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. [x] More than once a year. If more than once a year, describe: In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. In addition, centers have an annual fire and sanitation inspection conducted by other agencies. [ ] 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: Child Care Consultants have a standard procedure to monitor applicable requirements for all regulated child care programs regardless of program type. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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: In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. [ ] 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: All applicable requirements are monitored at the annual visit. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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? [ ] No. [x] Yes. If yes, does your pre-licensure inspection for licensed in-home providers assess compliance with health, safety, and fire standards? [x] 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. [x] More than once a year. If more than once a year, describe: In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. [ ] Other. If other, describe: 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. North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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. [x] More than once a year. If more than once a year, describe: In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. In addition, centers have an annual fire and sanitation inspection conducted by other agencies. [ ] 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. North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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. [x] More than once a year. If more than once a year, describe: In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. [ ] 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. North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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. In addition to annual monitoring visits, child care consultants conduct routine unannounced visits each year. DCDEE does not conduct differential monitoring visits. 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: North Carolina Department of Health and Human Services, Division of Child Development and Early Education 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: Star Rated License - Star Rated License (ncdhhs.gov) https://ncchildcare.ncdhhs.gov/Services/Licensing/Star-Rated-License iv. [x] Other. Describe: DCDEE received a preliminary notice letter January 18 indicating the posting monitoring and inspection reports in accordance with 45 CFR 98.33 (a)(4) was a possible area of non-compliance. The Lead Agency does maintain monitoring and inspection reports on the consumer education website; however, the reports do not include all required information. The Lead Agency only includes items of non-compliance and does not identify all items observed to be in-compliance during the visit. DCDEE plans to submit a waiver to allow additional time to come into compliance with the regulation. 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: Within the inspection report, there is a separate section for violations of child care requirements, including the rule citation and customization of the violation. Violations of child care requirements regarding serious injuries and fatalities are included in the inspection reports. All violations of child care requirements are posted on the DCDEE website. iii. [x] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: If violations are cited during a monitoring visit, the inspection report indicates violations must be corrected immediately and a letter must be sent to the consultant within two weeks stating how each violation has been corrected and a plan to maintain compliance. A facility will be referred to a Child Care Health Consultant if the issue is related to health and safety to provide guidance in developing, implementing, and maintaining behavioral or environmental improvements. A consultant may conduct a follow-up visit within two weeks to verify compliance. Violations are listed on the public website and indicate if the violations were confirmed corrected by letter received from the provider, pending correction, or corrected during the visit. iv. [x] A minimum of 3 years of results, where available. v. If any of the components above are not selected, please explain: Not applicable 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://ncchildcare.ncdhhs.gov/childcaresearch ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: After the annual monitoring visit or a licensing complaint visit, the visits are reviewed by consultants for accuracy and posted on the Division website typically within 48 hours of the visit in accordance with agency procedures. Pending child maltreatment investigations do not display on the consumer website until the investigation has been completed. At the conclusion of a child maltreatment investigation, all visits will display, along with all violations of child care requirements cited during the course of the investigation. Data reports are run periodically to ensure visits are completed in a timely manner. 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? [ ] Yes. [x] No. If no, describe: The Lead Agency does maintain monitoring and inspection reports on the consumer education website; however, the reports do not include all required information. The Lead Agency only includes items of non-compliance and does not identify all items observed to be in-compliance during the visit. 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 education and experience for child care consultants is as follows: Graduation from a four-year college or university with a degree in child development, early childhood education, special education, social work, or related human services area and three years' experience in a child care or related setting involving the coordination, evaluation, or administration of a comprehensive program of child care services or in the coordination or management of the child care component of a local social services program; or Master's degree in one of the above areas and two years' experience in a child care or related setting involving the coordination, evaluation, or administration of a comprehensive program of child care services in the coordination or management of the child care component of a local social services program, or as an instructor or curriculum design specialist at the university or community college level; or An equivalent combination of education and experience. Once hired, child care consultants must complete orientation and basic job skills training. This includes training on the required health and safety topics and all aspects of the State's licensing requirements, as well as, field visits with other child care consultants, investigators, and supervisors. Their completion of orientation and Basic Job Skills training is tracked. As changes to requirements occur, child care consultants receive training at regional meetings, team meetings, and through online modules. 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. As of January 2024, there are a total of 5,668 licensed child care facilities and 111 child care consultants. The caseload averages 50-60 facilities per child care consultant. This caseload is sufficient to conduct effective inspections in a timely manner and provide technical assistance, as needed. The Regulatory Services Section of the Division of Child Development and Early Education aligns practices closely with the National Association for Regulatory Administration, which recommends 50-60 facilities per child care consultant.