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? [ ] Yes. [x] No. If no, describe: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Family Child Care Home I and II providers Emergency Preparedness and response planning components do not include staff training and volunteer training and volunteer drills). Inspecting group size ratio has been completed. 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: Programs providing care to 29 or fewer children are required to receive one unannounced annual licensing inspection. Programs providing care to 30 or more children are required to receive two unannounced licensing inspections annually. The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Family Child Care Home I and II providers Emergency Preparedness and response planning components do not include staff training and volunteer training and volunteer drills). Inspecting group size ratio has been completed. 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: To ensure providers are competent and use safe and adequate Health and Safety Standards as expected in applicable regulations and statutes, Child Care Inspection Specialists complete unannounced inspections at the child care program at least annually for a program licensed to provide care for 29 or fewer children and at least twice every year for a program licensed to care for 30 or more children under the Child Care Licensing Act. At each unannounced routine inspection, the applicable Regulations Compliance Review Licensing Checklist is used to determine if a program is: in compliance, not in compliance, or if the regulation is not applicable or not observed. At programs with 29 or fewer children, an entire checklist is completed during the annual inspection and all regulations must be documented as in compliance, not in compliance, or not applicable. At programs requiring two annual inspections, the Regulations Compliance Review Licensing Checklist is completed in its entirety between the two inspections. This means every regulation must be observed between the two inspections conducted annually. This is conducted for all licensed and licensed CCDF providers. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. Department of Health and Human Services, Division of Public Health, Children’s Services Licensing 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? [ ] Yes. [x] No. If no, describe: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Family Child Care Home I and II providers Emergency Preparedness and response planning components do not include staff training and volunteer training and volunteer drills). Inspecting group size ratio has been completed. 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: There are annual inspections for family home providers. The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. Family Child Care Home I and II providers Emergency Preparedness and response planning components do not include staff training and volunteer training and volunteer drills). Inspecting group size ratio has been completed. 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: At programs with 29 or fewer children, an entire checklist is completed during the annual inspection and all regulations must be documented as in compliance, not in compliance, or not applicable. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. Department of Health and Human Services, Division of Public Health, Children’s Services Licensing 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: Nebraska does not license CCDF in-home child care providers. 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. Nebraska does not license CCDF in-home child care providers. 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: Nebraska does not have CCDF-eligible license- exempt center-based child care providers. 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. Nebraska does not have CCDF- eligible license-exempt center-based child care providers. 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: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency needs additional time to meet the requirement and does not expect to have it met by October 1, 2024. The Lead Agency has health and safety requirements for license exempt providers which are monitored annually, however was found to be out of compliance with inspecting for some of these standards. 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. Department of Health and Human Services, Office of Economic Assistance, Child Care Subsidy 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. The Lead Agency funds in-home child care (care provided in child's home) with state dollars; no CCDF funds or state matching funds are used. The Lead Agency does not conduct inspections of in-home providers or post annual inspections and monitoring reports for in-home child care subsidy providers. The Lead Agency has policies and procedures in place to monitor in-home child care providers. These include initial and annual in-person meetings between the Lead Agency and the in- home provider to renew the child care subsidy provider agreement; signed checklist agreement between the provider and client stating they understand subsidy rules and regulations; applicable required background checks; required CPR and First Aid training; required to Prepare to Care (Health and Safety) training; completion of the emergency preparedness workbook; and required 4 hours of annual training. 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: Department of Health and Human Services, Office of Economic Assistance, Child Care Subsidy 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. [ ] Pre-licensing inspection reports for licensed programs. ii. [x] 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://dhhs.ne.gov/licensure/Pages/Child-Care-Licensing.aspx iv. [x] Other. Describe: The Lead Agency received the preliminary monitoring notice on April 20, 2024. The Lead Agency will be in compliance by October 1, 2024 with posting pre-licensing inspection reports for licensed programs. 