5.5 Monitoring and Enforcement of Licensing and Health and Safety Requirements

5.5.1 Inspections for licensed CCDF providers Licensing inspectors must perform at least one annual, unannounced inspection of each licensed CCDF provider for compliance with all child care licensing standards, including an inspection for compliance with health and safety and fire standards. Lead Agencies must conduct at least one pre-licensure inspection for compliance with health, safety, and fire standards of each child care provider and facility in the State/Territory. a. Licensed CCDF center-based providers i. Does your pre-licensure inspection for licensed center-based providers assess compliance with health standards, safety standards, and fire standards? [x] Yes. [ ] No. If no, describe: ii. Identify the frequency of annual unannounced inspections for licensed center- based providers addressing compliance with health, safety, and fire standards: [ ] Annually. [ ] More than once a year. If more than once a year, describe: [x] Other. If other, describe: The Division of Child Care received a non-compliance notice issued 6/15/2023, non compliances were found that the Lead Agency monitors for completion of pre-service/orientation training, but the pre- service/orientation training does not include all required components of the topics. Additionally, although the Lead Agency monitors for the completion of ongoing training, the ongoing training isn’t sufficient for all of the provider types. The Monitoring Team did not find evidence that the Lead Agency conducts pre- licensure and annual inspections that address the following: -All Licensed Type I and II providers for compliance with health and safety standards on the following components of emergency preparedness and response: volunteer emergency preparedness training and practice drills and accommodations of infants and toddlers, children with disabilities, and children with chronic medical conditions The Lead Agency is affirming that additional time is needed to create the technical assistance, guidance, and standards to comply with the findings of the monitoring visit. -All Licensed Type I and II providers for compliance with pre-service/orientation training requirements for pediatric first aid and CPR. Orientation was updated to include a section on pediatric first aid and CPR training in 2021. The Lead Agency also created a training specific to CPR and First Aid., "Non Certified First Aid and CPR for Early Childhood Professionals" to ensure each staff member in a program has training in these areas, if not a certification. 922 KAR 2:090 Child care center licensure Section 11 Staff Requirements: (3) For a child-care center licensed for infant, toddler, or preschool-age children, at least one (1) person on duty and present with the children shall be currently certified by a cabinet-approved training agency in the following skills: (a) Infant and child cardiopulmonary resuscitation; and (b) Infant and child first aid. All Certified providers and contracted substitutes are required to have certification in age-appropriate CPR and First Aid. 922 KAR 2:100 Certification of family child care homes Section 10 (6) Standards for the provider: (6) Prior to being left alone with a child, an assistant shall be certified by a cabinet- approved agency in infant, child, and adult: (a) Cardiopulmonary resuscitation (CPR); and (b) First aid. iii. Does the Lead Agency implement a differential monitoring approach when monitoring licensed center-based providers? [ ] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. [x] No. If no, describe: The following inspections require Division of Regulated Child Care (DRCC) regional staff to assure compliance with all health, safety, and fire standards: pre-licensure, post-preliminary, and annual renewal. DRCC regional staff conduct a post-preliminary inspection within the first six (6) months of initial licensure as a child care center. When a licensed or certified CCDF child care provider has been issued a directed plan of correction (DPOC) by DRCC following any inspection, regional DRCC staff will conduct additional monitoring inspections of the child care center to assure compliance with the terms of the DPOC. DRCC regional staff investigate all allegations of regulatory non-compliance. The investigative findings are recorded in narrative from, and an inspection report is generated via KICCS. Follow-up inspections may be required to assure compliance or implementation of a plan of correction for any inspection. DPOC’s, investigations, initials, and changes of location are the only surveys completed that do not utilize the full regulation set. We do consider all matters of health, safety, and fire standards during each visit. We always check supervision and ratios during every visit. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. The Office of Inspector General (OIG), Division of Regulated Child Care (DRCC) b. Licensed CCDF family child care providers i. Does your pre-licensure inspection for licensed family child care homes assess compliance with health standards, safety standards, and fire standards? [x] Yes. [ ] No. If no, describe: ii. Identify the frequency of annual unannounced inspections for licensed family child care homes addressing compliance with health, safety, and fire standards: [ ] Annually. [ ] More than once a year. If more than once a year, describe: [x] Other. If other, describe: Per the preliminary notice issued 6/15/2023, non compliances were found in that inspections by the Lead Agency do not include monitoring and enforcement for standards for all components of Emergency Preparedness and Response, standards for pediatric first aid/CPR; and preservice orientation that contains all components of Emergency Preparedness and Response; compliance with standards for prevention of shaken baby syndrome and abusive head trauma; preservice/orientation training required for substitutes and assistants. The Lead Agency requires additional time to amend the standards for inspections and monitoring of the non-compliance items. iii. Does the Lead Agency implement a differential monitoring approach when monitoring licensed family child care providers? [ ] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. [x] No. If no, describe: The following inspections require Division of Regulated Child Care (DRCC) regional staff to assure compliance with all health, safety, and fire standards: pre-licensure, post-preliminary, and annual renewal. DRCC regional staff conduct a post-preliminary inspection within the first six (6) months of initial licensure as a child care center. When a licensed or certified CCDF child care provider has been issued a directed plan of correction (DPOC) by DRCC following any inspection, regional DRCC staff will conduct additional monitoring inspections of the child care center to assure compliance with the terms of the DPOC. DRCC regional staff investigate all allegations of regulatory non-compliance. The investigative findings are recorded in narrative from, and an inspection report is generated via KICCS. Follow-up inspections may be required to assure compliance or implementation of a plan of correction for any inspection. DPOC’s, investigations, initials, and changes of location are the only surveys completed that do not utilize the full regulation set. We do consider all matters of health, safety, and fire standards during each visit. We always check supervision and ratios during every visit. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. The Office of Inspector General (OIG), Division of Regulated Child Care (DRCC) c. Licensed in-home CCDF child care providers i. Does your Lead Agency license CCDF in-home child care (care in the child’s own home) providers? [x] No. [ ] Yes. If yes, does your pre-licensure inspection for licensed in-home providers assess compliance with health, safety, and fire standards? [ ] Yes. [ ] No. If no, describe: ii. Identify the frequency of annual unannounced inspections for licensed in-home child care providers for compliance with health, safety, and fire standards completed: [ ] Annually. [ ] More than once a year. If more than once a year, describe: [x] Other. If other, describe: Registered relative child care providers providing care in the child's home are not subject to inspection. iii. Does the Lead Agency implement a differential monitoring approach when monitoring licensed in-home child care providers? [ ] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. [x] No. iv. Identify which department or agency is responsible for completing the inspections for licensed in-home providers. Registered relative child care providers providing care in the child's home are not subject to inspection. 5.5.2 Inspections for license-exempt providers Licensing inspectors must perform at least one annual monitoring visit of each license-exempt CCDF provider for compliance with health, safety, and fire standards. Inspections for relative providers will be addressed in subsection 5.8. Describe the policies and practices for the annual monitoring of: a. License-exempt CCDF center-based child care providers i. Identify the frequency of inspections for compliance with health, safety, and fire standards for license-exempt center-based providers: [ ] Annually. [ ] More than once a year. If more than once a year, describe: [x] Other. If other, describe: N/A License-exempt CCDF center-based child care providers are not subject to inspection. ii. Does the Lead Agency implement a differential monitoring approach when monitoring license-exempt center-based providers? [ ] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. [x] No. iii. Identify which department or agency is responsible for completing the inspections for license-exempt center-based CCDF providers. N/A License-exempt providers are not inspected b. License-exempt CCDF family child care providers i. Identify the frequency of the inspections of license-exempt family child care providers to determine compliance with health, safety, and fire standards: [ ] Annually. [ ] More than once a year. If more than once a year, describe: [x] Other. If other, describe: Registered relative child care providers are not inspected. ii. Does the Lead Agency implement a differential monitoring approach when monitoring license-exempt family child care providers? [ ] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. [x] No. iii. Identify which department or agency is responsible for completing the inspections for license-exempt family child care providers. Registered relative child care providers are not inspected. 