Transcript for audio podcast:
Child Care and Development Fund: Monitoring of Licensed Child Care Providers
From the Office of Inspector General of Department of Health and Human Services
[Brian Whitley] I'm Brian Whitley, Regional Inspector General for the Office of Evaluations and Inspections in Kansas City. I'm speaking with Teresa Dailey, a program analyst in our office about a report entitled Child Care and Development Fund: Monitoring of Licensed Child Care Providers. Teresa, can you tell us a little bit about the Child Care and Development Fund, otherwise known as the CCDF program?
[Teresa Dailey] Sure, CCDF is a program run by the Administration for Children and Families, or ACF. In Fiscal Year 2012, ACF provided over $5 billion a year in child care subsidies to working low-income families. Over one and half million children benefit from these subsidies every month. States also spend this money on quality improvement activities for child care.
[Brian Whitley] So Teresa, what did you find when you reviewed licensing requirements across all the States?
[Teresa Dailey] We reviewed the three Federal requirements of prevention and control of infectious disease, building and physical premises safety, and health and safety training. All States complied by having at least one requirement in each of these three areas. We also reviewed States' monitoring requirements. States can choose how they meet the Federal health and safety and monitoring requirements. This flexibility means that not all States met National Standards and ACF recommendations for monitoring and background checks.
[Brian Whitley] What are the National Standards?
[Teresa Dailey] A book funded by a grant from the Health Resources and Services Administration sets the Standards. According to the National Standards, every State should require its licensing inspectors to conduct at least two inspections per year of each child care provider. At least one of the inspections should be unannounced.
[Brian Whitley] So did all States require at least one unannounced inspection per year?
[Teresa Dailey] No, we actually found that 21 States did not require routine unannounced inspections for all child care providers once a year. Unannounced inspections are important. University of Pennsylvania researchers found many more violations were discovered during unannounced inspections compared to announced inspections. Some violations were more serious, like staff to child ratios and access to hazardous substances.
[Brian Whitley] What did ACF recommend to States regarding background checks?
[Teresa Dailey] ACF recommended that all providers who care for children receiving CCDF subsidies undergo a comprehensive background screening. This includes fingerprints to check for State and FBI criminal history records, as well as checking the child abuse and neglect registry, and the sex offender registries.
[Brian Whitley] Did you find that all States met those ACF recommendations for background checks?
[Teresa Dailey] Only 15 States reported performing checks that ACF would consider to be comprehensive. States have developed complicated requirements and all checks are done differently.
[Brian Whitley] In what ways do States vary?
[Teresa Dailey] For example, New Jersey allows family daycare home providers to self-disclose criminal convictions. Virginia does too, but their providers still undergo State criminal background checks. Wyoming uses its child abuse registry as a pre-screening, with a fingerprint check through their State, if necessary. So it is very important that parents be informed about their States' requirements.
[Brian Whitley] What did you find when you reviewed how States fulfill their monitoring requirements?
[Teresa Dailey] We chose five States based on the number of children in licensed care paid for by CCDF: California, Florida, Illinois, Ohio, and Texas. We requested inspection records from 125 licensed providers in each State. We wanted to see how often the States actually conducted the inspections and background check reviews they were required to do.
[Brian Whitley] What did you find?
[Teresa Dailey] We found that sometimes inspectors missed visits, which means providers were operating without appropriate oversight. And when inspectors conducted these visits, they often found deficiencies. So missed visits could mean missed opportunities to identify and fix deficiencies that affect the health and safety of children.
[Brian Whitley] Could you give us some examples of the deficiencies you reviewed?
[Teresa Dailey] The deficiencies that States found were wide ranging. Some included incorrect sign-in sheets, expired first aid and CPR certification, and not enough staff to maintain legal staff-to-child ratios. More serious risks included unscreened individuals living in family daycare homes, bleach within reach of the children, and broken playground equipment.
[Brian Whitley] Wow, so what does the agency plan to do with the results of your report to help protect CCDF children?
[Teresa Dailey] ACF has already proposed regulations to strengthen health and safety requirements. For example, States would have to conduct comprehensive criminal background checks for all providers using fingerprints. States would also have to require specific health and safety training, and conduct unannounced, on-site monitoring for compliance. While we're recommending at least one unannounced visit per year, we are encouraged by ACF's steps to improve monitoring through the proposed regulations.
[Brian Whitley] Teresa Dailey, program analyst for the Office of Evaluation and Inspections, I want to thank you so much for sharing this important work.
[Teresa Dailey] Thank you.
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