Department of Health and Human Services 
OFFICE OF 
 
INSPECTOR GENERAL 
 
 
 
 
 
 
 
 
C C
HILD  ARE AND 
 
 
D F : 
EVELOPMENT  UND   
 
 
M L
ONITORING OF  ICENSED 
C C P  
HILD  ARE  ROVIDERS 
 
Daniel R. Levinson   
Inspector General  
 
November 2013 
OEI-07-10-00230   
   
EXECUTIVE SUMMARY:  CHILD CARE AND DEVELOPMENT FUND:  
MONITORING OF LICENSED CHILD CARE PROVIDERS 
OEI-07-10-00230 
 
WHY WE DID THIS STUDY  
 
The Administration for Children and Families (ACF) administers the Child Care and  
Development Fund (CCDF), which provides financial assistance with child care for 
approximately 1.6 million children each month.  In accordance with Federal regulations, 
States must certify that they have in effect, under State or local law, requirements 
designed to protect the health and safety of children receiving CCDF subsidies and to 
monitor these requirements.  Such certification helps ensure that Federal money is used to 
pay for care that meets health and safety requirements.  
 
HOW WE DID THIS STUDY  
 
For Federal fiscal years (FYs) 2010 through 2011, we reviewed each States licensing and 
health and safety requirements and surveyed State staff responsible for licensing, health 
and safety, and monitoring providers for compliance.  We selected five States (California, 
Florida, Illinois, Ohio, and Texas) representing 35 percent of all children in the CCDF 
program in FY 2009 for review.  We obtained information on the results of activities to 
monitor child care providers through documentation review and discussions with State 
staff.  We surveyed ACF staff to determine the extent to which  ACF monitors States  
licensing and health and safety requirements.     
 
WHAT WE FOUND 
 
Federal law requires States to have health and safety requirements in three areas:   
(1) the prevention and control of infectious diseases, (2) building and physical premises 
safety, and (3) minimum health and safety training.  All States complied with the Federal 
requirement to have health and safety requirements for licensed child care providers in 
these three areas. However, States monitoring requirements did not always meet ACFs 
recommendations for background screenings or the recommended standards for 
unannounced inspections found in the book entitled Caring for Our Children: National 
Health and Safety Performance Standards; Guidelines for Out-of-Home Child Care 
Program. In selected States we reviewed, monitoring of licensed providers was not 
conducted in accordance with States own requirements.  Moreover, ACF did little to 
monitor how States were overseeing CCDF providers. 
 
WHAT WE RECOMMEND 
 
We recommend that ACF seek authority to develop health and safety standards and 
ensure that States requirements meet them, develop requirements for States to conduct 
mandatory background screenings and periodic unannounced inspections, conduct 
periodic reviews of States compliance with their own licensing requirements related to 
minimum health and safety standards, and ensure that State plans comply with health and 
safety requirements.  Many of our concerns are addressed in ACFs Notice of Proposed 
Rulemaking issued on May 20, 2013.  ACF concurred with all five of our 
recommendations.    
   
   
TABLE OF CONTENTS 
 
Objectives ....................................................................................................1 

Background..................................................................................................1 

Methodology................................................................................................8 

Findings......................................................................................................12 

All States complied with the Federal requirement to have health 

and safety requirements for licensed child care providers in three 

basic areas ......................................................................................12 

States monitoring requirements did not always meet ACFs 

recommendations for background screening or the  

recommended National Standards for unannounced inspections ..13 

In selected States, monitoring was not conducted in accordance 
with States own requirements  .......................................................14 

ACF did little to monitor how States were overseeing  

CCDF providers .............................................................................16 
 
Conclusion and Recommendations ............................................................18 

Agency Comments and Office of Inspector General Response .................19 

Appendixes ................................................................................................21 

A: Point Estimates and Confidence Intervals Based on Case  

File Reviews...................................................................................21 

B: State-Reported Specific Requirements  ....................................23 

C: Agency Comments  ...................................................................29 

Acknowledgments......................................................................................33 

 
 
   
   