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: When investigating, the Licensing Inspection Specialist cites all relevant regulations in the investigation report. Compliance review reports are completed following an inspection and/or investigation. For licensing inspections, the compliance review report is divided into three sections: the regulation evaluated, observations/discussions/determination, and what is needed to come into compliance. If a health and safety regulation was violated, the reader can easily identify which regulation was evaluated and which were found to be in violation. In addition to these being posted on the public website, all licensed programs are required to have these reports available to show to parents upon request. A compliance review report is completed for all license-exempt inspections. This report lists all regulations applicable for license exempt providers and that they must be following. It identifies if the program was in compliance, out of compliance, or if the regulation is not applicable to the provider. All license exempt reports are found on the Lead Agency’s website. In-Home child care is not funded with CCDF or state matching funds. The Lead Agency does not conduct home inspections of In-Home providers or post annual inspection or monitoring reports for In-Home Child Care Subsidy Providers. iii. [x] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: Nebraska has a negative action option that is referred to as Corrective Action Status (CAS), which is an option that can be offered to a licensee in the event the violation does not rise to the level of a discipline. Programs have the option to refuse, but if they do, it is likely the Lead Agency would then initiate disciplinary action. Part of the process includes the requirement that licensees submit a formal corrective action plan that addresses the violations to Children’s Services Licensing for approval. The CAS document informs the provider of the violation(s) identified during inspection and develops a plan (or steps) on how to correct the violation(s). If approved, Children’s Services Licensing monitors the submitted plan. The CAS document is uploaded onto the public website once all corrections have been made. If the program fails to follow its plan, Children’s Services Licensing may initiate disciplinary action, such as being placed on a probationary license, for failure to follow through on the agreed plan. A new, probationary license is issued to the child care provider and information is located on the public website. The probationary license will indicate the probation period. If the provider completes the probationary period successfully, a new operating license will be issued to the provider. Not all violations warrant a Corrective Action Status. Less serious violations will be cited, and the provider will be asked to fix these on-site during the inspection, immediately following the inspection, or may be given up to 30 days to correct the violation(s). The licensing specialist verifies that all cited violation(s) are corrected. The date of correction for each violation is updated on the inspection report, which supports compliance. This document is uploaded on the Lead Agency's website, demonstrating violations are corrected. For license exempt providers, violations are identified on the inspection form with time frames on when the violations need to be corrected. Notes are added to the inspection form once the issue is corrected and/or a new inspection form is uploaded to the webpage indicating full compliance. iv. [x] A minimum of 3 years of results, where available. v. If any of the components above are not selected, please explain: 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: License Exempt Providers: https://dhhs.ne.gov/Pages/Search-for-Child-Care- Providers.aspx Licensed Providers: https://www.nebraska.gov/LISSearch/search.cgi ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: Children's Services Licensing Inspections are posted within 30 days of completion of the inspection except in relation to negative or disciplinary actions. Inspections containing negative or disciplinary actions are not posted until the actions are finalized, which may exceed 30 days. License Exempt Annual Monitoring Compliance checklists are updated on the Lead Agency webpage at least every 90 days. 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. State of Nebraska Class Specification for a Child Care Inspection Specialist states these individuals must graduate from an accredited 4-year college or university with a specialization in elementary/early childhood education, human development, sociology, psychology, child development, social work, nursing, or a related field. They must also have experience as an inspector/complaint investigator in human services licensing or child welfare, and/or a children’s services provider at the level of licensee, director, or assistant director at a child care center. During the first six months of employment, new Child Care Inspection Specialists are expected to learn regulations, statutes, policies, and procedures related to licensed child care. They shadow experienced Specialists for the first six months, and once they begin to complete their own inspections, their reports are monitored by a supervisor until it has been determined they are competent to complete inspections independently. Child Care Resource Developers must have post-high school coursework or training in social work, sociology, guidance, psychology, child development, or a related field and experience in resource development, eligibility determination, or contract monitoring within a public service organization, or a bachelor’s degree in one of the above. Resource Developer candidates are also preferred to have experience providing case management services to children and families and/or previous experience working with child care providers. 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. The Lead Agency does not have a policy/procedure regarding the ratio of licensing inspectors to child care programs. Nebraska law states that all licensed child care programs must have at least one unannounced inspection annually if the program has a capacity of 29 or fewer children, and at least two unannounced annual inspections if the program has a capacity of 30 or more children. Inspection numbers are monitored monthly to ensure they are on track to be completed by the end of the year. If an area of the state has more complaints or staff vacancies, inspections are re-assigned to other staff. Metro areas have larger centers which, if over a licensing capacity of 30 would require two unannounced inspections annually. An estimation of the number of annual/semi-annual inspections at the beginning of the year is made to adjust staff/program ratios for the year. Metros areas with larger centers can average 1:125 and rural areas of the state, where there are smaller facilities that do not require as many inspections but require more traveling, can average 1:55. Each January, caseloads and supervisor caseload assignments are reviewed to account for any changes in child care provider populations and growth. Most caseloads have approximately 160 required annual routine inspection to be completed within an average of 250 annual working days. The average ratio of Resource Developers to CCDF child care providers, including licensed and license-exempt for rural areas, is typically 1:120, and in urban areas is typically 1:140. Resource Developer Supervisors review caseloads and assignments regularly and assign new providers as appropriate.