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: [x] Annually. [ ] More than once a year. If more than once a year, describe: [ ] 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: Licensed center based providers are monitored on all standards. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. Department of Health and Human Services, Child Care Licensing Unit NH was cited and notified of non-compliance on May 23, 2024 for the following: The Monitoring Team did not find evidence the Lead Agency has requirements for prevention of shaken baby syndrome and abusive head trauma and Background Checks including FBI fingerprints and State Criminal Registry checks with fingerprints for staff under 18 years old and therefore does not monitor Licensed Centers and Licensed Family Child Care for compliance for these topics. In addition, the Lead Agency does not have a requirement for volunteer emergency preparedness training and practice drills for Licensed Child Care Centers and therefore does not monitor compliance for this topic. Although the Lead Agency does monitor all licensed providers for pre- service/orientation training, the training does not include and therefore NH does not monitor Licensed Centers and Licensed Family Child Care for compliance for these topics: immunization exemptions, immunization grace periods, the five domains for child development training, and the following sub-components of emergency preparedness and response planning: communication and reunification with families and accommodations for infants and toddlers, children with disabilities, and children with chronic medical conditions. Additionally, substitutes are exempt from ongoing training requirements and therefore, the Lead Agency does not monitor ongoing training for substitutes. 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: [x] Annually. [ ] More than once a year. If more than once a year, describe: [ ] 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: Licensed family child care providers are monitored on all standards. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. Department of Health and Human Services, Child Care Licensing Unit NH was cited and notified of non-compliance on December 12, 2021 and on May 23, 2024 for the following: The Monitoring Team did not find evidence the Lead Agency has requirements for prevention of shaken baby syndrome and abusive head trauma and Background Checks including FBI fingerprints and State Criminal Registry checks with fingerprints for staff under 18 years old and therefore does not monitor Licensed Centers and Licensed Family Child Care for compliance for these topics. In addition, the Lead Agency does not have a requirement for volunteer emergency preparedness training and practice drills for Licensed Child Care Centers and therefore does not monitor compliance for this topic. Although the Lead Agency does monitor all licensed providers for pre- service/orientation training, the training does not include and therefore NH does not monitor Licensed Centers and Licensed Family Child Care for compliance for these topics: immunization exemptions, immunization grace periods, the five domains for child development training, and the following sub-components of emergency preparedness and response planning: communication and reunification with families and accommodations for infants and toddlers, children with disabilities, and children with chronic medical conditions. Additionally, substitutes are exempt from ongoing training requirements and therefore, the Lead Agency does not monitor ongoing training for substitutes. 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 in home providers are not licensed iii. Does the Lead Agency implement a differential monitoring approach when monitoring licensed in-home child care providers? [x] Yes. If yes, describe how the differential monitoring approach is representative of the full complement of health and safety requirements. N/A in home providers are not licensed [ ] No. iv. Identify which department or agency is responsible for completing the inspections for licensed in-home providers. N/A in home providers are not licensed 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. Department of Health and Human Services, Child Care Licensing Unit NH was cited and notified of non-compliance on May 23, 2024 for the following: The Monitoring Team did not find evidence that the Lead Agency has requirements for staff under 18 years old to complete FBI fingerprints and State Criminal Registry checks with fingerprints and therefore does not monitor these requirements for License-Exempt Centers and License-Exempt Family Homes. There was no evidence that pre-service/orientation training for License-Exempt Centers and License-Exempt Family Homes includes immunizations, including exemptions and grace periods, prevention of child maltreatment, all components of emergency preparedness and response planning, and the five domains for child development training and therefore does not monitor compliance for these topics. 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. Department of Health and Human Services, Child Care Licensing Unit NH was cited and notified of non-compliance on May 23, 2024 for the following: The Monitoring Team did not find evidence that the Lead Agency has requirements for staff under 18 years old to complete FBI fingerprints and State Criminal Registry checks with fingerprints and therefore does not monitor these requirements for License-Exempt Centers and License-Exempt Family Homes. There was no evidence that pre-service/orientation training for License-Exempt Centers and License-Exempt Family Homes includes immunizations, including exemptions and grace periods, prevention of child maltreatment, all components of emergency preparedness and response planning, and the five domains for child development training and therefore does not monitor compliance for these topics. 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. An announced monitoring inspection occurs annually on all standards. He-C 6914.04 (8) If license-exempt shall: a. If home based: 1. Submit to an annual announced monitoring visit as defined in He-C 6916.03(l) prior to DHHS enrollment; and 2. Comply with all the minimum standards for health and safety as required by He-C 6916; NH was cited and notified of non-compliance on December 13th 2021 and May 23, 2024 for the following: The Monitoring Team did not find evidence that the Lead Agency has requirements for staff under 18 years old to complete FBI fingerprints and State Criminal Registry checks with fingerprints and therefore does not monitor these requirements for License-Exempt Centers and License-Exempt Family Homes. There was no evidence that pre- service/orientation training for License-Exempt Centers and License-Exempt Family Homes includes immunizations, including exemptions and grace periods, prevention of child maltreatment, all components of emergency preparedness and response planning, and the five domains for child development training and therefore does not monitor compliance for these topics. 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, Child Care Licensing Unit. 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. [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. [ ] 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. [ ] Other. Describe: 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: The online system indicates, with a visual symbol of an exclamation point in a red circle, the regulations that when are found non-compliant identify a greater risk to the health and safety of children. iii. [x] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: The corrective action plan provided by the child care provider, or as directed by the department, is presented with the citation and evidence. 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: https://new- hampshire.my.site.com/nhccis/NH_ChildCareSearch ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: Per RSA 170-E:10, the findings of investigatory and monitoring visits, and final decisions relative to licensure of the child day care agency shall be considered public information, posted on the department's website, and available for review by members of the public. The findings of investigatory and monitoring visits and final decisions relative to licensure shall be posted on the department's website not less than 21 business days from the date of the finding or decision, and shall be available on the website for a period of 3 years. 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 qualifications for a NH Child Care Licensing Coordinator are found in the Department's Human Resource Supplemental Job description for this position: Education: Bachelor's degree in early childhood education, child development, education, social services, or a discipline focused on children or social programs. Each additional year of approved formal education may be substituted for one year of required work experience. Experience: Four years' experience in early childhood education, child development, education, or social services delivery. Each additional year of approved work experience may be substituted for one year of required formal education. Preferred Qualifications: Responsibility for program implementation, direct service delivery, program management, planning and evaluation. Special requirements: Must be able to satisfactorily complete or meet additional training criteria relevant to the assigned program area; such as but not limited to: Basic Child Care Licensing Health and Safety Course. Child Care Licensing Coordinators have an approximate 3-month mentorship with an experienced licensing coordinator before completing inspections independently. The National Association for Regulatory Administration Licensing Curriculum is also used in training new licensing coordinators. DHHS makes available translation services for instances when a licensing coordinator needs to communicate with a provider in the provider's language, which includes having a translator during inspections. 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 Child Care Licensing Unit has 11 inspectors, who are assigned to a specific territory. The ratio ranges from 60-75 programs per inspector. This ratio allows for at least one unannounced inspection, in addition to completing complaint inspections, pre-licensure inspections, revision of licenses, and onsite consultations. Reports indicating program annual inspection dates, regularly reviewed by supervisors, assist with ensuring that all inspections are completed annually.