave knowledge of the applicant’s character,experience and ability;

9. If a day care home is incorporated,the names and addresses of two (2) referencesfor the officer designated to be responsiblefor the daily operation of the facility and tomeet the requirements of the child careprovider. The references shall not be relatedto the officer designated by the corporation;

10. Sample forms used, other than thosesupplied by the department;

11. Evidence of compliance, if applica-ble, with local or state requirements, or both,for any nonpublic water supply or sewage dis-posal system;

12. If the family day care home is incor-porated, Articles of Incorporation, Certifi-cate of Incorporation and the Annual Regis-tration Report (if applicable) as issued by theMissouri secretary of state;

13. Required information for assistants;and

14. Other information required by thedepartment to make a determination regard-ing licensure of the family day care home.

(E) Prior to the granting of a license, theprovider shall meet the requirements of 19CSR 30-61.086 Fire Safety.

(F) Prior to initial issuance of the license,the child care provider shall request and haveon file the results of a criminal record review(CRR) from the Missouri State HighwayPatrol for the child care provider, all personsemployed by the child care provider, and alladult household members. The child careprovider shall request a criminal recordreview within ten (10) days following theemployment of any person and within ten(10) days after any adult becomes a house-hold member. The department may request acriminal record review for any adult presentin the family day care home when child carechildren are present. The criminal recordreviews shall include records of criminal con-victions, pending criminal charges, and sus-pended imposition of sentence during theterm of probation. Requests for criminalrecord reviews shall be made on a form pro-vided by the highway patrol.


Secretary of State


1. When the department determines thata nationwide check is warranted, the depart-ment may request a criminal record reviewfrom the Missouri State Highway Patrol forclassification and search of fingerprints forany person seeking employment with theprovider or for any person seeking issuanceor renewal of a license as provided in sections43.530 and 43.543, RSMo. Requests forcriminal record reviews shall be made on aform provided by the highway patrol that shallbe signed by the subject of the request. Theprovider shall submit the signed form to thedepartment with two (2) sets of fingerprintsfor each person who is the subject of a crim-inal record review.

2. Information received by the providershall be retained in the individual’s file in aconfidential manner.

(G) The child care provider, other house-hold members and other child care personnelshall be screened for child abuse/neglectprior to initial issuance of the license.

(H) Medical examination reports for theprovider and child care assistants as requiredby 19 CSR 30-61.125 Medical ExaminationReports, shall be on file at the home andavailable for review.

(I) Medical examination reports shall be onfile at the home within thirty (30) days fol-lowing the admission of each infant, toddleror preschool child as required by 19 CSR 30-61.125 Medical Examination Reports. Ahealth report for school-age children shall beon file as required by 19 CSR 30-61.125.

(J) Enrollment information for each childshall be on file at the home as required by 19CSR 30-61.135 Admission Policies andProcedures.

(K) Identifying information shall be on fileat the home for each child to be cared forwho is related to the provider and not livingin the home as required by 19 CSR 30-61.135Admission Policies and Procedures.

(L) The child care provider shall not pro-vide care for more than four (4) unrelatedchildren until the home is in compliance withstate statutes and licensing rules for familyday care homes.

(M) After approval by a licensing repre-sentative and a licensing supervisor, a tempo-rary license may be granted by the depart-ment for a period not to exceed sixty (60)days.

(N) The official license shall be granted forup to two (2) years and may be renewed uponreapplication and reinvestigation. Until theofficial license is received, the temporarylicense shall be posted near the entrance ofthe home where it may be seen easily by par-ents or others who visit. Thereafter, the offi-

cial license shall be posted near the entranceof the home.

(O) The address and telephone number ofthe Child Care Licensing Unit shall be post-ed near the license.

(P) The granting of a license shall bedenied by the director upon failure of theapplicant to comply with state statutes andlicensing rules for family day care homes.

(Q) The license shall not be transferableand shall apply only to the person(s) andaddress shown on the license.

(R) If there is a change of ownership of afamily day care home, the new owner(s) shallmeet the requirements of the current licensingrules. A licensing investigation shall be madeas required by 19 CSR 30-61.045 InitialLicensing Information.

(S) The license shall be the property of thedepartment and shall be subject to revocationby the director upon failure of the provider tocomply with state statutes and licensing rulesfor family day care homes. The license shallbe returned to the department if revoked ornot renewed.

(T) If a facility’s license is revoked ordenied due to failure to comply with statestatutes and licensing rules, the departmentshall not accept a subsequent applicationfrom the provider for that facility withintwelve (12) months after the effective date ofrevocation or denial or within twelve (12)months after all appeal rights have beenexhausted, whichever is later.

(U) The number and ages of children afamily day care home is authorized to have incare at any one time shall be specified on thelicense and shall not be exceeded except aspermitted within these rules.

(V) All day care provided on the premisesof a licensed family day care home shall be incompliance with the licensing rules and theconditions specified on the license.

(W) Upon issuance of the license, a licens-ing representative shall visit the family daycare home throughout the licensing period forsupervision and consultation. Both announc-ed and unannounced visits shall be made.Visits shall be at varying times during thehours child care is provided, with the entirepremises subject to inspection.

(X) Upon the department’s receipt of acomplaint regarding the facility, a complaintinvestigation shall be made as determinednecessary by the department.

(Y) The provider shall permit the depart-ment access to the facility, premises andrecords during all visits.

(Z) A licensed child care provider shall notdeny a child admission to, or the benefits of,any program provided by the family day care

home on the basis of race, sex, religion ornational origin.

(AA) Licensing records are public recordsand may be reviewed by appointment with theChild Care Licensing Unit as authorized insections 610.010–610.150, RSMo.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1998.* This rule previously filed as 13CSR 40-61.020, 13 CSR 40-61.045 and 19CSR 40-61.045. Original rule filed March29, 1991, effective Oct. 31, 1991. Changed to19 CSR 40-61.045, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,effective April 9, 1994. Amended: FiledSept. 12, 1995, effective March 30, 1996.Changed to 19 CSR 30-61.045 July 30, 1998.Amended: Filed Feb. 18, 1999, effective Sept.30, 1999.

*Original authority: 210.221.1(3), RSMo, 1949, amended1955, 1987, 1993, 1995..

19 CSR 30-61.055 License Renewal

PURPOSE: This rule defines the proceduresfor license renewal.

(1) An application for license renewal shallbe filed at least sixty (60) days prior to expi-ration of the license. In addition, the follow-ing information is required:

(A) Evidence of compliance with a fire andsafety inspection as conducted by the StateFire Marshal or his/her designee;

(B) If incorporated, a copy of the currentAnnual Registration Report filed with theMissouri secretary of state;

(C) Medical examination reports on file atthe home as required by 19 CSR 40-61.125Medical Examination Reports;

(D) A health report on file at the home foreach school-age child in care as required by19 CSR 40-61.125 Medical ExaminationReports;

(E) Enrollment information on file at thehome for each child in care as required by 19CSR 40-61.135 Admission Policies andProcedures;

(F) Identifying information on file at thehome regarding each child in care who isrelated to the provider and not living in thehome as required by 19 CSR 40-61.135Admission Policies and Procedures;

(G) A current list of available equipment;and



(H) Materials and information which havechanged since the previous licensing period.

(2) The child care provider, other personneland other household members shall bescreened for child abuse/neglect prior torenewal of the license.

(3) After the child care provider applies forrenewal of the license, the child care providershall request the results of a criminal recordreview (CRR) from the Missouri StateHighway Patrol for the child care provider, allpersons employed by the child care provider,and all adult household members. The childcare provider shall request a criminal recordreview within ten (10) days following theemployment of any person and within ten(10) days after any adult becomes a house-hold member. The department may request acriminal record review for any adult presentin the family day care home when child carechildren are present. The criminal recordreviews shall include records of criminal con-victions, pending criminal charges, and sus-pended imposition of sentence during theterm of probation. Requests for criminalrecord reviews shall be made on a form pro-vided by the highway patrol.

(A) When the department determines thata nationwide check is warranted, the depart-ment may request a criminal record reviewfrom the Missouri State Highway Patrol forclassification and search of fingerprints forany person seeking employment with theprovider or for any person seeking issuanceor renewal of a license as provided in sections43.530 and 43.543, RSMo. Requests forcriminal record reviews shall be made on aform provided by the highway patrol that shallbe signed by the subject of the request. Theprovider shall submit the signed form to thedepartment with two (2) sets of fingerprintsfor each person who is the subject of a crim-inal record review.

(B) Information received by the providershall be retained in the individual’s file in aconfidential manner.

(4) Upon determination of the applicant’scontinued compliance with state statutes andlicensing rules for family day care homes, anofficial license shall be granted for up to two(2) years.


Amended: Filed Feb. 18, 1999, effective Sept.30, 1999.

*Original authority: 210.221.1(3), RSMo 1949, amended1955, 1987, 1993, 1995.

19 CSR 30-61.085 Physical Requirementsof the Family Day Care Home

PURPOSE: This rule sets forth the require-ments for the physical plant and indoor andoutdoor space.

(1) General Requirements.(A) The premises shall be safe and suitable

for the care of children. (B) The premises shall conform to the fire

and safety requirements of the State FireMarshal or his/her designee.

(C) It shall be the responsibility of thechild care provider to determine any applica-ble local zoning regulations.

(D) Water supply and sewage disposal sys-tems shall conform to state or local require-ments, or both.

(E) Children shall have no access to areasnot approved for child care.

(F) Stairways in approved child care spaceshall be well-lighted and free of obstructions.Stairways in approved child care space havingmore than three (3) steps shall have a handrailthe children can reach.

(G) Porches, decks, stairwells or otherareas in approved child care space having adrop-off of more than twenty-four inches(24") from which children might fall and beinjured shall have an approved railing orapproved barrier. The railing or barrier shallbe constructed to prevent the child fromcrawling or falling through, or becomingentrapped.

(H) Approved safety gates at stairways anddoors shall be provided and used as needed.

(I) Heaters, floor furnaces, radiators, hotwater heaters or other equipment which posesa threat to children shall meet the require-ments of 19 CSR 30-61.086 Fire Safety.

(J) All flammable liquids, matches, clean-ing supplies, poisonous materials, medicines,alcoholic beverages, hazardous personal careitems or other hazardous items shall be inac-cessible to children.

(K) Ammunition, guns, hunting knives,bows and arrows or other weapons shall bestored in a locked cabinet or locked closet.

(L) No person shall smoke or otherwise usetobacco products in any area of the child carefacility during the period of time when chil-dren cared for under the license are present.

(2) Indoor Space. (A) General Requirements.

1. Any floor of a home used for childcare shall be approved by the State FireMarshal or his/her designee.

2. Open windows and doors shall bescreened securely. Barriers to prevent chil-dren from falling against windows or fallingfrom windows shall be provided when win-dows are less than twenty-four inches (24")from the floor and not constructed of safetyglass or other nonbreakable material.

3. Clear glass doors shall be markedplainly at varying heights to avoid impact.

4. Artificial or natural lighting shall sup-ply at least ten (10) footcandles of lightthroughout each room used for child care.

5. The home shall be dry, temperaturecontrolled, well-ventilated and free of drafts.Children shall not be overheated or chilled.The temperature of the rooms shall be no lessthan sixty-eight degrees Fahrenheit (68°F)and no more than eighty-five degreesFahrenheit (85°F) when measured two feet(2') from the floor.

6. Walls, ceilings and floors shall be fin-ished with material which can be cleaned eas-ily and shall be free of splinters, cracks andchipping paint. Floor covering shall be ingood condition. Lead-free paint shall be usedfor all painted surfaces.

7. Concrete floors in areas counted aschild care space shall be covered with carpet,tile, linoleum or other floor covering.

8. Floor surfaces under indoor equip-ment over twenty-four inches (24") in heightfrom which children might fall and be injuredshall be protected with pads or mats whichwill effectively cushion the fall of a child.Carpeting alone is not an acceptable resilientsurface under indoor equipment.

9. The home shall be clean at all timesand free of dirt, insects, spiders, rodents orother pests.

10. A telephone in working order shallbe available for incoming and outgoing calls.If a telephone answering machine is used, itmust be turned on so incoming messages canbe heard and parents’ calls can be returnedpromptly.

11. Telephone numbers for the police,fire department, ambulance and other emer-gency telephone numbers shall be posted nearthe telephone.

(B) Floor Space Calculations andUtilization.

1. At least thirty-five (35) square feet ofusable floor space shall be provided for eachchild coming into the home for day care.

2. Floor space shall be measured wall-to-wall from the inside walls of areas used forchildren’s activities.

3. Floor space shall not include foodpreparation areas, bathrooms, hallways used

8 CODE OF STATE REGULATIONS (3/31/16) JASON KANDER

Secretary of State


exclusively as passageways, closets, officespace or floor space occupied by furniture orshelving not used by the children or for theiractivities.

4. Space occupied by permanentlyplaced cots, cribs, beds or playpens used fornapping cannot be counted as usable floorspace. Cots shall not be set up early or left inplace to interfere with children’s play activi-ties.

5. Storage space for play materials shallbe provided. Some of the space shall beaccessible to the children.

(C) Bathrooms. 1. General requirements.

A. A flush toilet and an adjacenthandwashing facility with running water shallbe provided.

B. Toilet and handwashing facilitiesshall be in working order and convenient forthe children’s use.

C. An individual cloth towel for eachchild or paper towels, soap and toilet papershall be provided and easily accessible so thechildren can reach them without assistance. Ifindividual towels are used, they shall be laun-dered daily.

