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 head trauma and child maltreatment g. Emergency preparedness and response planning and procedures [x] [x] [ ] h. Handling and storage of hazardous materials and disposal of biocontaminants [x] [x] [ ] i. Appropriate Precautions in transporting children, if applicable [x] [x] [ ] j. Pediatric first aid and pediatric CPR (age- appropriate) [x] [x] [ ] k. Child abuse and neglect recognition and reporting [x] [x] [ ] l. Child development including major domains of cognitive, social, emotional, physical development and approaches to learning. [x] [x] [ ] 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: Lead Agency received a non-compliance notice on September 29, 2023 due to not having the inspection checklist show that all of the CCDF Health and Safety topics are inspected for at the CCDF licensed center visits. Non-compliance will be addressed by October 1, 2024. Child Care Licensing and ABC Quality staff are working to align between the two areas to ensure all topics are showing on the appropriate checklists for inspection. Evidence will be provided to Regional Office for consideration during the Plan review process. iv. Identify which department or agency is responsible for completing the inspections for licensed center-based providers. The Department of Social Services, Division of Early Care and Education, Child Care 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? [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: Lead Agency received a non-compliance notice on September 29, 2023 due to not having the inspection checklist show that all of the CCDF Health and Safety topics are inspected for at the CCDF family child care visits. Non-compliance will be addressed by October 1, 2024. Child Care Licensing and ABC Quality staff are working to align between the two areas to ensure all topics are showing on the appropriate checklists for inspection. Evidence will be provided to Regional Office for consideration during the Plan review process. iv. Identify which department or agency is responsible for completing the inspections for licensed family child care providers. Child Care Licensing is responsible for completing the inspections for the licensed family child care providers. 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: No, CCDF in-home providers are not licensed in South Carolina. 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 has established that ABC Quality will conduct the inspections of license-exempt center-based CCDF programs. 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. Child Care Licensing is responsible for completing the inspections for the Non-Related license-exempt family child care providers. 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. For new FFN providers, a Licensing Specialist will contact the provider by phone and/or email (announced) within 90 days of enrollment to schedule the on-site visit. During this visit, the Specialist will review the Health & Safety Inspection checklist with the FFN provider. Additionally, Child Care Licensing will monitor and conduct the annual inspection of Non-related FFN Provider. The checklist that is used outlines the areas and items that will be verified during the on-site inspection. Therefore, an unannounced visit will also be conducted to inspect the requirements on the checklist approximately 6 months after the Enrollment visit. 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: Child Care Licensing in the Division of Early Care and Education is responsible for conducting inspections of the non-related FFN 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. [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: Currently the results of inspections are provided on each individual provider's webpage which includes any violations. Violations are categorized low, medium or high based on risk to children. The Lead Agency is working to expand information that is currently on the child care website. To that end, full reports regarding complaints, renewals, and annual inspections of all regulated providers will be place on the child care website as required in a timely manner. License-exempt programs participating in ABC Quality receive a Health and Safety Inspection that is displayed as a document upload on the program's profile found on www.scchildcare.org. The Lead Agency does not display non-related FFNs on the consumer education website, because this provider type is typically used by parents in the event of an emergency and is not considered long-term care. Non-related FFN providers are limited to serving children from one family. SC Child Care Licensing law requires providers in home settings who serve children from more than one family to be licensed/registered. Therefore, a blank copy of the FFN Non-Related Health and Safety Inspection checklist is posted on the website. Development of a Child Care Integrated System portal for Development of a license-exempt and FFN portal within the Child Care Integrated System is planned. This system will collect information and display results of the inspection reports automatically on the website. For FFN providers, the monitoring report is added to the FFN provider page that can only be accessed by the family that the FFN provider is caring for. The family must have the provider number to search in the more search options field for the inspection report. iii. [x] Corrective action plans taken by the Lead Agency and/or child care provider. Describe: The existing table format shows a quick reference with status of the deficiency so that the parent knows the outcome of the deficiency. The website indicates whether the deficiency was corrected on-site or is pending correction. Additionally, we include the provider’s corrective action on the DSS Form 2910 Deficiency Correction, to include how the provider plans to correct the violations and the date it will be completed. Lastly, the CodePal software that is currently being configured will include deficiency correction within the checklist when using the electronic inspection check list. 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://www.scchildcare.org/. https://abcquality.org/families/find-a-provider/ ii. Identify the Lead Agency’s established timeline for posting monitoring reports and describe how it is timely: Currently, after the monitoring visit, the Licensing Specialist enters the information from the report into the CCSS database. Once entered, the Regional Supervisor must review and approve the information from the visit and the monitoring reports. Once approved, the monitoring reports are emailed to the Central Office and uploaded to the provider's page SC Child Care website. This process typically takes two weeks. Additionally, inspection software has been purchased to assist with electronic inspection at the monitoring visit that will upload automatically once the Licensing Specialist syncs to the network. Reportedly, this will allow for a more efficient way of approving monitoring reports before it goes to the website. For FFN providers, the monitoring report is added to the FFN provider page that can only be accessed by the family that the FFN provider is caring for. The family must have the provider number to search in the more search options field for the inspection report. License-exempt monitoring visits are conducted within 30 days of enrolling in ABC Quality and then subsequent visits are conducted annually during the programs unannounced visits. Additional visits are required for complaints and follow-up. The inspection reports are posted within 15 days of the initial visit on the Friday within the week the report is received. Providers can make any corrections needed till the posting of the report. After 15 days from the visit, the report is posted. Any corrections made thereafter are recorded on a subsequent report that is posted on the website using the same timeframe as the initial visit. ABC Quality posting of monitoring reports of participating license-exempt center care falls within the perimeters of the corrective action process making posting of monitoring reports timely. 