5.5 Monitoring and Enforcement of Licensing and Health and Safety Requirements

e. Building and physical premises safety, including identification of and protection from hazards, bodies of water, and vehicular traffic [x] [x] [x] f. Prevention of shaken baby syndrome, abusive head trauma and child maltreatment [x] [x] [x] g. Emergency preparedness and response planning and procedures [x] [x] [x] h. Handling and storage of hazardous materials and disposal of biocontaminants [x] [x] [x] i. Appropriate Precautions in transporting children, if applicable [x] [x] [x] j. Pediatric first aid and pediatric CPR (age- appropriate) [x] [x] [x] k. Child abuse and neglect recognition and reporting [x] [x] [x] l. Child development including major domains of cognitive, social, emotional, physical development and approaches to learning. [x] [x] [x] 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. [x] More than once a year. If more than once a year, describe: After initial licensure, licensed child care centers typically receive an unannounced inspection once every six months but are required to receive, at minimum, one unannounced inspection annually. Additional inspections are conducted as necessary to ensure compliance with health and safety standards. The Child Care Compliance Section is working with the National Association for Regulatory Administration (NARA) to determine if a more efficient differential monitoring process could be an effective option for Missouri. [ ] Other. If other, describe: 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 Lead Agency contracted with NARA to develop and implement a Key Indicator System, Weighted Risk Assessment and Differential Monitoring. This project will take 24 to 36 months to complete and the Lead Agency is approximately 12 months into the project. The projected completion of the project is June 2026. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. The Lead Agency’s Child Care Compliance Section completes the monitoring inspections, the Department of Health and Senior Services conducts sanitation inspections and the Department of Public Safety conducts fire safety inspections. Fire safety and sanitation inspections are not conducted for programs licensed for school-age children only. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating Lead Agency does not currently inspect for immunizations and continuity of care for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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. [x] More than once a year. If more than once a year, describe: After initial licensure, licensed family child care homes typically receive an unannounced inspection once every six months but are required to receive, at minimum, one unannounced inspection annually. Additional inspections are conducted as necessary to ensure compliance with health and safety standards. The Child Care Compliance Section is working with NARA to determine if a more efficient differential monitoring process could be an effective option for Missouri. [ ] Other. If other, describe: 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 Lead Agency contracted with NARA to develop and implement a Key Indicator System, Weighted Risk Assessment and Differential Monitoring. This project will take 24 to 36 months to complete and the Lead Agency is approximately 12 months into the project. The projected completion of the project is June 2026. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. The Lead Agency’s Child Care Compliance Section completes the monitoring inspections, the Department of Health and Senior Services conduct sanitation inspections and the Department of Public Safety conducts fire safety inspections. Fire safety and sanitation inspections are not conducted for programs licensed for school-age children only. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating Lead Agency does not currently inspect for immunizations and continuity of care for providers who serve fewer than 10 children. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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: N/A 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. N/A 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: [x] Annually. [ ] More than once a year. If more than once a year, describe: [ ] Other. If other, describe: 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. The Lead Agency’s Child Care Compliance Section conducts the initial and annual inspections for license-exempt center-based providers. The Department of Health and Senior Services conducts sanitation inspections and the Department of Public Safety conducts fire safety inspections. Fire safety and sanitation inspections are not conducted for programs licensed for school-age children only. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating Lead Agency does not inspect for the full complement of required health and safety standards for license-exempt providers. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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: [x] Annually. [ ] More than once a year. If more than once a year, describe: [ ] Other. If other, describe: 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. The Lead Agency’s Child Care Compliance Section conducts the initial and annual inspections for license-exempt family child care providers. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating Lead Agency does not inspect for the full complement of required health and safety standards for license-exempt providers. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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. After the initial announced onsite inspection, the Lead Agency conducts an unannounced onsite inspection annually if care is being provided in the child’s home but does not inspect the physical plant. The Lead Agency reviews trainings to ensure that the provider meets the training requirements and has an understanding of the health and safety requirements in regard to emergency planning, handwashing, health care, administering of medications, behavior management and guidance, prevention of shaken baby syndrome, abusive head trauma, child maltreatment, prevention of sudden infant death syndrome, safe sleep, transportation, child abuse and neglect reporting, and physical safety. The provider is required to review the Subsidy Child Care Provider Policy Manual, adopt it as their own, or create a manual that includes all components found in the manual provided by the Lead Agency. The Lead Agency received a Preliminary Notice of Possible Non-Compliance for this item on February 14, 2024, indicating Lead Agency does not inspect for the full complement of required health and safety standards for license-exempt providers. As this requirement will require a change in statute, the Lead Agency will need additional time to meet the requirement. 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: The Lead Agency’s Child Care Compliance Section conducts the initial and annual inspections for license-exempt in-home child care providers. 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. [x] 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: https://dese.mo.gov/childhood/child-care-subsidy iv. [x] Other. Describe: On February 14, 2024, the Lead Agency was issued a Preliminary Notice of Possible Non-Compliances indicating that they do not post full monitoring and inspection reports for all CCDF-eligible provider types. The Lead Agency will submit a waiver request for additional time to meet this requirement. 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: If the violations are discovered during a regular monitoring inspection, they are documented in the inspection report and displayed on the website. If violations are substantiated because of a complaint investigation, the violations and the conclusion summary of the investigation are displayed on the website. iii. [ ] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: iv. [x] A minimum of 3 years of results, where available. v. If any of the components above are not selected, please explain: The Lead Agency does not post corrective action plans for unlicensed child care providers but the information is available to the public upon request. The final report that is posted does indicate the date the provider came into compliance with the listed violation(s). 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: https://healthapps.dhss.mo.gov/childcaresearch/ ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: The Lead Agency posts inspections no sooner than 10 days after the inspection has occurred. 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 minimum qualifications for the Lead Agency’s Compliance Inspectors are (1) a bachelor’s degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following: Elementary or Early Childhood Education, Sociology, Psychology, Child Development, Social Work, Nursing, or a closely related field; or (2) an associate’s degree from an accredited college or university with a minimum of six earned credit hours in elementary or early education, sociology, psychology, child development, social work, or a closely related field or other related area with two or more years of professional or technical experience in elementary or early education, social services for children, or experience in the provision of child care in a licensed family or group child care home, or a licensed or license exempt child care center, or experience in investigations; or (3) four or more years of professional or technical experience in child care licensing, elementary or early childhood education, social services for children, or experience in the provision of child care in a licensed family or group child care home, or a licensed or license exempt child care center, or experience in investigations, and possession of a high school diploma or high school equivalency. New Compliance Inspectors in the Lead Agency receive on-the-job training, which includes mentoring from supervisors and seasoned staff. Within six months of hire, Compliance Inspectors receive orientation training which includes an overview of child care regulations in Missouri; ethics in regulations; child abuse and neglect mandated reporting and awareness; critical thinking; phases of licensing; conducting and managing complaint investigations; child care regulation and the disciplinary process; cultural competency, diversity and inclusion awareness; and the licensing process. In addition to the required training, the Compliance Inspectors are required to complete ABC’s of Safe Sleep training, CCDF Health and Safety regulation training and Early Childhood Social and Emotional Health training. All Compliance Inspectors and Child Care Inspector Supervisors are required to obtain a minimum of 12 hours of professional development training each calendar year to expand their knowledge in regulation, health, safety, early childhood and child related areas. 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. Compliance Inspector caseloads range between 67 and 82 facilities. The Lead Agency’s Regulatory Procedure Manual outlines the required number of inspections to be conducted each year, as well as provides guidance to licensing staff to ensure effective inspections are conducted timely. To ensure that inspectors can effectively complete inspections and investigations, there is a team of 10 Compliance Inspectors who only conduct complaint investigations and do not carry an ongoing caseload. Supervisors meet with their staff each month to review their caseload and to ensure they are conducting inspections in a timely manner. The Lead Agency has a policy that during staff vacancies inspections outside of the annual inspection can be skipped if the facility is compliant with licensing rules.