OBJECTIVES 
For the Child Care and Development Fund (CCDF) grant program, 
1. 	  determine the extent to which States child care licensing and health 
and safety requirements comply with Federal requirements,  
2. 	  determine the extent to which States monitoring requirements for 
licensed providers meet Administration for Children and Families 
(ACF) recommendations and National Standards, 
3. 	  identify results of selected States monitoring of child care providers 
related to those States licensing and health and safety requirements, 
and 
4.	   assess ACFs monitoring of States oversight of child care providers. 
BACKGROUND 
ACF is the operating division within the Department of Health and Human 
Services (HHS) that administers CCDF.1, 2 CCDF is authorized by the 
CCDBG Act and section 418 of the Social Security Act.  In fiscal year 
(FY) 2012, Congress appropriated $5.2 billion through the CCDBG Act to 
help low-income families in States, territories, and tribes obtain child care  
so that parent(s) could work or participate in training or education.   
CCDF provides financial assistance with child care for approximately 
1.6 million children each month.  A child is eligible to participate in CCDF 
if:   
(1) the child is under 13 years old (or, at the States option, if the 
child is under the age of 19 and physically or mentally unable to 
care for himself or under court supervision);  
(2) the child lives with a family whose income does not exceed  
85 percent of the States median income for a family of the same  
size; and 
(3) the child resides:  (a) with a parent who is working or attending 
a job training or educational program or (b) with a parent other 
 
1 ACF,  Fundamentals of CCDF Administration.  Accessed at http://www.acf.hhs.gov/ on 
March 23, 2011. 

2 The Child Care and Development Block Grant Act  of  1990  (the CCDBG Act)
  
( 5082(2) of the Omnibus Reconciliation Act of 1990, P.L. 101-508, Nov. 5, 1990) 

established the program (42  U.S.C.   9858, et seq.).  The CCDBG  Amendments of  1996 
 
(The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 

P.L. 104-193,  603,  Aug. 22, 1996) reauthorized  the program.  
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   1   
   
than the one described in (a) and the child needs or receives 
protective services.3    
The parent of an eligible child who receives or is offered child care 
services may either (1) enroll the child with an eligible child care provider 
with which the State has contracted or provided grant funds for such 
services or (2) receive a certificate to obtain services from a variety of 
providers. Categories of eligible providers include:  
 	  center-based child care providerdefined as a provider licensed or 
otherwise authorized to provide child care services in a 
nonresidential setting,  
	   group home child care providerdefined  as two or more 
individuals who provide child care services in a private residence 
other than the childs residence,4  
 	  family home child care providerdefined as one individual as the 
sole caregiver in a private residence other than the childs  
residence,5 and 
 	  in-home child care providerdefined as one individual who 
provides child care services in the childs own residence.6  
In FY 2011, approximately 505,000 child care providers in 50 States and 
the District of Columbia (States) provided child care funded through 
CCDF. 7, 8  In the same FY, two types of child care providerscenter-based 
providers and family home providerstogether covered, on average, 
89 percent of children in CCDF-funded care.9  
 
3 45 CFR   98.20.  The regulations at  45 CFR   98.2 state that parent means a parent by 
 
blood, marriage or adoption and also means a legal guardian, or  other person standing in
  
loco parentis.  

4 Eleven States did not have this provider type for FYs 20102011:  the District of 

Columbia, Indiana, Louisiana, Maryland, Maine, North Carolina, New Jersey, Virginia, 

Vermont, Washington, and Wisconsin. 
 
5 For center-based, group home, and family home child care providers, generally 

providers are allowed to  provide service only for less than  24  hours per day. 

6 45 CFR   98.30(e)(1) and 98.2 (Definitions).  

7 Table 7, CCDF, Preliminary Estimates of Number of Child Care Providers Receiving 

CCDF Funds (FFY [Federal fiscal year]  2011). Accessed at  http://acf.hhs.gov on 
 
January  15, 2013.  All FYs referred to in this report are Federal fiscal years. 