D. Children shall be monitored whilein the bathroom.

E. Bathrooms shall be clean and odorfree.

2. Infants and toddlers. At least one (1)potty chair, junior commode or toilet with anadaptor seat shall be provided. Potty chairsshall be located in the bathroom and shall beemptied, cleaned and disinfected after eachuse.

(D) Kitchens. 1. A kitchen shall be required for meal

preparation unless meals are catered from asource approved by the local or state sanitar-ian, or both.

2. Kitchens used for meal preparationshall be equipped with a stove, sink, hot andcold running water, a refrigerator and storagespace for food, dishes and cooking utensils.

3. If meals are catered, a sink, hot andcold running water, a refrigerator and storagespace for food, dishes and cooking utensilsshall be provided.

4. Kitchens shall not be used for chil-dren’s play activities unless the activities arepart of the learning program and the childrenare supervised by adults.

5. Kitchens shall not be used for nap-ping.

(3) Outdoor Space. (A) General Requirements.

1. An outdoor play area shall be avail-able on or adjoining the day care property.The play area shall be located so it is conve-

nient and the children can gain access to itwithout hazard. It shall be fenced when nec-essary for the protection of children fromtraffic, water or other hazards. For family daycare homes initially licensed after the effec-tive date of these rules, or for the installationof new fences in existing facilities, the fenceshall be at least forty-two inches (42") high.Fences shall be constructed to prevent chil-dren from crawling or falling through orbecoming entrapped.

2. A minimum of seventy-five (75)square feet per child of outdoor play areashall be provided.

3. An adult shall be outside at all timesto provide supervision for children underthree (3) years of age.

4. An adult shall be outside with thechildren at all times if the play area is notfenced and adjoining the building exit, orunless the children are of school age and def-inite limits have been established as theirboundaries. These children shall receive fre-quent and routine supervision.

5. The play area shall be safe for chil-dren’s activities, well-maintained, free ofhazards such as poisonous plants, brokenglass, rocks or other debris and shall havegood drainage.

6. The fall-zone area under and aroundoutdoor equipment where children might falland be injured shall be covered with impact-absorbing materials which effectively cush-ions the fall of a child. This material mayinclude sand, pea gravel, tanbark, shreddedtires, wood chips, rubber matting or otherapproved resilient material. Grass may be anapproved resilient material, but if grassbecomes worn or sparse, the area must becovered with another approved resilient mate-rial.

7. The provider shall be responsible forthe type, depth and fall-zone area of resilientmaterial necessary for the protection of chil-dren.

8. Areas under and around outdoorequipment shall have continuous maintenanceto ensure that the material remains in placeand retains its cushioning properties. Theresilient material shall be supplementedimmediately or replaced as needed.

9. Concrete, asphalt, carpet or bare soilis not an acceptable surface under outdoorequipment from which children might falland be injured.

(B) Swimming and Wading Pools. 1. Swimming and wading pools used by

children shall be constructed, maintained andused in a manner which safeguards the livesand health of children.

2. Swimming and wading pools shallhave a water filtration system. The water inswimming and wading pools shall be treated,cleaned and maintained in accordance with

health practices and rules as determined bythe local or state health authority, or both.

3. Swimming and wading pools shall befenced to prevent access by children. Forfamily day care homes initially licensed afterthe effective date of these rules, the fenceshall be at least forty-two inches (42") highand shall have a locked gate. Above-the-ground pools may use a forty-two inch (42")fence around the top of the pool with barri-cades of the steps to the pool deck.

4. Children using swimming or wadingpools shall be instructed in water safety andsupervised by an adult at all times.

5. An adult with a current lifeguardtraining certificate, including infant/child car-diopulmonary resuscitation (CPR) training,shall be on duty when a swimming or wadingpool containing a depth of forty-eight inches(48") or more of water is being used.

6. An adult who has completed a coursein basic water safety, which includesinfant/child CPR, shall be on duty when aswimming or wading pool containing lessthan forty-eight inches (48") of water is beingused.

(4) Animals. (A) Animals which may pose a threat to

the health or safety of children shall not bepermitted on the premises or shall be pennedsecurely in an area which is inaccessible tothe children.

(B) If an animal bites a child, the parent(s)shall be notified immediately. The providershall contact a veterinarian to determine acourse of action in the diagnosis of possiblerabies in the animal. If possible, the providershall restrain the animal for observation by aveterinarian.

(C) Animal pens shall be kept clean. (D) Areas used by children shall be free of

animal excrement. (E) Litter boxes shall not be located in

areas used by children or in food preparationareas.

(F) Food and water dishes used by animalsshall not be accessible to the children.

AUTHORITY: sections 210.221 and 210.223,RSMo Supp. 2015.* This rule previously filedas 13 CSR 40-61.070 and 13 CSR 30-61.085.Original rule filed March 29, 1991, effectiveOct. 31, 1991. Changed to 19 CSR 40-61.085, effective Dec. 9, 1993. Changed to19 CSR 30-61.085 July 30, 1998. Amended:Filed Feb. 18, 1999, effective Sept. 30, 1999.Emergency amendment filed Nov. 10, 2015,effective Nov. 20, 2015, expired May 17,2016. Amended: Filed Nov. 10, 2015, effectiveApril 30, 2016.

*Original authority 210.221.1(3), RSMo 1949, amended1955, 1987, 1993, 1995, 1999, 2015 and 210.223, RSMo2015.



19 CSR 30-61.086 Fire Safety

PURPOSE: This rule establishes the fire safe-ty requirements for family day care homes.

(1) The following definitions shall be used ininterpreting this rule:

(A) Alterations are changes made to thestructure or floor plan of the facility byremoving or adding walls and doors or addingspace;

(B) Dead-end is a corridor or hallway withno exit at the end that causes occupants toretrace their path to reach an exit;

(C) Exit is the portion of a means of egressthat is separated from all other areas of thebuilding or structure by construction orequipment required to provide a protectedway of travel to the exit discharge. Exitsinclude exterior exit doors, exit passageways,horizontal exits, separated exit stairs, andseparated exit ramps;

(D) Exit access is the portion of a means ofegress that leads to an exit;

(E) Exit discharge is the portion of a meansof egress between the termination of an exitand a public way;

(F) Fire barrier is a structural element,either vertical or horizontal, such as a wall orfloor assembly that is designed and con-structed with a specified fire resistance ratingto limit the spread of fire and restrict themovement of smoke. Such barriers may haveprotected openings;

(G) Fire resistance rating is the length oftime in minutes or hours that materials orstructural elements can withstand fire expo-sure;

(H) Flame resistant material is the proper-ty of material or their structural elements thatprevents or retards the passage of excessiveheat, hot gases, or flames under the condi-tions in which they are used;

(I) Flame retardant is a chemical applied tomaterial or other substance that is designed toretard ignition or the spread of fire;

(J) Interior finish includes the interior walland ceiling finish, and interior floor finish;

(K) Level exit discharge is a horizontalplane that is located from the point at whichan exit terminates and the exit dischargebegins. The horizontal plane shall not varymore than two inches (2") in rise or fall;

(L) Level is the portion of a buildingincluded between the upper surface of a floorand the ceiling above it, or any upper surfaceof a floor and the ceiling above it that is sep-arated by more than five (5) steps on a stair-way;

(M) Means of egress is a continuous andunobstructed way of travel from any point ina building or structure to a public way. A

means of egress consists of three (3) distinctparts: the exit access, the exit, and the exitdischarge;

(N) Mixed occupancy is when a family daycare home is located in the same building orstructure as another occupancy. This mayinclude a business or place of assembly;

(O) Public way is an area such as a streetor sidewalk that is open to the outside and isused by the public for moving from one loca-tion to another;

(P) Remote exit or means of egress is whentwo (2) exits or two (2) exit access doors arerequired. Each exit or exit access door shallbe placed at a distance apart equal to at leastone-half (1/2) the length of the maximumoverall diagonal dimension of the building orarea to be used;

(Q) Self-closing means to be equipped withan approved device that will ensure closingafter having been opened;

(R) Smoke barrier is a structural element,either vertical or horizontal, such as a wall,floor, or ceiling assembly that is designed andconstructed to restrict the movement ofsmoke. A smoke barrier may or may nothave a fire resistance rating; and

(S) Supervised automatic sprinkler systemis a system with the initiating devices moni-tored by the fire alarm control panel. Thismay include switches used to monitor theposition of valves, a low air pressure switch,a water flow switch, and a tamper switch.

(2) General Requirements.(A) The Missouri Division of Fire Safety

shall inspect the facility annually for thecapacity specified on the license applicationand the fire inspection request. The inspec-tion shall include a determination of whetheror not the facility is approved for overlap careas provided in 19 CSR 30-61.155 OverlapCare of Children.

(B) At least one (1) portable, operableflashlight for each staff member shall belocated on each level of the home and acces-sible to staff in the event of power failure.

(C) Child care staff shall conduct at leastone (1) fire drill each month and a disasterdrill at least every three (3) months. The dis-aster drills shall include tornado drills. Theprovider shall maintain a written record at thefacility of the date, type of drill, timerequired to evacuate the building, and num-ber of children present during the drill.

1. Unscheduled drills may be held at thefire inspector’s discretion.

2. A full evacuation of the home may bepostponed during severe weather.

3. An evacuation/emergency plan forfires and tornadoes that is approved by thefire inspector shall be posted in the home in

a central location and be visible to all occu-pants. The plan shall include special instruc-tions for infants and nonambulatory children.

4. Fire drills shall be conducted as fol-lows:

A. Drills shall simulate an actual firecondition;

B. The children shall not obtain cloth-ing or other items after the alarm has sound-ed;

C. The children shall proceed to apredetermined location outside the buildingthat is sufficiently remote to avoid fire dan-ger, interference with fire department opera-tions, or confusion among different groups ofchildren; and

D. Groups shall remain in place untila recall to the building is issued or the chil-dren are dismissed.

(D) Children shall have no access to areasof the building that do not meet fire safetyrequirements.

(E) All flammable or combustible liquids,matches, lighters, or other hazardous itemsshall be stored so they are inaccessible to thechildren.

(F) The house numbers shall be plainlyvisible from the street in case of emergency.

(G) Housekeeping practices that ensurefire safety shall be maintained daily.

(H) Stairways, walks, ramps, and porchesshall be kept free of ice and snow.

(I) The provider shall immediately reportany fire in the family day care home to theOffice of the State Fire Marshal and theDepartment of Health, Bureau of Child CareSafety and Licensure.

(J) No fresh-cut Christmas trees shall beused unless they are treated with a flameresistant material. Documentation of thetreatment shall be on file at the facility andavailable for review by the fire inspector.

(K) The Division of Fire Safety may makeadditional requirements that provide adequatelife safety protection if it is determined thatthe safety of the occupants is endangered.Every building or structure shall be con-structed, arranged, equipped, maintained,and operated to avoid danger to the lives andsafety of its occupants from fire, smoke,fumes, or resulting panic during the period oftime necessary for escape from the building.

(L) Mobile homes manufactured afterNovember 27, 1973, shall comply with theMissouri Public Service Commission, regu-lations for mobile home tie-down systems.Manufactured homes shall comply with sec-tion 700.070, RSMo 1994, regarding tie-down systems.

(M) The latest edition of the National FireProtection Association (NFPA), Chapter 101,


Secretary of State


Life Safety Code, shall prevail in the inter-pretation of this rule.

(N) When the licensed capacity increases,hours of care change, alterations are complet-ed, or other changes occur that affect firesafety, the provider shall meet all the require-ments of this rule unless otherwise exceptedby the Division of Fire Safety.

(O) Facilities that were licensed and areasapproved for child care prior to the effectivedate of this rule shall have ceilings at leastseven feet (7') in height. Facilities initiallylicensed and areas initially approved for childcare on or after the effective date of this ruleshall meet all the requirements of this ruleand shall have ceilings at least seven feet, sixinches (7'6") in height. If alterations aremade in facilities licensed prior to the effec-tive date of this rule, those facilities shallmeet all the requirements of this rule andshall have ceilings at least seven feet, sixinches (7'6") in height in the altered space.The fire inspector may make an allowance forthe installation of ductwork and plumbing.

(P) Facilities served by a volunteer ormembership fire department shall be a mem-ber in good standing with the fire depart-ment. A copy of the membership or receiptfor membership shall be on file at the facilityand available for review.

(Q) Clothes dryers shall be vented andmaintained properly.

(3) Mixed Occupancies.(A) In addition to meeting all the require-

ments of this rule, family day care homes ini-tially licensed and areas initially approved forchild care on or after the effective date of thisrule, shall meet the following requirements.If alterations are made in facilities licensedprior to the effective date of this rule, thosefacilities shall meet these requirements in thealtered space—

1. When a facility is located in a build-ing containing mixed occupancies, the otheroccupancies shall be separated from the fam-ily day care home by at least a one (1)-hourfire barrier; and

2. In facilities in apartment buildings,when both exit accesses exit into the samecorridor, the corridor shall be protectedthroughout by a fire barrier with at least aone (1)-hour fire resistance rated construc-tion. All doors that open into the corridorshall be at least thirty-two inches (32") wide,have a twenty (20)-minute fire resistance rat-ing, and be self-closing.

(4) Exiting and Means of Egress.(A) Each level occupied by children shall

have at least two (2) remotely located meansof egress. Each door opening in a means of

egress shall be at least twenty-eight inches(28") wide. In new construction, each dooropening shall be a minimum of thirty-twoinches (32") wide.