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 Lead Agency hires Child Care Licensing (CCL) Specialists in the positions of Human Service Specialist II within Division of Early Care Education in the CCL Office of SC Department Social Services. The minimum requirement for this position is a bachelor's degree in early childhood education, social work or a related field. The qualifications indicate the licensing specialist must have considerable knowledge of fact gathering methods and interviewing techniques; of regulations, departmental standards and policies governing the operation and licensing of child care facilities, case management and of community resources. They must have the ability to examine and evaluate licensing applications and other forms and to make sound recommendations based upon written material and personal visits. The Lead Agency strives to hire Licensing Specialists from diverse cultural and linguistic backgrounds to enable staff to communicate with providers by treating them with respect and dignity and to avoid cultural or linguistic barriers. Lastly, all licensing specialists are trained during orientation for their employment. They are given a training plan that involves classroom instruction and on-the-job instruction and training. Training lasts for 10 weeks and is conducted by the training director and the regional supervisor where the licensing specialist is assigned. This training plan consists of understanding the law and regulations; reviewing the process for the registration of Family Child Care Homes and conducting the inspection; reviewing the process to open a new facility (any category of care); reviewing the renewal process; learning how to conduct an unannounced visit to all categories of care; ADA training module to better understand what is required of child care programs; learning how to conduct a complaint visit; investigating illegal operations; and understanding corrective action plans, appeals and testifying in hearings. Additionally, CCL has instituted Topic Tuesdays which occurs quarterly related to the health and safety topics as indicated by the CCDBG Act for all licensing specialists and all licensing supervisors. In October of 2024, CCL will be having an annual training for all Licensing Staff. This training will focus on health and safety in child care across the state. CCL has also participated in the Advanced Training for Program Infant and Toddler Care which supports caregiver and helping build resilience in care in March 2024. Currently, many staff in CCL has taken the Early Childhood Outdoor Learning course certification provided for by SC Department of Health and Environmental Control in conjunction with NC State University. In previous years, most of the CCL Regional Supervisors have been certified by National Association for Regulatory Administration (NARA). Other CCL staff are currently participating in the NARA based training offered through an approved Office of Child Care Quality TA staff. The Lead Agency has designated ABC Quality Assessors and ABC Quality Health Educators as qualified to inspect license-exempt child care providers participating in ABC Quality for health and safety requirements. ABC Quality assessors are hired in the position of a Program Coordinator II within the Lead Agency. The preferred requirement for the position is a master's degree in early childhood education or related field. ABC Quality assessors are trained one on one upon being hired on manuals, standards, health and safety inspections, Business Procedures, and other key documents. Each assessor completes the SC 15 hour Health and Safety Pre-service course that is required of child care staff, to ensure they have the same understanding of the health and safety requirements. They must have a broad understanding of developmentally appropriate practice and best practice observed in a wide variety of settings and quality levels. They shadow multiple assessors, conduct parallel assessments, and complete inter-rater reliability with the guidance of a lead anchor who provides mentorship, training and support. They must master the Process Quality assessment tool which is an intensive on-site observation tool for classrooms of children age birth through 12 years, a Structural Quality portfolio that addresses key elements of program policies and procedures, and mandatory Eligibility Requirements. Once reliable, assessors conduct reviews independently with cell phone access to anchors and program management if there is an unusual scenario not encountered during training. They conduct reviews with tablet pc and use an integrated data system to enter their findings. Anchors and program management review completed reports for accuracy prior to assessments being finalized. ABC Quality assessors are provided regular updates and changes at monthly staff meetings or called meetings. A protocol is followed for inter-rater reliability on a continuing basis to assure consistency of reviews. ABC Quality Health Educators are hired in the position of a Health Educator III within the Lead Agency. The preferred requirement for the position is a master’s degree in health education, public health education or a related field and 2 years of health education experience. They will conduct the health and safety checklist at license exempt programs which are primarily after-school centers. The current team of 3 ABC Quality health educators and any future health educators hired will receive training on outdoor play equipment from the Certified Playground Safety Inspector (CPSI) certification program of the National Recreation and Park Association (to be recertified every 3 years). The training objectives include how to identify hazards on public playgrounds and playground equipment, rank hazards according to injury potential, and apply that knowledge. They will also receive the Serve Safe Manager Certification sponsored by the National Restaurant Association. Fire inspections will be conducted by the local fire chief/inspector of the locality of the program to be assessed. 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. Child Care Licensing establishes caseload sizes by best practices recommended by the National Association of Regulatory Agencies (NARA). There are 2329 licensed/registered providers in South Carolina. There are 56 Licensing Specialist which consist of a caseload size on the average of no more than 42 cases per Specialist. At the end of April 2024, ABC Quality had 17 assessors, with an additional assessor beginning in May. At that time 1,239 programs were currently enrolled in ABC Quality. After accounting for the new assessor, this places the average caseload at 69 programs. The anchor role has been established to train, mentor, and provide ongoing support to quality assessors. Anchors also read the completed assessments to ensure accuracy. ABC currently has 4 anchors supporting the assessor team. Child Care Licensing establishes caseload sizes by best practices recommended by the National Association of Regulatory Agencies (NARA). Each program that is assessed by ABC Quality receives a detailed report on the program as a whole (Structural Quality) as well as each classroom observation (Process Quality). Recommendations to the Lead Agency include a recommended assessor caseload of no more than 50 programs, similar to Child Care Licensing. To adequately ensure timely and quality visits, it is estimated that a minimum of 26 Quality Assessors and 6 anchors are needed as well as other staff to support the varied responsibilities of ABC Quality. Continued growth will require recalculations.