8 Although there are tribal and territorial programs in CCDF, we are looking only at State 
programs.  Tribal programs are subject to  different legal requirements and policies.  
9 Table 3, CCDF, Average Monthly Percentages of Children Served  by Types of Care 
(FFY 2009). Accessed at http://acf.hhs.gov on January 15, 2013.  
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Federal Requirements for State Participation in CCDF 
For a State to be eligible to receive funds through CCDF,  ACF must 
review and approve a State plan every 2 years.10, 11  
Through the State plan, each State must certify that it has: 
	   licensing requirements for child care services,12, 13  
	   requirements designed to protect the health and safety of children 
being cared for by those who provide services under the Act,14 and 
	   procedures to ensure that child care providers comply with 

applicable health and safety requirements.15
  
Licensing Requirements. Each State is required to provide a detailed 
description of its licensing requirements.16  The Health Resources and 
Services  Administrations (HRSA) National Resource Center for Health 
and Safety in Child Care and Early Education (NRC) provides an online 
listing of the licensing and regulatory requirements for child care in the 
51 States. 17   ACF accepts the NRC compilation as fulfilling the statutory 
requirement.  According to ACF guidance, however, States should verify 
that the NRC listing accurately reflects their requirements.18  
 
10 Each State Plan includes information about the States CCDF program with regard to 

the way in  which it administers the program, the way in  which the program was 

developed, child care services  offered, parental rights and  responsibilities, activities and 
 
services to improve the quality and availability of child care, and  health and safety 

requirements.  Although section 658I(b)(1)  of the CCDBG Act specifies the Secretary of 

HHS as responsible for reviewing and approving State plans, that responsibility has been 
 
delegated to ACF.  Per section 658I(a)(3) of the CCDBG  Act, ACF is also required to 
 
provide technical assistance to States in  carrying out the requirements of the Act. 
 
11  45  CFR  98.17.  
   
12 Section 658E(c)(2)(E) of the CCDBG  Act.  The Act states that licensing requirements do 

not have to apply to all types of providers.  Providers commonly exempted from licensing 
 
include relatives; in-home child care providers; and some center-based child care 

providers, such as school-based and/or school-age  programs, centers that operate 

part-time or on a drop-in basis, and centers operated  by religious organizations.  Taken 

from ACF, Child Care and Development Fund Report of State and Territory Plans  

FY 20102011. Accessed at http://acf.hhs.gov on January  15, 2013. 
 
13 45 CFR   98.2 defines licensing or  regulatory requirements as requirements necessary 

to legally provide child care services in a State or locality, including  registration 

requirements established under State or local law.  

14 Section 658E(c)(2)(E) and (F) of the CCDBG Act. 
 
15 Section 658E(G)  of the CCDBG Act.  

16 Section 658E(c)(2)(E) of the CCDBG  Act. 

17 Under contract from HRSAs Maternal and Child  Health Bureau, this database is 

maintained  by  the University of Colorado Health Sciences  Center School  of Nursing.
   
The NRC database can be accessed at  http://nrckids.org/. 

18ACF, CCDF  State and Territories Plan Preprint Guidance, FFY 20102011. Accessed 

at http://www.acf.hhs.gov/ on February 1,  2011.  
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Health and Safety Requirements. Each State must certify that it has in 
effect under State or local law requirements designed to protect the health 
and safety of children.19  Federal law requires States to have health and 
safety requirements in three areas: (1) the prevention and control of 
infectious diseases (including by immunizations), (2) building and 
physical premises safety, and (3) minimum health and safety training 
appropriate to the provider setting.20    
States have discretion in how they meet health and safety requirements.  
ACF acknowledged in July 2012 that because the CCDBG Act does not 
specifically define health and safety standards, some States lack 
requirements for such things as criminal background checks, training on 
first aid and cardiopulmonary resuscitation (CPR), and safe sleep 
practices.21  In testimony before the Senate Subcommittee on Health, 
Education, Labor, and Pensions, Linda Smith, the Deputy Assistant 
Secretary and Inter-Departmental Liaison for Early Childhood 
Development, noted that 
... in too many cases, it takes well-publicized deaths in child care 
settings to prompt State action to strengthen their licensing 
standards to better address childrens safety.  These tragic losses 
emphasize the importance of health and safety standards and 
building a strong foundation for high quality care. 
Monitoring and Compliance.   ACF accepts States licensing descriptions  
as proof that they effectively enforce licensing requirements.  In its plan, 
each State is required to certify it has  procedures to ensure that child care 
providers comply with applicable health and safety requirements.22  
The CCDBG Act requires Federal monitoring of each States compliance 
with its plan. 23   Although the Act does not require States to (1) conduct 
routine unannounced inspections of child care providers, (2) perform  
background screenings on providers (or their family members), or 
(3) require providers to report serious injuries that occur while a child is in 
care, ACF guidance instructs each State to indicate whether it performs  
these three activities. States are also asked to describe any other methods 
 