(B) Each room over three hundred (300)square feet in size that is used for day careshall have at least two (2) means of egress.At least one (1) means of egress shall be adoor or stairway providing a means of unob-structed travel through the home to the out-side of the building at street or ground level.The second means of egress may be a win-dow in accordance with 19 CSR 30-61.086(5) Fire Safety.

(C) No room or space that is accessibleonly by a ladder, folding stairs, overheaddoor, or through a trap door shall be occu-pied at any time.

(D) Facilities that use a garage as a secondexit shall have no flammable or combustibleliquids stored in the garage unless approvedby the fire inspector. Overhead garage doorsare not recognized as exit doorways.

(E) Automobiles shall not be stored in thegarage during day care hours if there is anexit through the garage, unless the fireinspector determines that there is sufficientspace for safe evacuation.

(F) No door in a means of egress shall belocked against egress travel when the buildingis occupied. Locking devices that impede orprohibit egress or that cannot be disengagedeasily shall not be used. Dead bolt locks thatrequire a key to unlock the door from theinside shall not be used. Locking or latchingdevices installed on doors shall not be locat-ed higher than fifty inches (50") above thefinished floor.

(G) Where two (2) exits or exit accessdoors are required, they shall be remotelylocated from each other.

(H) Closet door latches shall be designedso children can open the doors from theinside. Bathroom door locks shall bedesigned to permit opening of the door fromthe outside in an emergency. The openingdevice or key shall be readily accessible tothe staff.

(I) Stairways, landings, and ramps shall befree of all objects.

(J) Dead-ends as defined by 19 CSR 30-61.086(1)(B) Fire Safety shall not exceedtwenty feet (20').

(5) Windows for Rescue and Ventilation.(A) In addition to meeting all the require-

ments of this rule, facilities initially licensedand areas initially approved for child care onor after the effective date of this rule, shallmeet the following requirements. If alter-ations are made in facilities licensed prior tothe effective date of this rule, those facilities

shall meet these requirements in the alteredspace—

1. Every room or space greater thanthree hundred (300) square feet used by chil-dren shall have at least one (1) outside win-dow for emergency rescue and ventilation.The window shall be operable from the insidewithout the use of tools and shall provide aclear opening of at least twenty inches (20")wide, twenty-four inches (24") in height.The total clear opening space shall be no lessthan 5.7 square feet in size. The bottom ofthe opening shall be no more than forty-fourinches (44") above the floor and any latchingdevice shall be operated easily. The clearopening shall be a rectangular solid, with aminimum width and height that provides therequired 5.7 square feet opening and a mini-mum depth of twenty inches (20") to allowpassage through the opening. The windowsshall be accessible by the fire department andshall open into an area having access to apublic way. This does not apply when theroom or space has a door leading directly tothe outside of the building; and

2. No windows shall have bars or anyother items placed over them in a stationarymanner that would impede a rescue or evacu-ation attempt.

(6) Level of Exit Discharge.(A) Areas used for day care shall not be

located more than one (1) level below groundlevel.

(B) In addition to meeting all the require-ments of this rule, facilities initially licensedand areas initially approved for child care onor after the effective date of this rule, shallmeet the following requirements. If alter-ations are made in facilities licensed prior tothe effective date of this rule, those facilitiesshall meet these requirements in the alteredspace—

1. Where children are occupying a levelbelow or above the level of exit discharge(basement or second floor), at least one (1)means of egress shall be an exit dischargingdirectly to the outside. The vertical travel toground level shall not exceed eight feet (8')for the basement and twelve feet (12') for thesecond floor; and

2. Where children are occupying a levelbelow or above the level of exit discharge(basement or second floor), arrangement ofmeans of egress shall be remote from eachother.

(7) Travel Distance.(A) The travel distance between any room

door intended as an exit access or an exitshall not exceed one hundred feet (100').This travel distance may be increased by fifty



feet (50') in buildings protected throughoutby a supervised automatic sprinkler systemthat is approved by the fire inspector based onthe National Fire Protection Association’sStandards for Sprinkler Systems.

(B) The travel distance between any pointin a room and an exit shall not exceed onehundred fifty feet (150'). This travel distancemay be increased by fifty feet (50') in build-ings protected throughout by a supervisedautomatic sprinkler system that is approvedby the fire inspector based on the NationalFire Protection Association’s Standards forSprinkler Systems.

(C) The travel distance between any pointin a sleeping room and an exit access to thatroom shall not exceed fifty feet (50').

(8) Emergency Lighting.(A) Emergency lighting shall be installed if

the facility is providing nighttime care or ifthe fire inspector determines that the safety ofthe occupants is endangered. Emergencylights shall have a ninety (90)-minute batterybackup and shall be installed at a locationdetermined by the fire inspector.

(9) Interior Finish.(A) Interior wall and ceiling finishes

throughout shall be Class C as provided inthe latest edition of the National FireProtection Association, Chapter 101, LifeSafety Code. Textile materials having anapped, tufted, looped, woven, nonwoven, orsimilar surface shall not be applied to wallsor ceilings. Foam plastic materials or otherhighly flammable or toxic material shall notbe used as an interior wall, ceiling, or floorfinish.

(B) In addition to meeting all the require-ments of this rule, facilities initially licensedand areas initially approved for child care onor after the effective date of this rule, shallhave wall studs, ceiling joists, and floor joiststhat are covered with a minimum of Class Cfinish with no exposed studs or joists. Ifalterations are made in facilities licensedprior to the effective date of this rule, thosefacilities shall meet these requirements in thealtered space.

(10) Detection and Extinguishment.(A) Smoke detectors shall be installed in

all family day care homes.(B) Smoke detectors shall be in good oper-

ating condition with a functional batteryinstalled. If the smoke detector is not opera-tional, the provider shall install a smokedetector that is powered by the home’s elec-trical system with a nine (9)-volt batterybackup.

(C) Smoke detectors shall be installed oneach level of the home in or near all sleepingareas. Additional smoke detectors shall berequired in other rooms and areas if the fireinspector determines that the safety of theoccupants is endangered.

(D) Facilities using equipment or appli-ances that pose a potential carbon monoxiderisk, including homes with attached garages,shall install a carbon monoxide detector(s).The detector(s) shall be installed according tothe manufacturer’s instructions. The fireinspector may require additional carbonmonoxide detectors if the inspector deter-mines that the safety of the occupants isendangered.

1. Carbon monoxide detectors shall bein good operating condition. If a battery-operated detector is not operational, theprovider shall install a detector that is pow-ered by the home’s electrical system with abattery backup.

2. If an elevated carbon monoxide levelis detected during a fire inspection, theprovider shall have all gas-fired applianceschecked by a heating and air conditioningcompany to identify the source of the carbonmonoxide. Until the provider has documen-tation on file at the facility verifying that allgas-fired appliances were checked by a heat-ing and air conditioning company and are insafe working order, and the facility is deter-mined safe by the fire inspector, the fireinspection shall not be approved.

3. If a level of carbon monoxide is deter-mined that endangers the children in care, thefire inspector shall take measures necessaryto protect the children. This may includeevacuation of the building or closing the facil-ity. The provider shall obtain and have onfile at the facility, documentation verifyingthat all gas-fired appliances were checked bya heating and air conditioning company andare in safe working order. The facility shallbe reinspected by the fire inspector and deter-mined safe before the children can return tothe building or the facility can reopen.

(E) At least one (1) portable, 5 lb., 2 A-10BC, fire extinguisher shall be required in allfacilities and located near the kitchen or alocation required by the fire inspector.Facilities using more than one (1) level shallhave an additional extinguisher on each level.

(F) Fire extinguishers shall be installed andmaintained according to the instructions ofthe fire inspector and shall be inspected andapproved annually by a fire extinguisher com-pany. Documentation of the inspection andapproval shall be on file at the facility andavailable for review by the fire inspector.

(G) In addition to meeting all the require-ments of this rule, facilities initially licensed

and areas initially approved for child care onor after the date of this rule, shall meet thefollowing requirements. If alterations aremade in facilities licensed prior to the effec-tive date of this rule, those facilities shallmeet these requirements in the alteredspace—

1. Smoke detectors shall be powered bythe home’s electrical system and have a nine(9)-volt battery backup. When more than one(1) smoke detector is required by the fireinspector, the smoke detectors shall be inter-connected so that when one smoke detectoractivates, it causes an alarm in all smokedetectors; and

2. Where the family day care home islocated within a building of another occupan-cy such as in an apartment building or officebuilding, any corridors serving the family daycare home shall be provided with a smokedetector(s) that will activate the smoke detec-tor(s) inside the family day care home.

(H) Facilities that have a supervised auto-matic sprinkler system installed shall have thesystem tested and approved annually by a firesprinkler company. A copy of the test reportand approval of the system shall be kept onfile at the facility and available for review bythe fire inspector.

(11) Electrical Services.(A) Electrical wiring shall be installed and

maintained in good working order. If the fireinspector considers the wiring to be unsafefor the occupants or it is installed improper-ly, an inspection by a licensed electrician maybe required prior to fire safety approval. Theinspection by the licensed electrician shall bebased on National Fire Protection Associa-tion, Chapter 70, National Electrical Code.

(B) Protective covers or inserts for electri-cal receptacles shall be installed in all areasoccupied by children.

(C) Electrical extension cords shall not beused unless approved in writing by the fireinspector.

(12) Heating, Cooling, and Air ConditioningEquipment.

(A) Unvented fuel-fired room heaters andportable electrical space heaters shall not beused during child care hours. The providershall sign a compliance letter verifying thatsuch equipment will not be used.

(B) Facilities with a water heater over twohundred thousand (200,000) British thermalunits (Btus) per hour input or larger, or thatis heating with a boiler, shall have a valid per-mit from the Division of Fire Safety postedon the premises. A copy of the permit shallbe kept on file at the Division of Fire Safety.


Secretary of State


(C) Floor furnaces shall have noncom-bustible protective guards installed aroundthem and shall be located so they do notblock access to an exit from any area of thelicensed day care space.

(D) Heating equipment, fireplaces, andradiators in areas occupied by children shallhave partitions, screens, or other means toprotect children from hot surfaces and openflames. If solid partitions are used, provi-sions shall be made to ensure adequate air forcombustion and ventilation for heating equip-ment. Partitions shall be constructed of non-combustible material and shall not obstructexit access.

(E) Gas and electric heating equipmentshall be equipped with thermostatic controls.Gas water heaters shall have a properly sizedpressure relief valve and be vented properlyby galvanized flue pipe and screws at everyjoint in the pipe or by material recommendedby the manufacturer. The drip leg pipe on thepressure relief valve shall extend to approxi-mately six inches (6") above the floor.

(F) Furnace rooms shall be vented proper-ly. Furnace flue pipes shall be constructed ofgalvanized pipe or material recommended bythe manufacturer. Galvanized pipe shall besecured by screws at every joint in the pipe.

(G) Joints in gas supply pipes shall belocated outside the furnace cabinet housing.

(H) Furnaces, water heaters and boilersshall be located inside a fire resistant roomthat is constructed of five-eighth inch (5/8")sheet rock or equivalent on the interior, exte-rior, and ceiling. The room shall have a oneand three-quarter inch (1 3/4") thick solidcore door. Furnace rooms and rooms con-taining water heaters shall not be required tobe fire resistive if an automatic sprinkler headis installed off the domestic water system anda smoke detector is located directly outsidethe room that is interconnected to the othersmoke detectors throughout the home.

(I) Furnace rooms and rooms containingwater heaters shall have adequate combustionair for the units. The vent size opening forthe combustion air shall be measured at one(1) square inch per one thousand (1,000) Btuinput, if the combustion air is drawn frominside the structure and one (1) square inchper four thousand (4,000) Btu input if the airis drawn from outside the structure throughthe attic or crawl space. There shall be two(2) combustion air vent openings in each fur-nace room. One (1) opening shall be locatedat the lower level and the other at the upperlevel.

(J) Air conditioning, heating, ventilatingductwork, and related equipment shall beinstalled safely and be in good operating con-dition as determined by the fire inspector.

The fire inspector shall base this on theNational Fire Protection Association,Chapter 90A, Standard for the Installation ofAir Conditioning and Ventilating Systems; orNational Fire Protection Association,Chapter 90B, Standard for the Installation ofWarm Air Heating and Air ConditioningSystems, as applicable.

(K) Fireplaces and wood burning stovesshall be installed safely and operate in goodworking condition as determined by the fireinspector.

(L) Flues shall be inspected and cleanedonce a year, and the provider shall have doc-umentation of the inspection and cleaning onfile at the facility and available for review bythe fire inspector. A spark arrestor shall beinstalled at the chimney outlet.

(M) In addition to meeting all the require-ments of this rule, facilities initially licensedand areas initially approved for child care onor after the effective date of this rule, shallmeet the following requirements. If alter-ations are made in facilities licensed prior tothe effective date of this rule, those facilitiesshall meet these requirements in the alteredspace—

1. Gas shut off valves shall be locatednext to all gas appliances, furnaces, andwater heaters;

2. If a furnace or water heater is locatedinside a garage, it shall be at least eighteeninches (18") above the finished floor andenclosed inside a fire resistant room. Theroom shall be constructed of five-eighth inch(5/8") sheet rock on the interior and exteriorwall and interior ceiling and shall have a oneand three-quarter inch (1 3/4") thick solidcore door; and

3. Furnaces shall be equipped with anelectrical fused switch to protect the unitfrom electrical overloading and to disconnectthe electrical supply.

