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care programs participating in the state’s child care subsidy program, CAPS, must be rated in the state’s quality rating and improvement system, Quality Rated (QR). License-exempt and informal CAPS providers cannot be QR and represent a very small proportion of CAPS providers and the number of children care for in CAPS. The full implementation of this requirement has led to prioritization of CAPS investment as well as QR activities and investment in areas of concentrated poverty and unemployment. The Lead Agency’s data shows that 12% of all licensed providers operate in zip codes identified as associated with extreme poverty (>40% in poverty) or high poverty (20-<40% in poverty), and 72% of those licensed child care providers are rated in the state’s QRIS. Additionally, the data shows that 57% of all licensed child care providers operate in zip codes identified as associated with medium poverty (10-<20% in poverty), and 67% those licensed child care providers are rated in the state’s QRIS. Lastly, the data shows that 31% of all licensed child care providers operate in zip codes identified as associated with low poverty (<10% in poverty), and 55% of licensed child care providers are rated in the state’s QRIS. The statistics show that CAPS families that live in areas of concentrated poverty have greater access to a Quality Rated CAPS provider and that CCDF-related activities and investments are being prioritized to those communities.

5 Health and Safety of Child Care Settings Child care health and safety standards and enforcement practices are essential to protect the health and safety of children while out of their parents’ care. CCDF provides a minimum threshold for child care health and safety policies and practices but leaves authority to Lead Agencies to design standards that appropriately protect children’s safety and promote nurturing environments that support their healthy growth and development. Lead Agencies should set standards for ratios, group size limits, and provider qualifications that help ensure that the child care environment is conducive to safety and learning and enable caregivers to promote all domains of children’s development. CCDF health and safety standards help set clear expectations for CCDF providers, form the foundation for health and safety training for child care workers, and establish the baseline for monitoring to ensure compliance with health and safety requirements. These health and safety requirements apply to all providers serving children receiving CCDF services – whether the providers are licensed or license-exempt, must be appropriate to the provider setting and age of the children served, must include specific topics and training on those topics, and are subject to monitoring and enforcement procedures by the Lead Agency. CCDF-required annual monitoring and enforcement actions help ensure that CCDF providers are adopting and implementing health and safety requirements. Through child care licensing, Lead Agencies set minimum requirements, including health and safety requirements, that child care providers must meet to legally operate in that State or Territory. In some cases, CCDF health and safety requirements may be integrated within the licensing system for licensed providers and may be separate for CCDF providers who are license- exempt. This section addresses CCDF health and safety requirements, Lead Agency licensing requirements and exemptions, and comprehensive background checks.