19 Section 658E(c)(2)(F) of  the CCDBG Act. 

20 Section 658E(F)(i)(iii) of the CCDBG Act. 

21
 Statement of Linda Smith, Deputy Assistant Secretary for Early Childhood Development, 

ACF, Child Care and Development Block Grant Reauthorization:  Hearing Before the U.S. 
Senate Subcommittee on Children and Families, Committee on Health, Education, Labor and 
Pensions, 112th Cong. (2012).   
22
 Section 658E(G) of the CCDBG Act.  
23 Section 658I(b)(1)  of the CCDBG  Act. 
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they use to enforce health and safety requirements (e.g., requiring that a 
certain percentage of providers be inspected annually and specifying the 
length of time between inspections).24    
ACF-Recommended Practices 
Although the CCDBG Act does not require criminal background 
screenings, ACF released an information memorandum on  
September 20, 2011, to all States, child care licensing agencies, child care 
resource and referral agencies, and other interested parties that strongly 
recommended comprehensive background screenings for all providers 
who care for children receiving CCDF subsidies.  A comprehensive 
criminal background screening, in ACFs guidance, includes all of the 
following: 
 	  using fingerprints for checks of State criminal history records,  
 	  using fingerprints for checks of Federal Bureau of Investigation 
(FBI) criminal history records,  
 	  checking the child abuse and neglect registry, and  
 	  checking the sex offender registries.25    
Additionally, ACF revised the FY 20122013 State Plan guidance to 
highlight areas of interest to the Federal Government, including a section 
addressing the types and frequency of background screenings that States 
require for child care providers and other child care workers.26   
National Health and Safety Performance Standards  
The CCDBG Act and implementing regulations contain no specific health 
and safety standards for child care providers that States must follow.   
Instead, ACF partners with HRSA to disseminate the book entitled Caring 
for Our Children:  National Health and Safety Performance Standards; 
Guidelines for Out-of-Home Child Care Programs, funded by a HRSA  
grant. In this report, we refer to the standards in this book as the National 
Standards. According to industry experts, the National Standards 
represent the best evidence, expertise, and experience on quality health 
and safety practices and policies that should be followed in early care and 
 
24 ACF,  CCDF State and Territories Plan Preprint  Guidance, FFY 20102011. 
Accessed at  http://www.acf.hhs.gov/ on  February 1, 2011. 

25 ACF, Log No:  CCDF-ACF-IM-2011-05.  Guidance released to States by the Office of 

Child Care related to criminal background checks, September  20, 2011.  

26 ACF,  CCDF State and Territories Plan Preprint  Guidance, FFY 20122013. 
Accessed at  http://www.acf.hhs.gov/ on  October 15, 2012.  
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education settings.27   The National Standards include guidelines on facility 
inspections and monitoring.   
According to the National Standards, every State should require its 
licensing inspectors to conduct onsite inspections to measure compliance 
with licensing rules prior to issuing an initial operating license to a child 
care center or family home.  The licensing agency should conduct at least 
two inspections per year of each center and family home.  At least one of 
the inspections should be unannounced; more unannounced inspections 
should be conducted if needed for the facility to achieve satisfactory 
compliance.  Routine unannounced inspections are a means for States to 
determine whether providers are operating healthy and safe environments 
for children who qualify for public funds. 
Related Studies 
In 2010, the Office of Inspector General (OIG) identified provider 
noncompliance with health and safety requirements in Head Start, another 
ACF program.28 Of the 24 Head Start grantees that OIG reviewed, none 
complied fully with Federal Head Start or State requirements to protect 
children from unsafe materials and equipment.  In addition, 
21 of 24 grantees did not comply fully with Federal Head Start or State 
requirements to conduct background screenings, recurring background 
screenings, checks of child care exclusion lists, or checks of child abuse 
and neglect registries or with requirements to document those records 
checks. 
A 2011 Government Accountability Office (GAO) report found cases of 
sex offenders working for child care providers or living in homes where 
child care was provided.  GAO found programs that employed offenders 
while receiving Federal Head Start or CCDF funds.29  
In 2012, the National Association of Child Care Resource & Referral 
Agencies (NACCRRA) issued white papers that identified vulnerabilities 
to childrens health and safety.30  NACCRRA found that only 12 States 
 