(13) Equivalency Concepts.(A) Nothing in this rule is intended to pre-

vent the use of systems, methods, or devicesof equivalent or superior quality, strength,fire resistance, effectiveness, durability, andsafety as alternatives required by this rule.These alternatives may be used only if tech-nical documentation to demonstrate equiva-lency and the system, method, or device issubmitted and approved by the MissouriDivision of Fire Safety.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1998.* Original rule filed Feb. 18,1999, effective Sept. 30, 1999.

*Original authority: 210.221.1(3), RSMo 1949, RSMo1955, 1987, 1993, 1995.

19 CSR 30-61.090 Disaster and EmergencyPreparedness

PURPOSE: This rule requires family childcare homes to prepare and respond to disas-ters and emergencies.

PUBLISHER’S NOTE: The secretary of statehas determined that the publication of theentire text of the material which is incorpo-rated by reference as a portion of this rulewould be unduly cumbersome or expensive.This material as incorporated by reference inthis rule shall be maintained by the agency atits headquarters and shall be made availableto the public for inspection and copying at nomore than the actual cost of reproduction.This note applies only to the reference mate-rial. The entire text of the rule is printedhere.

(1) Disaster Emergency Plan. (A) The facility shall develop, implement,

and maintain policies and procedures forresponding to a disaster emergency, includinga written plan for:

1. Medical and non-medical emergen-cies and disaster situations that could pose ahazard to staff and children, such as a fire,tornado, flood, chemical spill, exposure tocarbon monoxide, power failure, bombthreat, person coming to the facility whosehealth or behavior may be harmful to a childor staff member, or kidnapping;

2. Evacuation from the facility in theevent of a disaster emergency that couldcause damage to the facility or pose a hazardto the staff and children;

3. Lock-down procedures in a situationthat may result in harm to persons inside thefacility such as a shooting, hostage incident,intruder, trespassing, or disturbance or to beused at the discretion of the director,designee, or public safety personnel; and

4. Evacuation from a vehicle used totransport children.

(B) When developing disaster emergencyplans, the facility shall consider—

1. The age and physical and mental abil-ities of the children;

2. The types of services offered, includ-ing whether the facility provides care for non-ambulatory children or overnight care;

3. The types of disasters likely to affectthe area;

4. The requirements of the Division ofFire Safety and the Department of Health andSenior Services’ The ABC’s of EmergencyPreparedness Ready in 3 Program (2006),which is incorporated by reference and is pub-lished by the Department of Health and SeniorServices, Center for Emergency Response and



Terrorism, PO Box 570, Jefferson City, MO65102-0570, telephone number 573-526-4768, and is available at www.health.mo.gov,and advice from the Red Cross or otherhealth and emergency professionals. This ruledoes not include any later amendments oradditions; and

5. The need for ongoing communicationand data sharing with other types of agenciesproviding services to children and with stateand local emergency management agencies.

(C) At a minimum, a disaster emergencyplan shall identify the staff members respon-sible for implementing the plan and ensuringthe safety of the children and shall include:

1. The location of the child’s attendancerecord and emergency information and emer-gency supplies;

2. Diagrams that identify exit routesfrom each area of the facility used for childcare to a safe location out of the facility andto a safe location within the facility wherechildren and staff members can stay until thethreat of danger passes;

3. A list of emergency contacts as set outin subsection (2)(B) below;

4. The disaster and emergency proce-dures to be followed, which include but arenot limited to the following:

A. Use of alarms to warn other build-ing occupants and summon staff;

B. Emergency telephone call to thefire department;

C. Response to alarms;D. Isolation of a fire, including con-

finement by closing doors to the fire area;E. Evacuation of the immediate area;F. Two (2) off-site locations identified

as meeting places in case of evacuation; G. Relocation as detailed in the disas-

ter and emergency plan, including individualswith special needs, such as non-ambulatorychildren and children who sleep overnight, ifapplicable; and

H. System of contact for parents ofchildren and notification of parents of theplan to assist in re-unification; and

5. Lock down procedures shall include:A. An announcement of the lock-

down by the director or designee. The alertmay be made using a pre-selected code word;

B. In a lock-down situation, staff shallkeep children in their rooms or other desig-nated location that are away from the danger;and

C. Staff is responsible for accountingfor children and ensuring that no one leavesthe room or safe area until “all clear” isannounced.

(2) Access to Disaster Emergency Informa-tion. The licensee shall ensure that—

(A) At all times, a copy of the facility’sdisaster emergency plan is readily available inthe office area and in each room used for careof children; and

(B) The following information is posted ineach room used for child care and besideeach telephone in the facility:

1. Contact information, including thefollowing:

A. The name, address, and telephonenumber of the facility;

B. A list of emergency numbers,including 911, if available, the fire depart-ment, police department, ambulance service,poison control center, and local radio station;

C. When a facility operates at morethan one (1) site, the name and telephonenumber of the facility’s principal place ofbusiness; and

D. When a facility occupies space itdoes not own, the name and telephone num-ber of the owner of the building or the build-ing manager;

2. A diagram of evacuation routes fromthe room; and

3. Any special instructions for infantsand non-ambulatory children.

(3) Disaster Emergency Response Drills forStaff and Children.

(A) The licensee shall ensure that the facil-ity has on file documentation that, at leastevery three (3) months, all staff and childrenat the facility have participated in a disasteror emergency drill based on the facility’s dis-aster and emergency plan.

(B) In addition to fire safety requirementsfound in 19 CSR 30-61.086, a review of thefollowing disaster drill procedures with thestaff and children shall be conducted:

1. Staff duties and responsibilities in theevent of an emergency;

2. Disaster drill procedures such as firedrill, tornado drill, carbon monoxide expo-sure, power failure, bomb threat, chemicalspill, intruder training, and CPR or othermedical procedures;

3. The use of and response to firealarms; and

4. The use of fire extinguishers.

AUTHORITY: section 210.221, RSMo 2000.*Original rule filed April 29, 2011, effectiveOct. 30, 2011.

*Original authority: 210.221, RSMo 1949, amended 1955,1987, 1993, 1995, 1999.

19 CSR 30-61.095 Furniture, Equipment,and Materials

PURPOSE: This rule sets forth the require-

ments for the furniture, equipment and mate-rials needed in a family day care home.

PUBLISHER’S NOTE: The secretary of statehas determined that the publication of theentire text of the material which is incorpo-rated by reference as a portion of this rulewould be unduly cumbersome or expensive.This material as incorporated by reference inthis rule shall be maintained by the agency atits headquarters and shall be made availableto the public for inspection and copying at nomore than the actual cost of reproduction.This note applies only to the reference mate-rial. The entire text of the rule is printedhere.

(1) Indoor Furniture and Equipment.(A) General Requirements.

1. All furniture and equipment shall beconstructed safely, in good condition and freeof sharp, loose or pointed parts. Only lead-free paint shall be used.

2. Furniture and equipment shall bearranged to provide a clear passage to all exits.

(B) Sleeping Equipment.1. General requirements.

A. A cot, bed, sofa, padded playpen,or crib shall be provided for each child whonaps or sleeps. An individually assigned sheetand blanket shall be provided for each childtwelve (12) months and older who naps orsleeps. Upper levels of bunk beds shall not beused.

B. If family beds are used for nappingor sleeping, a clean sheet shall be spread overthe family bedding.

C. If a double bed or larger is usedonly two (2) children may nap or sleep on itat one (1) time.

D. All bedding shall be clean withsheets laundered at least once a week. Oncebedding has been used by a child, it shall notbe used by another child until it has beenlaundered.

E. Sleeping equipment shall bearranged to provide at least a two-foot (2')aisle on one (1) long side of the equipment.

2. Infants.A. A crib, portable crib, or playpen

shall be provided and used for each infant.Stack cribs shall not be used.

B. Cribs and playpens shall meet theConsumer Product Safety Commission andASTM International (formerly the AmericanSociety for Testing and Materials) safety stan-dards for full size baby cribs as found in 16CFR Part 1219 and for non-full size baby cribsas found in 16 CFR Part 1220. The 2014 cribsafety standards found in 16 CFR Parts 1219and 1220 are incorporated by reference as partof this rule and are published by and available


Secretary of State


at the U.S. Government Publishing Office,732 North Capitol Street NW, Washington,D.C. 20401-0001, 202-512-1800, www.book-store.gpo.gov/catalog/laws-regulations/code-federal-regulations-cfrs-print. This rule doesnot include any later amendments or addi-tions.

C. The crib mattress or playpen padshall be sized correctly to the crib or playpen,in good condition, waterproof, and kept cleanand dry, be firm and maintain its shape evenwhen the fitted sheet designated for that modelis used, such that there are no gaps betweenthe mattress and the side of the crib orplaypen. Only fitted sheets shall be used andshall be changed immediately when soiled orwet.

D. Soft materials or objects such aspillows, quilts, comforters, or sheepskins,even if covered by a sheet, shall not be placedunder a sleeping infant. If a mattress cover toprotect against wetness is used, it shall be tightfitting and thin.

E. Cribs, portable cribs, and playpensshall be free of soft objects, loose bedding, orany object that can increase the risk of entrap-ment, suffocation, or strangulation. Examplesinclude bumper pads, pillows, quilts, com-forters, sleep positioning devices, sheepskins,blankets, flat sheets, cloth diapers, bibs, pil-low-like toys, wedges, infant positioners, spe-cial mattresses, special sleep surfaces, andother similar items.

F. Blankets or other soft or loose bed-ding shall not be hung on the sides of cribs orput under the fitted sheet. Only sleep clothingthat is designed to keep an infant warm with-out the possible hazard of covering the heador face may be used during sleep or nap time.

G. Sitting devices such as car safetyseats, strollers, swings, infant carriers, infantslings, and other sitting devices shall not beused for sleep/nap time. Infants who fallasleep anywhere other than a crib, portablecrib, or playpen must be placed in the crib orplaypen for the remainder of their sleep or naptime.

(C) Tables and Seating Equipment. 1. Preschool and school-age children.

Table and seating space for eating and tableactivities shall be available for childrentwelve (12) months of age and older.

2. Infants and toddlers. Infants and tod-dlers who are unable to sit at a table shall beserved meals at a feeding table, high chair,infant seat or other safely designed infant-seating equipment. Equipment shall be pro-vided which will allow a child to sit comfort-ably and securely while being fed.Appropriate restraints shall be used.

(2) Indoor Play Equipment and Materials.

(A) General Requirements. 1. Play equipment and materials shall be

clean, in good condition with all parts intactand accessible to children.

2. Play equipment and materials shall bereplaced as needed to maintain the number ofitems required for the licensed capacity of thehome.

3. Toys or materials that come in setsshall be considered one (1) item.

(B) Preschool and School-Age Children. 1. Children twenty-four (24) months of

age or older shall have an ample variety ofage-appropriate toys, books, creative materi-als and activities which provide fun, stimula-tion, development and opportunities for indi-vidual choices.

2. A minimum of forty (40) approveditems shall be required. The forty (40) itemsshall include at least four (4) items from eachof the following categories:

A. Blocks, construction and trans-portation toys;

B. Manipulatives; C. Creative arts; D. Large muscle activities; E. Library and language activities; F. Music and rhythm activities; G. Dramatic and housekeeping play;

and H. Science activities or sensory expe-

riences. (C) Infants and Toddlers.

1. Infants and toddlers shall have safetoys which shall be washed when soiled.Toys, parts of toys or other materials shall notbe small enough to be swallowed. Toys andmaterials shall include a minimum of one (1)approved item from each of the following cat-egories for each infant and toddler in thelicensed capacity of the home:

A. Push-pull toys; B. Balls or other large muscle equip-

ment; C. Blocks, stacking toys or other

manipulatives; and D. Cloth or plastic-coated books.

(3) Outdoor Equipment. (A) All outdoor equipment shall be con-

structed safely, in good condition and free ofsharp, loose or pointed parts. Only lead-freepaint shall be used.

(B) Outdoor equipment shall be providedfor the ages and number of children in care tomeet their physical and developmental needs.

(C) Children shall be instructed in the safeuse of outdoor equipment.

(D) Stationary equipment such as swings,slides and climbers shall be securelyanchored, have no exposed footings and beplaced to avoid accidents or collisions.

(E) For family day care homes initiallylicensed after the effective date of these rulesor for homes installing new equipment, anypart of the equipment from which childrenmight fall shall not be more than six feet (6')in height.

(F) Equipment with moving parts whichmight pinch or crush children’s hands or fin-gers shall not be used unless the moving partswhich pose a threat to children have guardsor covers. “S” hooks shall be pinched togeth-er to avoid catching children's skin or cloth-ing.

(G) Swings shall have lightweight seats ofrubber, plastic, canvas or nylon.

(H) Exposed bolts and screws shall berecessed into the frame, covered or filed toavoid sharp edges.

(I) Ropes, loops or any hanging apparatusthat might entrap, close or tighten upon achild shall not be permitted.

(J) Trampolines shall not be used. Mini-trampolines, aerobic bouncers or other simi-lar small jumping equipment may be usedwith close supervision.

AUTHORITY: sections 210.221 and 210.223,RSMo Supp. 2015.* This rule previously filedas 13 CSR 40-61.080, 13 CSR 40-61.095,and 19 CSR 40-61.095. Original rule filedMarch 29, 1991, effective Oct. 31, 1991.Changed to 19 CSR 40-61.095, effective Dec.9, 1993. Changed to 19 CSR 30-61.095 July30, 1998. Emergency amendment filed Nov.10, 2015, effective Nov. 20, 2015, expiredMay 17, 2016. Amended: Filed Nov. 10,2015, effective April 30, 2016.

