Child care oversight too lax, says DHHS report

Parents with children in day care often assume workers have cleared background checks and the facility has passed unannounced inspections, but a review to be released today finds a large number of states don't have such requirements.

The watchdog arm of the Department of Health and Human Services found that 21 states do not require an annual unannounced inspection of all licensed child care providers and that only 15 require background checks considered comprehensive by the agency's Administration for Children and Families, according to a copy of the report obtained by The Associated Press.

About 1.6 million children use federal subsidies to attend day care programs at about 500,000 different centers and home-based providers.

Even when unannounced inspections are required by states, they aren't always done, according to the report from HHS's inspector general, which took a closer look at California, Florida, Illinois, Ohio, and Texas as part of its review. When inspection visits were done, the deficiencies found included not enough staff to maintain required staff-to-child ratios, unscreened people living in family day care homes and broken playground equipment.

The states tended to have more stringent requirements for center-based day cares than those based in homes, the report found. For example, seven states don't require a background check of family members living in the house of a licensed home-based childcare provider. But even in centers, 18 states don't require background checks of janitorial staff; eight don't require it for drivers; and seven don't require it for owners.

The Administration for Children and Families oversees the Child Care and Development Fund, which last year distributed more than $5 billion in child care subsidies to parents living in poverty who work or go to school. Participating parents pick a provider – as long as it meets state and local requirements. That means children who don't participate in the program often attend day care with those who do.

The agency has expressed concern about whether states are ensuring that child care centers are safe, even though some local governments do provide oversight. Agency official Linda Smith testified last year before a congressional committee that some states lack basic requirements for their child cares, and that far too often, this "lack of accountability leads to tragedy," including deaths.

The IG report recommends that more rigorous standards be rolled out and enforced as a condition for states to participate in the program, including requiring all licensed providers to undergo comprehensive criminal background checks using fingerprints and annual unannounced inspections. The Administration for Children and Families, earlier this year, proposed regulation changes that would implement much of what the IG has recommended. One key difference is that while the Administration for Children and Families would require unannounced onsite monitoring of all providers, the proposed regulations do not require a set number of unannounced inspections.

One parent who supports the proposed regulation changes is Alecia Patrick, 35, of Olathe, Kan. Her 18-month-old daughter, Ava, died in 2009 in a home-based day care from suffocation after her head got caught in the slats of a wooden fence. The operator later went to prison on charges that included involuntary manslaughter and operating a registered day care center with too many children. Ms. Patrick and her husband helped successfully lobby for a state law in Kansas that requires all providers to be licensed and inspected.

"It's a start," Patrick said in a phone interview. "When you get a start, then you know there's room for improvement in the years to come."

The proposed regulations include safety training requirements for providers in first aid, CPR, and safe sleeping practices. And, childcare providers would be required to report any serious injuries or deaths. Parents then would be able to look up information about child care on a web site and report problems to a hotline.

An estimated 10 percent of children who participate in the program receive child care from unlicensed providers.

Home-based day cares are exempt from licensing in some states, for example, if they serve just a small number of children or children from one family. A separate HHS IG investigation earlier this year found that not all states are requiring unlicensed providers to meet federal health and safety requirements. Self-reported compliance was allowed in 23 states for family home providers to meet building and physical premises safety requirements and in 29 states, these providers were not required to report serious injuries, the report found.

The proposed regulations seek to improve quality among both licensed and unlicensed providers that participate in the Child Care and Development Fund.

The Administration for Children and Families is currently reviewing public comments on the proposed regulations.

The Senate Committee on Health, Education, Labor, and Pensions also passed a bill in September that incorporates many of the proposed regulations. It has not been addressed in the House.

The Obama administration has pushed to increase both the safety and quality of early learning in America. High quality early childhood programs are viewed by many educators as a critical way to help overcome the learning deficit many low-income kidsface when they start kindergarten – an obstacle many never overcome.

In 2011, HHS and the Education Department awarded $500 million in "Race to the Top" competitive grants to nine states to improve early learning in pre-K programs and others, and another round of similar early learning grants is expected to be awarded later this year worth $280 million. Obama has proposed using an increase in cigarette taxes to fund a "Preschool for All" plan. HHS also implemented new rules requiring lower-performing Head Start programs to compete for funding as part of an effort to improve the quality of Head Start programs.