5.5.3 Inspections for CCDF license-exempt in-home child care providers Lead Agencies may develop alternate monitoring requirements for care provided in the child’s home that are appropriate to the setting. This flexibility cannot be used to bypass the monitoring requirement altogether. a. Describe the requirements for the annual monitoring of CCDF license-exempt in-home child care (care in the child’s own home) providers, including if monitoring is announced or unannounced, occurs more frequently than once per year, and if differential monitoring procedures are used. Registered relative child care providers are not inspected. b. List the entity(ies) in your State/Territory responsible for conducting inspections of license-exempt CCDF in-home child care (care in the child’s own home) providers: N/A 5.5.4 Posting monitoring and inspection reports Lead Agencies must post monitoring and inspection reports on their consumer education website for each licensed and CCDF child care provider, except in cases where the provider is related to all the children in their care. These reports must include the results of required annual monitoring visits and visits due to major substantiated complaints about a provider’s failure to comply with health and safety requirements and child care policies. A full report covers everything in the monitoring visit, including areas of compliance and non-compliance. If the Lead Agency does not produce any reports that include areas of compliance, the website must include information about all areas covered by a monitoring visit. The reports must be in plain language or provide a plain language summary Lead Agency and be timely to ensure that the results of the reports are available and easily understood by parents when they are deciding on a child care provider. Lead Agencies must post at least 3 years of monitoring and inspection reports. a. Does the Lead Agency post: i. [x] Pre-licensing inspection reports for licensed programs. ii. [ ] Full monitoring and inspection reports that include areas of compliance and non-compliance for all non-relative providers eligible to provide CCDF services. iii. [ ] Monitoring and inspection reports that include areas of non-compliance only, with information about all areas covered by a monitoring visit posted separately on the website (e.g., a blank checklist used by monitors) for all non-relative providers eligible to provide CCDF services. If checked, provide a direct URL/website link to the website where a blank checklist is posted: iv. [x] Other. Describe: Initial dates of notification on 12/13/21 and 6/15/23 were received and have been addressed. Upon receiving a Statement of Deficiency, a provider is required to complete a Plan of Correction, which states the adjustments made and corrections for any violation. These are posted on KYNECT. Additionally, once the DPOC is corrected, the DPOC Agreement form is uploaded to display on the KYNECT Provider Search, including the attachment to show the completed checklist, the start date of the agreement, and the end date of the finalized DPOC. This function was added to the Provider Search in June 2024. The Division of Regulated Child Care may re-check for compliance prior to a scheduled visit or investigation. Additionally, at any future investigative or licensing visit, DRCC will check for compliance from a previously submitted Plan of Correction. https://kynect.ky.gov/benefits/s/child-care- provider?fromNavBar=true&language=en_US. b. Check if the monitoring and inspection reports and any related plain language summaries include: i. [x] Date of inspection. ii. [x] Health and safety violations, including those violations that resulted in fatalities or serious injuries occurring at the provider. Describe how these health and safety violations are prominently displayed: KYNECT (https://kynect.ky.gov/benefits/s/child-care- provider?fromNavBar=true&language=en_US) Child care provider search function can be used to find a provider. All of the monitoring and inspection reports are then listed. iii. [x] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: KYNECT (https://kynect.ky.gov/benefits/s/child-care- provider?fromNavBar=true&language=en_US) Child care provider search function can be used to find a provider. All of the monitoring and inspection reports are then listed; they are updated with provider responses and plans to correct. Upon receiving a Statement of Deficiency, a provider is required to complete a Plan of Correction, which states the adjustments made and corrections for any violation. These are posted on KYNECT. Additionally, once the DPOC is corrected, the DPOC Agreement form is uploaded to display on the KYNECT Provider Search, including the attachment to show the completed checklist, the start date of the agreement, and the end date of the finalized DPOC. This function was added to the Provider Search in June 2024. iv. [x] A minimum of 3 years of results, where available. v. If any of the components above are not selected, please explain: The Division of Regulated Child Care may re-check for compliance with a plan of correction, if needed. At the next visit, all points are reviewed for compliance with a previously submitted plan of corrections. Plans of corrections are also posted on KYNECT. c. Lead Agencies must post monitoring and inspection reports and/or any related summaries in a timely manner. i. Provide the direct URL/website link to where the reports are posted: KYNECT (https://kynect.ky.gov/benefits/s/child-care- provider?fromNavBar=true&language=en_US) Child care provider search function can be used to find a provider. All of the monitoring and inspection reports are then listed. ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: If the inspection report included deficiencies, the statement of deficiencies and the accepted plan of correction (POC) will be posted as soon as the POC is received. If there were no violations during the inspection, the report will be available online once it has been reviewed and approved by a manager. These timeframes can vary because the provider can have up to 45 days to submit an acceptable plan of correction. d. Does the Lead Agency certify that the monitoring and inspection reports or the summaries are in plain language that is understandable to parents and other consumers? [x] Yes. [ ] No. If no, describe: e. Does the Lead Agency certify that there is a process for correcting inaccuracies in the monitoring and inspection reports? [x] Yes. [ ] No. If no, describe: f. Does the Lead Agency maintain monitoring and inspection reports on the consumer education website? [x] Yes. [ ] No. If no, describe: 5.5.5 Qualifications and training of licensing inspectors Lead Agencies must ensure that individuals who are hired as licensing inspectors (or qualified monitors designated by the Lead Agency) are qualified to inspect child care providers and facilities and have received health and safety training appropriate to the provider setting and age of the children served. Describe how the Lead Agency ensures that licensing inspectors (or qualified monitors designated by the Lead Agency) are qualified and have received training on health and safety requirements that are appropriate to the age of the children in care and the type of provider setting. The licensing inspectors must meet an educational requirement to qualify to be employed, and where possible, have expertise or experience in child care or early childhood education. In addition, each licensing inspector must participate in training prior to inspecting child care facilities and providers. This training includes a power-point presentation as well as shadowing of other inspectors before the new licensing inspector conducts an inspection as the team lead. Management staff periodically shadow inspectors to assure that complete and thorough inspections are conducted, and consistency is maintained. Ongoing training for licensing surveyors is also conducted within DRCC, as well as within the Cabinet for Health and Family Services. Division of Regulated Child Care current and new licensing surveyors are required to complete the following online training modules per contract deliverable: 1) Introduction to Licensing and Regulation; 2) Orientation (Health &Safety, Recognizing &Reporting Child Abuse and Neglect and Developmentally appropriate child care practice); 3) Online Orientation through ECOOL for all DRCC Licensing Surveyors; and 4) Licensing and Certification Standards of Practice (SOP). 5.5.6 Ratio of licensing inspectors Lead Agencies must ensure the ratio of licensing inspectors to child care providers and facilities in the State/Territory are maintained at a level sufficient to enable the Lead Agency to conduct effective inspections of child care providers and facilities on a timely basis in accordance with federal, State, and local laws. Provide the ratio of licensing inspectors to child care providers (i.e., number of inspectors per number of child care providers) and facilities in the State/Territory and include how the ratio is sufficient to conduct effective inspections on a timely basis. A targeted ratio of one (1) licensing inspector per fifty (50) child care providers allows for the provision of an expedient, constructive, and thorough licensing visit. Excerpt from contract with Office of Inspector General, Division of Regulated Child care requirements for Staffing and Professional Development: DRCC shall monitor monthly to assure its ratio of dedicated child-care licensing surveyor positions is one surveyor for each 50 child-care centers and family child-care homes, including two surveyors to conduct registered provider home visits to the extent that funding is available. DRCC shall ensure that all newly hired surveyors complete the Child Care Standards of Practice training within the first 90 days of employment and/or prior to surveying independently and completing surveys or making decisions on surveys. DRCC shall monitor surveyor staff and provide ongoing training to assure consistency of regulation enforcement statewide. DRCC shall ensure that all staff are meeting contractual time-frames as listed within each deliverable, including professional, clerical, and administrative duties necessary for the licensure, certification and registration. KRS 199.8994 Uniform administration of child-care funds - Dedicated child-care licensing surveyors. (https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=7248)