*Original authority: 210.221.1(3), RSMo 1949, amended1955, 1987, 1993, 1995, 1999, 2015 and 210.223, RSMo2015.

19 CSR 30-61.105 The Day Care Providerand Other Day Care Personnel

PURPOSE: This rule sets forth the require-ments for the day care provider and assis-tants, and number and age limitations of chil-dren in care and staff training.

PUBLISHER’S NOTE: The secretary of statehas determined that the publication of theentire text of the material which is incorporat-ed by reference as a portion of this rule wouldbe unduly cumbersome or expensive. Thismaterial as incorporated by reference in thisrule shall be maintained by the agency at itsheadquarters and shall be made available tothe public for inspection and copying at nomore than the actual cost of reproduction.This note applies only to the reference materi-al. The entire text of the rule is printed here.



(1) General Requirements. (A) The provider routinely shall be present

during the hours of highest attendance a min-imum of forty (40) hours per week.

(B) The provider shall name an assistantcaregiver who shall be available to substituteduring his/her absence or to meet staff/childratios.

(C) Caregivers shall be eighteen (18) yearsof age or older, have knowledge of the needsof children, and be sensitive to the capabili-ties, interests, and problems of children incare.

(D) Caregivers shall be of good characterand intent and shall be qualified to providecare conducive to the welfare of children.

(E) Caregivers shall be capable of handlingemergencies promptly and intelligently.

(F) All caregivers shall cooperate with thedepartment.

(G) The provider shall not be engaged inany other employment while on duty at thefamily day care home.

(H) The provider shall have available acopy of the Licensing Rules for Family DayCare Homes in Missouri. Providers and assis-tants shall review and be knowledgeable ofthe rules at the time they begin work, andshall be able to understand and apply therules which relate to their respective respon-sibilities.

(I) All child care providers and assistantsshall acquaint themselves with the childabuse and neglect law and shall make a reportof any suspected child abuse or neglect to theDivision of Family Services at the toll freenumber, 1-800-392-3738.

(J) The provider or others in the homeshall not be under the influence of alcohol orillegal drugs while child care is being provid-ed. The child care provider or other childcare personnel shall not be in a state ofimpaired ability due to use of medicationwhile providing child care.

(K) The provider, other household mem-bers, and other child care personnel shall bescreened for child abuse/neglect. Any inves-tigated allegation of child abuse or neglectinvolving these persons in which the investi-gator finds reasonable cause to believe thatthis person is the alleged perpetrator of childabuse or neglect shall be evaluated by thedepartment. After review, the departmentmay prohibit this person from being presentin the home during child care hours.

(L) The child care provider shall requestand have on file the results of a criminalrecord review from the Missouri StateHighway Patrol as defined by 19 CSR 30-61.045 Initial Licensing Information and 19CSR 30-61.055 License Renewal. This shallinclude the results of a criminal record review

from the Missouri State Highway Patrol forthe child care provider, all persons employedby the child care provider, and all adulthousehold members. The child care providershall request a criminal record review withinten (10) days following the employment ofany person and within ten (10) days after anyadult becomes a household member. Thedepartment may request a criminal recordreview for any adult present in the family daycare home when child care children are pre-sent. The criminal record reviews shallinclude records of criminal convictions,pending criminal charges, and suspendedimposition of sentence during the term ofprobation. Requests for criminal recordreviews shall be made on a form provided bythe highway patrol.

1. When the department determines thata nationwide check is warranted, the depart-ment may request a criminal record reviewfrom the Missouri State Highway Patrol forclassification and search of fingerprints forany person seeking employment with theprovider as provided in sections 43.530 and43.543, RSMo. Requests for criminal recordreviews shall be made on a form provided bythe highway patrol that shall be signed by thesubject of the request. The provider shall sub-mit the signed form to the department withtwo (2) sets of fingerprints for each personwho is the subject of a criminal recordreview.

2. Any information received by thedepartment that indicates that the subject ofthe criminal record review poses a threat tothe safety or welfare of children shall be eval-uated by the department. After review, thedepartment may prohibit such person frombeing present on the premises of the familyday care home during child care hours.

3. Information received by the providershall be retained in the individual’s file in aconfidential manner.

(M) If an employee reports licensing defi-ciencies in the home, the child care providershall not take any action against the employ-ee because of the report that would adverselyaffect his/her employment or terms or condi-tions of employment.

(N) The provider shall have documentationon file at the home of current certification inage-appropriate first aid and cardiopul-monary resuscitation (CPR) training. Thetraining shall be certified by a nationally-rec-ognized organization, such as the AmericanRed Cross, American Heart Association, oran equivalent certification approved by thedepartment. At least one (1) caregiver withcurrent certification in age-appropriate firstaid and CPR must be on site at all times whenchildren are present. First aid/CPR training

may count toward the annual clock hour train-ing requirement.

(2) Licensing Capacities. (A) If there is one (1) adult provider, the

home may be licensed for up to six (6) chil-dren including a maximum of three (3) chil-dren under age two (2), or for up to ten (10)children including a maximum of two (2)children under age two (2), or both. If onlyfour (4) children are present, all the childrenmay be under the age of two (2).

(B) If the provider has an assistant present,the home may be licensed for up to ten (10)children including a maximum of four (4)children under age two (2) or for up to eight(8) children who may all be under age two(2).

(C) A family day care home may belicensed at maximum capacity for a period ofeighteen (18) consecutive hours of the twen-ty-four (24)-hour day. For the remaining six(6) hours of the twenty-four (24)-hour day,care may be provided for one-third (1/3) thelicensed capacity of the home.

(3) Assistants. (A) An approved assistant shall be avail-

able. If there is a change of assistants, theprovider shall notify the Child CareLicensing Unit immediately.

(B) All assistants shall submit to thedepartment the names and addresses of two(2) references not related to them who haveknowledge of their character, experience, andability.

(C) All assistants shall be screened forchild abuse/neglect.

(D) An assistant who is employed or vol-unteers more than five (5) hours per weekshall provide a medical examination reportaccording to 19 CSR 40-61.125 MedicalExamination Reports.

(E) The names, addresses, and telephonenumbers of all assistants shall be posted withother emergency numbers in the home.

(F) Parents shall be notified of any absenceof the provider and informed of the name ofthe assistant on duty.

(4) Child Care Training. (A) The provider shall obtain at least

twelve (12) clock hours of child care-relatedtraining during each year of employment intraining which is approved by the departmentin health, safety, nutrition, guidance and dis-cipline, appropriate activities and learningexperiences for children, positive communi-cation and interaction with parents, planningand setting up an appropriate environment forchildren, professional and administrativepractices, or other child-related areas. Any


Secretary of State




assistant working more than five (5) hoursper week shall meet the same trainingrequirements.

(B) All training for the provider and assis-tants shall be documented with the dates, thenumber of hours of training completed, thesubject, and the name of the individual(s)who conducted the training. This informationshall be on file at the home and available forreview.

(5) Safe Sleep Training. Every three (3) yearsthe provider and assistant(s) in a family childcare home licensed to provide care for infantsless than one (1) year of age shall successful-ly complete department-approved trainingregarding the American Academy of Pediatrics(AAP) safe sleep recommendations containedin the American Academy of Pediatrics TaskForce on Sudden Infant Death Syndrome.Technical report – SIDS and other sleep-relat-ed infant deaths: expansion of recommenda-tions for a safe infant sleeping environment,by Moon RY, which is incorporated by refer-ence in this rule as published in PEDIATRICSVolume 128, No. 5, November 1, 2011, andavailable from the University of VermontCollege of Medicine, Given Building S261, 89Beaumont Avenue, Burlington, Vermont05405-0068, telephone number 802-656-2505, fax number 802-656-4844, or atwww.pediatrics.aapublications.org/con-tent/128/5/1030.full. This rule does not incor-porate any subsequent amendments or addi-tions.

(A) The training shall be documented andmaintained as described in subsection (4)(B)of this rule.

(B) The provider and assistant(s) in a fam-ily child care home licensed prior to theeffective date of this rule shall complete thesafe sleep training described in section (5) ofthis rule within three (3) months of the effec-tive date of this rule.

(C) The provider and assistant(s) in a fam-ily child care home licensed after the effec-tive date of this rule shall complete the safesleep training described in section (5) of thisrule prior to licensure.

(D) The provider and any assistant hired orvolunteering at the facility after initial licen-sure shall complete the safe sleep trainingdescribed in section (5) of this rule withinthirty (30) days of employment or volunteer-ing at the facility.

AUTHORITY: sections 210.221 and 210.223,RSMo Supp. 2015.* This rule previously filedas 13 CSR 40-61.090, 13 CSR 40-61.105,and 19 CSR 40-61.105. Original rule filedMarch 29, 1991, effective Oct. 31, 1991.Changed to 19 CSR 40-61.105, effective Dec.

9, 1993. Emergency amendment filed Aug.18, 1993, effective Aug. 28, 1993, expiredDec. 25, 1993. Emergency amendment filedJan. 4, 1994, effective Jan. 14, 1994, expiredMay 13, 1994. Amended: Filed Aug. 18,1993, effective April 9, 1994. Changed to 19CSR 30-61.105 July 30, 1998. Amended:Filed Feb. 18, 1999, effective Sept. 30, 1999.Amended: Filed Jan. 28, 2011, effective July30, 2011. Emergency amendment filed Nov.10, 2015, effective Nov. 20, 2015, expiredMay 17, 2016. Amended: Filed Nov. 10,2015, effective April 30, 2016.

*Original authority: 210.221, RSMo 1949, amended 1955,1987, 1993, 1995, 1999, 2015 and 210.223, RSMo 2015.

19 CSR 30-61.115 Day Care Family andHousehold

PURPOSE: This rule contains the require-ments for family members and others sharingthe home with day care children.

(1) Relationships between members of theday care household shall provide a positiveenvironment for children. There shall beagreement among the adult members of thehousehold for sharing their home with theday care children.

(2) The financial resources of the family shallbe sufficient to maintain minimum standardsof care as set forth by the department.

(3) If an individual(s) requiring extensivecare due to illness or handicapping conditionsis present in the home during the hours ofchild care, another adult shall be available inthe home on a full-time basis who shall beresponsible for caring for the individual(s)requiring extensive care.

(4) The provider shall notify the departmentof any new household members.

(5) Any household member or any personpresent at the home during hours in whichchild care is provided shall not present athreat to the health, safety or welfare of thechildren.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 13CSR 40-61.100, 13 CSR 40-61.115 and 19CSR 40-61.115. Original rule filed March 29,1991, effective Oct. 31, 1991. Changed to 19CSR 40-61.115, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,

effective April 9, 1994. Changed to 19 CSR30-61.115 July 30, 1998.


19 CSR 30-61.125 Medical ExaminationReports

PURPOSE: This rule sets forth the require-ments for medical examinations for care-givers and children in care.

(1) Day Care Provider and Assistants. (A) The child care provider shall be in

good physical and emotional health with nophysical or mental conditions which wouldinterfere with child care responsibilities.

(B) The provider shall have a medicalexamination report on file at the time of ini-tial licensure.

(C) All assistants shall be in good physicaland emotional health with no physical ormental conditions which would interfere withchild care responsibilities.

(D) Assistants who are employed or volun-teer more than five (5) hours per week shallhave a medical examination report on filewithin thirty (30) days of beginning work inthe home.

(E) Medical examination reports shallinclude a “Risk Assessment for Tuberculosis”form, included herein, completed and signedby a health care professional, as provided bythe Missouri Department of Health andSenior Services (MDHSS). If the person hassigns or symptoms of tuberculosis, or riskfactors for tuberculosis, then testing fortuberculosis shall occur.

1. If the person has no documented his-tory of ever receiving a tuberculin skin test(TST), and elects to receive a TST, then a two(2)-step TST is required. A history of bacilliCalmette-Guerin vaccination (BCG) shall notexempt a person from receiving a tuberculintest.

2. Persons that have a newly positivetuberculin test(s) shall not be allowed to workuntil a medical evaluation is performed todetermine if the person has active contagioustuberculosis.

3. Persons with active contagious tuber-culosis shall be excluded from employmentuntil deemed non-infectious by MDHSS orthe local public health agency. The personmay return to work once the above criteriahave been met, as long as the person adheresto his/her prescribed treatment regimen.

4. All positive tuberculin tests shall bereported to the Missouri Department ofHealth and Senior Services or local public

health agency as required by 19 CSR 20-20.020.

(F) Medical examination reports shall besigned by a licensed physician or registerednurse who is under the supervision of alicensed physician and completed not morethan twelve (12) months prior to beginningwork in the home. These reports may betransferable to another day care facility forsubsequent employment.

(G) The medical examination report formshall be supplied by the department or theprovider may use his/her own form if it con-tains all the information on the department'sform.

(H) A child care employee, who is identi-fied as a contact to an active tuberculosiscase, shall be evaluated for tuberculosis todetermine if the person has active contagioustuberculosis, or be excluded from work.

(I) If at any time the department has reasonto question the physical or mental health of aprovider or assistant, the department shallrequire a physical or mental examination ofthat person.

(J) No individual shall work when ill if thehealth or well-being of children is endan-gered.

(2) Children. (A) The provider shall require, within thir-

ty (30) days following the admission of eachinfant, toddler or preschool child, a medicalexamination report signed by a licensedphysician or registered nurse who is underthe supervision of licensed physician andcompleted not more than twelve (12) monthsprior to admission.

(B) Examination reports shall determine ifa child’s medical history and current state ofhealth is satisfactory for participation in a daycare program.

(C) Medical examination reports shall notapply to any child if the parent(s) files asigned statement of objection based on reli-gious beliefs.

(D) The parent(s) of a school-age childshall provide a report at the time of enroll-ment indicating the child’s health history, anycurrent health problems, and any restrictionsnecessary for the child’s care.

(E) The medical examination report formand the health history report for school-agechildren shall be supplied by the departmentor the provider may use his/her own form ifit contains all the information on the depart-ment's form.


Secretary of State



Secretary of State




AUTHORITY: section 210.221, RSMo 2000.*This rule was previously filed as 13 CSR 40-61.110, 13 CSR 40-61.125, and 19 CSR 40-61.125. Original rule filed March 29, 1991,effective Oct. 31, 1991. Changed to 19 CSR40-61.125, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,effective April 9, 1994. Changed to 19 CSR30-61.125 July 30, 1998. Amended: FiledApril 29, 2011, effective Oct. 30, 2011.

*Original authority: 210.221, RSMo 1949, amended 1955,1987, 1993, 1995, 1999.

19 CSR 30-61.135 Admission Policies andProcedures

PURPOSE: This rule defines admission poli-cies and procedures for children in care.

PUBLISHER’S NOTE: The publication of thefull text of the material that the adoptingagency has incorporated by reference in thisrule would be unduly cumbersome or expen-sive. Therefore, the full text of that materialwill be made available to any interested per-son at both the Office of the Secretary of Stateand the office of the adopting agency, pur-suant to section 536.031.4, RSMo. Suchmaterial will be provided at the cost estab-lished by state law.

(1) The provider shall establish, implement,and maintain written policies pertaining tothe program goals, admission, safe sleeppractices for children less than one (1) year ofage, care and discharge of children, and shallprovide a copy to the parent(s) at the time ofenrollment.

(2) The provider’s infant safe sleep policyshall comply with section 210.223, RSMo,and shall include, but not be limited to:

(A) The following safe sleep practices:1. The policy shall list the licensee’s

expectations regarding how and when care-givers are to be trained on safe sleep;

2. A requirement that children less thanone (1) year of age be placed on their backsto sleep;

3. A requirement that the facility shallreceive a written statement from the infant’slicensed health care provider stating that theinfant requires alternative sleep positions orspecial sleeping arrangements that differ fromthose set forth in 19 CSR 30-61.175(2)(C)prior to allowing the infant to be placed in asleep position that is not on his or her back;

and4. Supervision of infants during nap/sleep

times, to include:A. Positioning of staff; B. Lighting in the nap room; C. Physical checks of the child to

ensure he or she is not overheated or in dis-tress; and

D. Prohibitions against the use of anyequipment such as a sound machine that mayinterfere with the caregiver’s ability to see orhear a child who may be distressed; and

(B) The following requirements for safesleep environments:

1. The policy shall state that cribs andplaypens must have a firm mattress and tightfitting sheets, be free of loose bedding,bumper pads, pillows, and soft toys;

2. Shall require infants’ heads be uncov-ered during nap/sleep times;

3. Shall prohibit covering cribs orplaypens with blankets or bedding;

4. Shall prohibit smoking in the childcare home during the hours children are incare; and

5. Shall require giving the parent(s) orguardian(s) of each infant in care a copy ofthe provider’s safe sleep policy upon thechild’s enrollment.

(3) The provider shall have available a copyof the Licensing Rules for Family Day CareHomes in Missouri and shall advise the par-ent(s) at the time of enrollment of his/herchild of the availability of the rules forreview.

(4) A child who has a special physical, devel-opmental, or behavioral need shall have onfile an individualized plan for specializedcare from a professionally qualified source.

(5) The provider shall assess his/her ability toprovide care for the special needs child whilealso meeting the needs of the other children.

(6) The provider shall develop and implementa procedure for admitting children whichshall include:

(A) A personal interview with the parent(s)and child to exchange information and arriveat a mutual decision about admitting a child;

(B) A plan for continuing communicationbetween the child care provider and the par-ent(s);

(C) Discussion of the plan for providing forthe care of the ill child as required by 19 CSR30-61.185 Health Care;

(D) Discussion of the parental plan for pro-viding for the care of the child when theprovider is ill or for the care of school-agechildren on scheduled days of school closing;

and (E) Completion by the parent(s) of the fol-

lowing written information which shall be onfile before the child is accepted for care:

1. All information required by 19 CSR30-61.210 Records and Reports;

2. Information regarding a child’s per-sonal development, behavior patterns, habits,and individual needs;

3. Instructions for action to be taken ifthe parent(s) or physician designated by theparent(s) cannot be reached in an emergencyand permission for emergency medical care;

4. Information indicating that the childhas completed age-appropriate immunizations,is in the process of completing immunizations,or is exempt from immunization requirementsas defined by 19 CSR 30-61.185 Health Care;

5. Permission for field trips, transporta-tion to and from school, and other transporta-tion;

6. Permission for school-age children toleave the home to participate in classes, clubs,or other activities, naming the activity, time ofleaving and returning, and the method oftransportation to and from the activity(Permission for regular activities such asscouting may be given for the entire schoolterm.); and

7. Acknowledgement by the parent(s)that—

A. They have received a copy of theprovider’s policies pertaining to the admis-sion, care, and discharge of children;

B. They have been informed that theLicensing Rules for Family Day Care Homesin Missouri are available in the home for theirreview;

C. They and the provider have agreedon a plan for continuing communicationregarding the child’s development, behaviorand individual needs;

D. They understand and agree that thechild may not be accepted for care when ill;

E. They have received a copy of theprovider’s safe sleep policy when enrollingchildren less than one (1) year of age; and

F. They have been notified that theymay request notice at initial enrollment in orattendance at the facility or upon request ofwhether there are children for whom animmunization exemption has been filed cur-rently enrolled in or attending the facility.

(7) If care is provided for children related tothe provider who do not live in the home, theparent(s) shall complete and sign a formwhich is supplied by the department. Theform shall be on file at the home before relat-ed children are accepted for care and shallcontain the following identifying information:

(A) Each child’s name, address, birth date,


Secretary of State


and date of admission; (B) Each child’s relationship to the

provider; and (C) The parent’s(s)’ name(s), address(es),

and telephone number(s).

(8) If a provider enrolls children for irregularor intermittent care, all procedures for admit-ting children shall be followed. Childrenenrolled on an irregular or intermittent basisshall be accepted only by appointment andshall not cause the home to exceed itslicensed capacity.

(9) After attempts have been made to meet achild’s individual needs, any child whodemonstrates an inability to benefit from thecare offered by the child care provider orwhose presence is detrimental to other chil-dren may be discharged from the home.

(10) Care of a child may be discontinued ifthe provider and the parent(s) cannot estab-lish a mutually satisfactory working relation-ship.

(11) Parents shall have access to the home atany time during child care hours.


Secretary of State


AUTHORITY: sections 210.221 and 210.223,RSMo Supp. 2015.* This rule previously filedas 13 CSR 40-61.120, 13 CSR 40-61.135,and 19 CSR 40-61.135. Original rule filedMarch 29, 1991, effective Oct. 31, 1991.Changed to 19 CSR 40-61.135, effective Dec.9, 1993. Emergency amendment filed Aug.18, 1993, effective Aug. 28, 1993, expiredDec. 25, 1993. Emergency amendment filedJan. 4, 1994, effective Jan. 14, 1994, expiredMay 13, 1994. Amended: Filed Aug. 18,1993, effective April 9, 1994. Changed to 19CSR 30-61.135 July 30, 1998. Emergencyamendment filed Nov. 10, 2015, effective Nov.20, 2015, expired May 17, 2016. Amended:Filed Nov. 10, 2015, effective April 30, 2016.

*Original authority: 210.221.1(3), RSMo 1949, amended1955, 1987, 1993, 1995, 1999, 2015 and 210.223, RSMo2015.

19 CSR 30-61.145 Nighttime Care

PURPOSE: This rule sets forth requirementsfor facilities providing nighttime care for chil-dren.

(1) If nighttime care is to be offered on a reg-ular basis, rules shall be met as set forth fornighttime care and the home shall be specifi-cally licensed to include nighttime care.

(2) Family day care homes licensed for night-time care shall meet the requirements of thefollowing additional rules:

(A) Special effort shall be made by thechild care provider to individualize care atchildren's bedtime and awakening. The par-ent(s) shall be consulted concerning his/herchild's particular behavior patterns at bed-time and awakening;

(B) As parents will be calling for childrenat various hours during nighttime care, roomarrangements shall take into consideration thechild's need for undisturbed sleep;

(C) Combs, brushes, toothbrushes or otherpersonal items shall be individually markedwith the child's name;

(D) Night-lights shall be located in areas asrequired by individual children's needs;

(E) Separate sleeping and dressing areasshall be provided for school-age boys andgirls; and

(F) During sleeping hours, the provider orassistant(s) shall be in close proximity tosleeping areas in order to respond to childrenneeding attention. Close proximity meansthat the provider shall be close enough to thechildren to be able to hear any sounds theymight make that would indicate a need forassistance.

AUTHORITY: section 210.221.1(3), RSMo

Supp. 1993.* This rule previously filed as 13CSR 40-61.130, 13 CSR 40-61.145 and 19CSR 40-61.145. Original rule filed March29, 1991, effective Oct. 31, 1991. Changed to19 CSR 40-61.145, effective Dec. 9, 1993.Changed to 19 CSR 30-61.145 July 30, 1998.


19 CSR 30-61.155 Overlap Care ofChildren

PURPOSE: This rule defines overlap careand sets forth the requirements of overlapcare.

(1) There may be situations (for example, toaccommodate parents’ work shifts or before-and after-school care) when the number ofchildren in care over two (2) years of age mayexceed the licensed capacity of the home. Thenumber in care shall never be more than one-third (1/3) over the licensed capacity of thehome at the time of overlap. The overlapperiod(s) shall not exceed two (2) hours totalin any twenty-four (24)-hour child-care day.The two (2) hours of available overlap timemay be utilized in smaller time periods.

(2) Overlap care of children under two (2)years of age shall not be permitted.

(3) Overlap care shall not be provided untilan overlap request has been submitted,including the hours overlap care will be pro-vided, and written approval has been receivedfrom the department. Any changes in thehours of overlap care shall require that a newoverlap request form be submitted andapproved.

(4) All procedures for admitting childrenshall be followed if a provider chooses toenroll children for overlap care.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 13CSR 40-61.140, 13 CSR 40-61.155 and 19CSR 40-61.155. Original rule filed March29, 1991, effective Oct. 31, 1991. Changed to19 CSR 40-61.155, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,effective April 9, 1994. Changed to 19 CSR30-61.155 July 30, 1998.


19 CSR 30-61.165 Emergency SchoolClosings

PURPOSE: This rule allows one-third addi-tional attendance of school-age children onunscheduled days of school closing.

(1) On days when schools are closed due toemergencies such as inclement weather orphysical plant failure, the home may accom-modate enrolled school-age children whoneed care. The provider shall be permitted toexceed for the day the licensed capacity of thehome by one-third (1/3). The one-third (1/3)excess attendance shall not be in addition tothe one-third (1/3) excess attendance allowedfor overlap care. At no time may the totalnumber in care be more than one-third (1/3)over the licensed capacity of the home.

(2) The provider shall maintain a writtenrecord including the date of the emergencyschool closing, the reason for the closing andthe number of children in care on that date.

(3) Emergency school closing overlap shallnot be permitted for scheduled days of schoolclosing.



19 CSR 30-61.175 Child Care Program

PURPOSE: This rule sets forth the require-ments for the care of children, includingsupervision, emergency drills, discipline, dia-pering and toileting, and daily activities.

(1) Care of the Child. (A) General Requirements.

1. Child care providers shall not leaveany child without competent adult supervi-sion.

2. The provider or an assistant personal-ly shall admit each child upon arrival and per-sonally shall dismiss each child upon depar-ture. Children shall be dismissed only to theparent(s), guardian, legal custodian, or to theindividual(s) approved by the parent(s),guardian, or legal custodian.

3. Caregivers shall provide frequent,direct contact so children are not routinelyleft unobserved on the premises.

4. Children under three (3) shall be

supervised and assisted while in the bath-room.

5. Caregivers shall check on the childrenfrequently during napping or sleeping andshall remain in close enough proximity to thechildren to be able to hear them if they havedifficulty during napping or when they awak-en. Home monitors or commercial devicesmarketed to reduce the risk of Sudden InfantDeath Syndrome (SIDS) shall not be used inplace of supervision while children are nap-ping or sleeping.

6. If children are napped with no care-giver in the room, the door to the room can-not be closed.

7. All children shall nap on the samefloor and a caregiver shall remain on thefloor where children are napping at all times.

8. Preschool children who do not sleepshall rest on sleeping equipment at least thir-ty (30) minutes, but shall not be forced toremain on the sleeping equipment longer thanone (1) hour. They shall then be permitted toleave the napping area to engage in quiet play.

9. The provider shall ensure that specialattention is given on an individual basis tonew children having problems adjusting, dis-tressed children, etc. Children shall beencouraged, but not forced, to participate ingroup activities.

10. Children shall not be subjected tochild abuse/neglect as defined by section210.110, RSMo.

(B) Fire and Tornado Drills. l. Fire, tornado, and other disaster drills

shall meet the requirements of 19 CSR 30-61.086 Fire Safety.

(C) Discipline. 1. The provider shall establish simple,

understandable rules for children’s behaviorand shall explain them to the children.

2. Expectations for a child’s behaviorshall be appropriate for the developmentallevel of that child.

3. Only constructive, age-appropriatemethods of discipline shall be used to helpchildren develop self-control and assumeresponsibility for their own actions.

4. Praise and encouragement of goodbehavior shall be used instead of focusingonly upon unacceptable behavior.

5. Brief, supervised separation from thegroup may be used based on a guideline ofone (1) minute of separation for each year ofthe child’s age.

6. Firm, positive statements or redirec-tion of behavior shall be used with infants andtoddlers.

7. Physical punishment including, butnot limited to, spanking, slapping, shaking,biting, or pulling hair shall be prohibited.

8. No discipline technique which is

humiliating, threatening, or frightening tochildren shall be used. Children shall not beshamed, ridiculed, or spoken to harshly, abu-sively, or with profanity.

9. Punishment or threat of punishmentshall not be associated with food, rest, or toi-let training.

10. Children shall not be placed in acloset, a locked or unlit room, or any otherplace which is frightening.

11. Children shall not be permitted tointimidate or harm others, harm themselves,or destroy property.

(D) Care of Infants and Toddlers. 1. Infants and toddlers shall have con-

stant care and supervision. 2. The provider shall be alert to various

needs of the child such as thirst, hunger, dia-per change, fear of or aggression by otherchildren, and the need for attention.

(E) Diapering and Toilet Training. 1. A safe diapering table or other

approved area with a waterproof, washablesurface shall be used for changing diapers.The table or area shall be cleaned thoroughlywith a disinfectant after each use.

2. Diapering supplies and warm, run-ning water shall be adjacent to the diaperingarea.

3. Disposable tissues or wipes shall beused to cleanse the child at each time of dia-pering. Any diapering creams, powders, orother products applied at the time of diaper-ing shall be provided by the parent(s) andlabeled with the child’s name.

4. The child shall not be left unattendedat any time while on the diapering table orapproved diapering area.

5. Diapers and wet clothing shall bechanged promptly.

6. Wet or soiled diapers shall be placedin an airtight disposal container. If cloth dia-pers are provided by the parent(s), individualairtight plastic bags shall be used to storeeach soiled diaper for return each day to theparent(s).

7. Caregivers changing diapers shallwash their hands with soap and water eachtime after changing a child’s diaper.

8. The diapering area and handwashingarea shall be separate from any food servicearea and any food-related materials.

9. No effort shall be made to toilet traina child until the parent(s) and provider agreeon when to begin.

10. The routine for toilet training shallbe discussed with the parent(s) so the samemethod will be used at the family day carehome and the child's home.

11. Children shall not be punished,berated, or shamed in any way for soilinghis/her clothes. The parent(s) shall provide


Secretary of State




extra clothing for his/her child in case thechild accidentally soils him/herself.

(2) Daily Activities for Children.(A) A daily schedule shall be established in

written form which shall include activities forall ages of children in care.

(B) Daily activities for preschool andschool-age children shall include:

1. Developmentally appropriate playexperiences and activities planned to meet theinterests, needs, and desires of the children;

2. Individual attention and conversationwith adults;

3. Indoor and outdoor play periodswhich provide a balance of quiet and activeplay, and individual and group activities.Activities shall provide some free choiceexperiences;

4. A total of at least one (1) hour of out-door play for children in attendance a full dayunless prevented by weather or special medi-cal reasons (Based on wind chill factor orheat index, children shall not be exposed toeither extreme element.);

5. Toilet and handwashing times; 6. Regular snack and meal times; 7. A supervised nap or rest period for

preschool children after the noon meal; 8. A quiet time for school-age children

after the noon meal with a cot or bed avail-able for those who wish to nap or rest; and

9. A study time for school-age childrenwho choose to do homework, with a separate,quiet work space.

(C) Daily activities for infants and toddlersshall include:

1. Developmental and exploratory playexperiences and free choices of play appro-priate to the interests, needs, and desires ofinfants and toddlers;

2. Regular snack and meal times accord-ing to each infant’s individual feeding sched-ule, as stated by the parent(s);

3. Supervised “tummy time” for chil-dren under one (1) year of age to promotehealthy development;

4. A supervised nap period that meetsthe child’s individual needs shall meet thefollowing requirements:

A. A child under twelve (12) monthsof age shall be placed on his/her back tosleep;

B. An infant’s head and face shallremain uncovered during sleep;

C. Infants unable to roll from theirstomachs to their backs and from their backsto their stomachs shall be placed on theirbacks when found face down. When infantscan easily turn from their stomachs to theirbacks and from their backs to their stomachs,they shall be initially placed on their backs,

but shall be allowed to adopt whatever posi-tions they prefer for sleep;

D. An infant shall not be overdressedwhen sleeping, to avoid overheating. Infantsshould be dressed appropriately for the envi-ronment, with no more than one (1) layermore than an adult would wear to be com-fortable in that environment;

E. When, in the opinion of theinfant’s licensed health care provider, aninfant requires alternative sleep positions orspecial sleeping arrangements that differfrom those set forth in this rule, the providershall have on file at the facility writteninstructions, signed by the infant’s licensedhealth care provider, detailing the alternativesleep positions or special sleeping arrange-ments for such infant. The provider and theassistant(s) shall put the infant to sleep inaccordance with such written instructions;

F. Pacifiers, if used, shall not be hungaround the infant’s neck. Pacifier mecha-nisms or pacifiers that attach to infant cloth-ing shall not be used with sleeping infants;

G. After awakening, an infant mayremain in the crib as long as s/he is content,but never for periods longer than thirty (30)minutes; and

H. Toddlers shall be taken out of bedfor other activities when they awaken;

5. Individual attention and play withadults, including holding, cuddling, talking,and singing;

6. Opportunities for sensory stimulationwhich includes visual stimulation throughpictures, books, toys, nonverbal communica-tion, games, and the like; auditory stimula-tion through verbal communication, music,toys, games, and the like; and tactile stimula-tion through surfaces, fabrics, toys, games,and the like;

7. Encouragement in the development ofmotor skills by providing opportunities forsupervised “tummy time,” reaching, grasp-ing, pulling up, creeping, crawling, andwalking; and

8. Opportunity for outdoor play whenweather permits.

AUTHORITY: sections 210.221 and 210.223,RSMo Supp. 2015.* This rule previously filedas 13 CSR 40-61.160, 13 CSR 40-61.175,and 19 CSR 40-61.175. Original rule filedMarch 29, 1991, effective Oct. 31, 1991.Changed to 19 CSR 40-61.175, effective Dec.9, 1993. Changed to 19 CSR 30-61.175 July30, 1998. Amended: Filed Feb. 18, 1999,effective Sept. 30, 1999. Amended: Filed Jan.28, 2011, effective July 30, 2011. Emergencyamendment filed Nov. 10, 2015, effective Nov.20, 2015, expired May 17, 2016. Amended:Filed Nov. 10, 2015, effective April 30, 2016.

*Original authority: 210.221, RSMo 1949, amended 1955,1987, 1993, 1995, 1999, 2015 and 210.223, RSMo 2015.

19 CSR 30-61.185 Health Care

PURPOSE: This rule outlines the require-ments for reporting communicable diseases,caring for a child when ill, medication, emer-gency care and handwashing.

(1) General Requirements. The provider shallreport to the local health department if anychild in the facility is suspected of having areportable disease as defined by section210.003, RSMo. In the event of an outbreakof communicable disease in the facility, care-givers shall implement control measures rec-ommended by a local or state health authori-ty as required by the department.

(2) The Ill Child. (A) Each child shall be observed for con-

tagious diseases and for other signs of illnesson arrival and throughout the day.

(B) Each child’s parent(s) shall be notifiedimmediately when any contagious diseaseoccurs in the home.

(C) Unusual behavior shall be monitoredclosely and parents shall be contacted if thebehavior continues or if other symptomsdevelop. These behaviors include, but shallnot be limited to:

1. Is cranky or less active than usual; 2. Cries more than usual; 3. Feels general discomfort or seems

unwell; or 4. Has loss of appetite.

(D) The parent(s) or his/her designee shallbe contacted when signs of illness areobserved. Unless determined otherwise bythe parent(s) or provider, a child with nomore than one (1) of the following symptomsmay remain in care:

1. A child with a temperature of up toone hundred degrees Fahrenheit (100°F) bymouth or ninety-nine degrees Fahrenheit(99°F) under the arm;

2. After an illness has been evaluated bya physician, medication has been prescribedand any period of contagion has passed asdetermined by a licensed physician;

3. When it has been determined that achild has a common cold unless the providerand the parent(s) agree that isolation precau-tions should be taken;

4. When a child has vomited once withno further vomiting episodes, other symp-toms, or both; or

5. When a child has experienced loosestools only one (1) time with no further prob-lems or symptoms.


Secretary of State


(E) If children exhibit any of the followingsymptoms, they must be sent home:

1. Diarrhea—more than one (1) abnor-mally loose stool. If a child has one (1) loosestool, s/he shall be observed for additionalloose stools or other symptoms;

2. Severe coughing—if the child gets redor blue in the face or makes high-pitchedcroupy or whooping sounds after coughing;

3. Difficult or rapid breathing (especial-ly important in infants under six (6) months);

4. Yellowish skin or eyes; 5. Pinkeye—tears, redness of eyelid lin-

ing, irritation, followed by swelling or dis-charge of pus;

6. Unusual spots or rashes; 7. Sore throat or trouble swallowing; 8. An infected skin patch(es)—crusty,

bright yellow, dry or gummy areas of theskin;

9. Unusually dark, tea-colored urine; 10. Grey or white stool; 11. Fever over one hundred degrees

Fahrenheit (100°F) by mouth or ninety-ninedegrees Fahrenheit (99°F) under the arm;

12. Headache and stiff neck; 13. Vomiting more than once; and 14. Severe itching of the body or scalp,

or scratching of the scalp. These may besymptoms of lice or scabies.

(F) Parental contact and the decision madeshall be recorded and filed in the child’srecord.

(G) The ill child shall be kept isolated fromthe other children until the parent(s) arrives.

(H) The caregiver shall be in close prox-imity to the child until the parent(s) arrives.Close proximity means that a caregiver isclose enough to hear any sounds a childmight make that would indicate a need forassistance.

(3) Medication. (A) The provider is not required to admin-

ister medication but may choose to do so. (B) All medication shall be given to a child

only with the dated, written permission of theparent(s) stating the length of time the medi-cation may be given.

(C) Prescription medication shall be in theoriginal container and labeled with thechild's name, instructions for administration,including the times and amounts for dosagesand the physician's name. This may includesample medication provided by a physician.

(D) All nonprescription medication shallbe in the original container and labeled by theparent(s) with the child’s name and instruc-tions for administration, including the timesand amounts for dosages.

(E) All medication shall be stored out ofreach of children or in a locked container.

(F) Medication shall be returned to storageimmediately after use.

(G) Medication needing refrigeration shallbe kept in the refrigerator in a container sep-arate from food.

(H) Medication shall be returned to theparent(s) or disposed of immediately when nolonger needed.

(I) The date and time(s) of administration,the name of the individual giving the medica-tion and the quantity of any medication givenshall be recorded promptly after administra-tion. This information shall be filed in thechild's record after the medication is nolonger necessary.

(4) Immunizations. (A) No child shall be permitted to enroll in

or attend any day care facility caring for ten(10) or more children unless the child hasbeen adequately immunized against vaccine-preventable childhood illnesses specified bythe department in accordance with recom-mendations of the Immunization PracticesAdvisory Committee (ACIP). The parent orguardian of the child shall provide satisfacto-ry evidence of the required immunizations.Satisfactory evidence means a statement, cer-tificate or record from a physician or otherrecognized health facility or personnel, stat-ing that the required immunizations havebeen given to the child and verifying the typeof vaccine and the month, day and year ofadministration.

(B) A child who has not completed allimmunizations appropriate for his/her agemay enroll, if—

1. Satisfactory evidence is produced thatthe child has begun the process of immuniza-tion. The child may continue to attend as longas the immunization process is being accom-plished according to the ACIP/MissouriDepartment of Health recommended sched-ule; or

2. The parent(s) or guardian has signedand placed on file with the day care adminis-trator a statement of exemption which may beeither of the following:

A. A medical exemption by which thechild shall be exempted from immunizationrequirements upon certification by a licensedphysician that the immunization would seri-ously endanger the child’s health or life; or

B. A parent or guardian exemption bywhich a child shall be exempted from immu-nization requirements if one (1) parent orguardian files a written objection to immu-nization with the day care administrator.Exemptions shall be accepted by the day careadministrator when the necessary informationas determined by the department is filed withthe day care administrator by the parent or

guardian. Exemption forms shall be providedby the department.

(C) In the event of an outbreak or suspect-ed outbreak of a vaccine-preventable diseasein the facility, the administrator of the facili-ty shall follow the control measures institutedby the local health authority or the depart-ment, or both, the local health authority andthe department.

(D) The administrator of each day carefacility shall prepare a record of immuniza-tion of each child enrolled in or attending thefacility. An annual summary report shall bemade by January 15 showing the immuniza-tion status of each child enrolled, using formsprovided by the department. The immuniza-tion records shall be available for review bydepartment personnel upon request.

(5) Accidents, Injuries and EmergencyMedical Care.

(A) In case of accident or injury to a child,the provider shall notify the parent’s immedi-ately. If the child requires emergency medicalcare, the provider shall follow the parent’swritten instructions.

(B) Information regarding the date and cir-cumstance of any accident or injury shall benoted in the child’s record.

(C) When planning for activities away fromthe home, the provider shall establish a pro-cedure for handling emergencies.

(6) Handwashing. (A) Caregivers shall wash their hands with

soap and running water after toileting orassisting a child with toileting, after diaper-ing a child, before food preparation or serv-ing of food and at other times as needed.

(B) Caregivers shall teach children to washtheir hands before eating and after toileting.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 13CSR 40-61.185 and 19 CSR 40-61.185.Original rule filed March 29, 1991, effectiveOct. 31, 1991. Changed to 19 CSR 40-61.185, effective Dec. 9, 1993. Emergencyamendment filed Aug. 18, 1993, effectiveAug. 28, 1993, expired Dec. 25, 1993.Emergency amendment filed Jan. 4, 1994,effective Jan. 14, 1994, expired May 13,1994. Amended: Filed Aug. 18, 1993, effec-tive April 9, 1994. Changed to 19 CSR 30-61.185 July 30, 1998.



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Secretary of State


19 CSR 30-61.190 Nutrition and FoodService

PURPOSE: This rule provides the require-ments for nutritious meals, snacks and meth-ods of food service.

(1) General Requirements. (A) The provider shall supply and serve

nourishing food according to the Meal andSnack Food Chart provided in this rule.

(B) The required meal schedule shallinclude breakfast or a midmorning snack,lunch and a midafternoon snack for childrenin care during daytime hours, with a maxi-mum time of four (4) hours between any mealor snack. School-age children shall be serveda snack after school.

(C) Children in care during evening hoursshall be served a snack. Upon parentalrequest, children in care during eveninghours shall be served supper and childrenspending the night shall be served breakfast.

(D) Snacks of fruit juice, raw fruit or veg-etable, milk, crackers, cheese, peanut butteror similar nutritious food shall be served.

(E) One (1) serving of fluid milk shall beserved with each meal.

(F) If the home is licensed exclusively forschool-age care, the child may be permittedto bring sack meals. The provider shall sup-ply one (1) serving of fluid milk with eachsack meal and shall supply nutritious snacks.

(G) The acceptable food components andserving sizes for meals and snacks are out-lined in the following chart for each agegroup. Menus and amounts served shall bebased on this chart.



Meal and Snack Food Chart

Age Age AgeFood Components 1 and 2 3 through 5 6 through 12

BREAKFASTRequirement— Fluid Milk*** 1/2 cup 3/4 cup 1 cup

Juice**or Fruitor Vegetable 1/4 cup 1/2 cup 1/2 cup

1 servingfrom each of the Bread or Bread3 food component Alternate* 1/2 slice* 1/2 slice* 1 slice*

SNACKRequirement— Fluid Milk*** 1/2 cup 1/2 cup 1 cup 2 servings Juice**or Fruit orselected Vegetable 1/2 cup 1/2 cup 3/4 cup from 2 of the 4 food Meat or Meatcomponents Alternate 1/2 ounce 1/2 ounce 1 ounce

1 serving from Bread or Breadthe bread component Alternate* 1/2 slice* 1/2 slice* 1 slice*

LUNCH/SUPPERRequirement—1 serving of Fluid Milk*** 1/2 cup 3/4 cup 1 cupmilk component

MEAT/MEAT ALTERNATEMeat, Poultry, or 1 ounce 1 1/2 ounces 2 ounces Fish or

1 serving Cheese or 1 ounce 1 1/2 ounces 2 ouncesfrom the Egg or 1 1 1meat/meat alternate Cooked Dry Beans 1/4 cup 3/8 cup 1/2 cup component and Peas or

Peanut Butter 2 table- 3 table- 4 table-spoons spoons spoons spoons

FRUIT/VEGETABLE2 servings 1 Vegetable and 1/4 cup total 1/2 cup total 3/4 cupfrom the 1 Fruit or total fruit/vegetable 2 Different Vegeta-component: bles or 2 Different

Fruits

1 serving Bread or 1/2 slice* 1/2 slice* 1 slice* Bread from the Alternate*bread component.

* Or an equivalent serving of an acceptable bread alternate such as cornbread, biscuits, rolls, muffins, cereal, rice, pasta, and the like.

** All fruit juices shall be one hundred percent (100%) fruit juice.

*** See subsection (1)(H) for acceptable milk supply.

(H) The water and milk supply shall beapproved by local and state health authorities,or both. Powdered milk shall not be usedexcept for cooking purposes. Milk substitutesshall not be used for drinking or cooking.

(I) State or local rules, or both, governingfood service sanitation shall be maintained inthe storage, preparation and service of foods.

(J) Mealtime atmosphere shall be enjoyableand relaxed. No child shall be forced to eat,but shall be encouraged to set his/her ownpace according to personal preferences.

(K) Menus shall be available to parentsupon request.

(L) Drinking water shall be convenientlylocated near playrooms so children may befree to drink as they wish. Water fountains orindividual cups shall be used.

(2) Nutrition and Food Service for Infants Upto Twelve (12) Months of Age.

(A) The provider shall serve nourishingfoods appropriate for the infant’s individualnutritional requirements and developmentalstages as specified by his/her parent(s).

(B) If preferred, formulas and special babyfoods may be provided by the parent(s) withindividual identification on each container.

(C) Until infants can hold a bottle com-fortably, they shall be held by a caregiverduring bottle feeding. Bottles shall not bepropped.

(D) When an infant/toddler shows evidenceof wanting to feed him/herself, the child shallbe encouraged and permitted to do so.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule was previously filedas 13 CSR 40-61.170, 13 CSR 40-61.190 and19 CSR 40-61.190. Original rule filed March29, 1991, effective Oct. 31, 1991. Changed to19 CSR 40-61.190, effective Dec. 9, 1993.Changed to 19 CSR 30-61.190 July 30, 1998.


19 CSR 30-61.200 Transportation andField Trips

PURPOSE: This rule sets forth the require-ments of a day care provider when transport-ing children and on field trips.

(1) General Requirements. (A) The provider shall be responsible for

the care, safety and supervision of childrenon field trips or at any time they transportchildren away from the family day care home.

(B) Written parental consent shall be onfile at the home for field trips and transporta-tion.

(C) Parents shall be informed when fieldtrips are planned.

(D) Short, unscheduled walks may betaken without parental notification. Theseunscheduled outings shall be discussed withthe parent(s) at the time of enrollment.

(2) Vehicle and Vehicle Operator. (A) The driver of any vehicle used to trans-

port children shall be no less than eighteen(18) years of age and shall have a valid driv-er's license as required by Missouri law.

(B) All vehicles used to transport childrenshall be licensed in accordance with Missourilaw.

(C) Children shall not be transported incampers, trailers or in the back of trucks.

(3) Safety and Supervision. (A) All children shall be seated in a per-

manent seat and restrained by seat belts orchild restraint devices as required byMissouri law.

(B) Identifying information regarding thename of the provider, the names of the chil-dren and the names, addresses and telephonenumbers of each child's parent(s) shall becarried in the vehicle.

(C) Staff/child ratios shall be maintained atany time the provider transports childrenaway from the home.

(D) Children shall be required to remainseated while the vehicle is in motion.

(E) Doors shall be locked when the vehicleis moving.

(F) Order shall be maintained in the vehi-cle at all times.

(G) Children shall not be left unattended ina vehicle at any time.

(H) Children shall enter and leave the vehi-cle from the curbside unless the vehicle is ina protected area or driveway.

(I) Children shall be assisted, when neces-sary, while entering or leaving the vehicle.

(J) Children shall be released only to theparent(s) or individual(s) authorized by theparent(s).

(K) The operator of the vehicle shall waituntil the child is in the custody of the par-ent(s) or individual(s) authorized by the par-ent(s) to receive the child.

(L) Head counts shall be taken before leav-ing the home, after entering the vehicle, dur-ing a field trip, after taking the children tobathrooms, after returning to the vehicle andwhen back at the home.

(M) When children leave the vehicle, thevehicle shall be inspected to ensure that nochildren are left on or under seats.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule was previously filedas 13 CSR 40-61.200 and 19 CSR 40-61.200.Original rule filed March 29, 1991, effectiveOct. 31, 1991. Changed to 19 CSR 40-61.200, effective Dec. 9, 1993. Changed to19 CSR 30-61.200 July 30, 1998.


19 CSR 30-61.210 Records and Reports

PURPOSE: This rule lists records and reportswhich must be on file at the facility.

(1) The child care provider shall maintainaccurate records to meet administrativerequirements and to ensure knowledge of theindividual needs of children and their fami-lies.

(2) An individual file shall be kept to identi-fy each child and to enable the provider tocommunicate with the parent(s), guardian orlegal custodian of the child in an emergency.Records shall include:

(A) The child’s full name, address, birth-date and the date care begins and ends;

(B) Full name of the parent(s), guardian orlegal custodian, home address, employers’name and address, work schedule and homeand work telephone numbers;

(C) Name, address and telephone numberof another individual (friend or relative) whomight be reached in an emergency when theparent(s), guardian or legal custodian cannotbe reached;

(D) Name and phone number of the fami-ly physician, or hospital, or both, to be usedin an emergency;

(E) Name of the individual(s) authorized totake the child from the home; and

(F) Field trip and transportation authoriza-tion.

(3) Records on related children, as requiredby 19 CSR 40-61.135 Admission Policies andProcedures, shall be on file.

(4) Health information shall be retained ineach child’s individual file and shall include:

(A) A medical examination report for eachinfant, toddler or preschool child or a healthreport for each school-age child as requiredby 19 CSR 40-61.125 Medical ExaminationReports;

(B) Parental authorization for medicationsand a record of medications administered;

(C) Information concerning any accidentor injury to the child while at the family day


Secretary of State




care home or any emergency medical care;and

(D) Any significant information learnedfrom observing the child.

(5) Individual children’s records shall beretained a minimum of one (1) year after thechild discontinues attendance.

(6) Daily child attendance records shall bemaintained and kept on file a minimum ofone (1) year.

(7) Daily attendance records for all care-givers shall be maintained and kept on file aminimum of one (1) year.

(8) All enrollment records, medical examina-tion records and attendance records shall befiled in a place known to caregivers and shallbe accessible at all times. Records shall notbe in a locked area or removed from thehome during the hours the home is open andoperating.

(9) Emergency school closing records, asrequired by 19 CSR 40-61.165 EmergencySchool Closings, shall be on file.

(10) The provider shall maintain the follow-ing information on file as required by 19 CSR30-61.086 Fire Safety:

(A) A written record at the facility for fire,tornado and other disaster drills;

(B) Documentation verifying that fresh-cutChristmas trees are treated with a flame resis-tant material;

(C) Documentation verifying that all gas-fired appliances were checked by a repaircompany and are in safe working order afteran elevated carbon monoxide level was deter-mined during a fire inspection;

(D) Documentation of the inspection andapproval of fire extinguishers;

(E) Documentation verifying the inspec-tion and approval of automatic fire sprinklersystems; and

(F) A copy of the membership or receiptfor membership documenting that facilitiesserved by a volunteer or membership firedepartment are a member in good standingwith the fire department.

(11) Medical examination reports, as requiredby 19 CSR 40-61.125 Medical ExaminationReports, shall be on file.

(12) Training records for the provider andassistants, as required by 19 CSR 40-61.105The Day Care Provider and Other Day CarePersonnel, shall be on file.

(13) The child care provider shall have theresults of criminal record reviews as providedin 19 CSR 30-61.045 Initial LicensingInformation, 19 CSR 30-61.055 LicenseRenewal, and 19 CSR 30-61.105 The DayCare Provider and Other Day Care Personnelon file at the family day care home.

(14) All records of children shall be confi-dential, protected from unauthorized exami-nation and available to parents upon request.

(15) All records shall be available in thehome for inspection by the department uponrequest.

(16) Reports to the department shall be sub-mitted as required.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1998.* This rule previously filed as 13CSR 40-61.180, 13 CSR 40-61.210 and 19CSR 40-61.210. Original rule filed March 29,1991, effective Oct. 31, 1991. Changed to 19CSR 40-61.210, effective Dec. 9, 1993.Emergency amendment filed Aug. 18, 1993,effective Aug. 28, 1993, expired Dec. 25,1993. Emergency amendment filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Amended: Filed Aug. 18, 1993,effective April 9, 1994. Changed to 19 CSR30-61.210 July 30, 1998. Amended: FiledFeb. 18, 1999, effective Sept. 30, 1999.


19 CSR 30-61.220 Variance Request

PURPOSE: This rule explains how a providermay request a variance from the rules of thischapter.

(1) Any provider may request a variance froma rule. The request for a variance shall bewritten to the Child Care Unit and shallinclude the item(s) for which a variance isrequested and the reason(s) the providerrequests the variance. Local inspectors mayrequest a variance on behalf of the provider.

(2) If a variance request is not approved bythe Child Care Unit, the provider shall beadvised in writing of the basis for the denial.The provider may request a review of thedecision by the director within thirty (30)days of receipt. The director or designee shallhave fifteen (15) days to make the final deter-mination on the variance request. That deter-mination is subject to Chapter 536, RSMoreview for licensed facilities.

AUTHORITY: section 210.221.1(3), RSMoSupp. 1993.* This rule previously filed as 19CSR 40-61.220. Emergency rule filed Aug.27, 1993, effective Sept. 5, 1993, expiredJan. 2, 1994. Emergency rule filed Jan. 4,1994, effective Jan. 14, 1994, expired May13, 1994. Original rule filed Aug. 27, 1993,effective April 9, 1994. Changed to 19 CSR30-61.220 July 30, 1998.


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