27 American Public Health Association, American Academy of Pediatrics, NRC, Caring  
for Our Children:  National Health and  Safety Performance Standards; Guidelines for 
Out-of-Home  Child Care Programs, 2011.  
28 OIG issued  24 reports on health and  safety compliance in  Head Start facilities 
following site visits conducted in FY 2010.  Accessed at 
https://oig.hhs.gov/oas/reports/region10/11102503.asp  on December 6, 2012.  
29 GAO,  Child Care:   Overview of Relevant  Employment Laws and Cases  of Sex  
Offenders at Child Care Facilities, GAO-11-747.  Accessed at  http://www.gao.gov on  
October 12, 2012.   
30 NACCRRA, Effective Inspections Policies Promote Childrens Safety and  Healthy 
Development in Child Care, and Background Checks:  It Is Time To Protect Children in 
Child Care. Accessed at http://www.naccrra.org  on October 12, 2012.   
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required staff in child care centers to have comprehensive background 
screenings, and only 10 States required family home providers to have 
comprehensive background screenings.  They also found that only 
8 States conducted monitoring inspections at least quarterly for centers 
and that 20 conducted inspections of centers once a year or less frequently.   
Proposed Regulations 
Subsequent to our study period, ACF issued a Notice of Proposed 
Rulemaking (NPRM) that included regulations to strengthen health and 
safety requirements and oversight of license-exempt providers.31 These 
regulations, as written, impose more stringent health and safety 
requirements on center-based, group home, and family home providers 
who care for children receiving CCDF subsidies, including license-exempt  
providers. (States, however, have the option to exempt in-home providers 
and continue to have the option to exempt relatives from some or all of 
these requirements.) 
Licensing Requirements. ACF proposes requiring a description of any 
exemptions to licensing requirements and a rationale for such exemptions. 
Health and Safety Requirements. ACF proposes minimum requirements 
for building and physical premises safety, including: 
	   Comprehensive background checks on child care providers.  These 
checks must include use of fingerprints for checks of State criminal 
history records; use of fingerprints for checks of FBI criminal 
history records; clearance through the child abuse and neglect 
registry, if available; and clearance through sex offender registries, 
if available.  
	   Compliance with State and local fire, health, and building codes 
for child care. These codes must include the ability to evacuate 
children in the case of an emergency.  Compliance must be 
determined before child care providers can serve children receiving 
CCDF assistance.  
	   Emergency preparedness and response planning, including 
provisions for evacuation and relocation, sheltering in place, and 
family reunification. 
ACF proposes adding a list of minimum health and safety preservice and 
orientation training, appropriate to the provider setting and ages of 
children served, including, but not limited to, first aid, CPR, and safe sleep 
practices.  
 
31 78 Fed. Reg. 29441  (May 20, 2013). Comments were  due by August 5, 2013.  
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Monitoring and Compliance. ACF proposes requiring that all providers 
who care for children receiving CCDF subsidies be subject to specific 
monitoring for compliance with health and safety requirements.  The 
States procedures: 
 	  must include unannounced onsite monitoring, 
 	  may not rely solely on child care providers self-certifying their 
compliance with health and safety requirements without 
documentation or other verification that requirements have been 
met,  
 	  must require an unannounced visit in response to a complaint 
pertaining to the health and safety of a child in the care of a 
provider paid with CCDF funds, and 
 	  must require child care providers paid with CCDF funds to report 
to a designated State entity any serious injuries or deaths of 
children occurring in child care. 
METHODOLOGY 
For FYs 2010 and 2011, we used multiple data sources and approaches to 
determine and describe (1) each States licensing and health and safety 
requirements, (2) the results of selected States monitoring activities, and 
(3) ACFs monitoring of compliance with States licensing and health and  
safety requirements.  
Scope 
We included all 51 States in an initial survey about child care licensing 
and health and safety requirements.  We selected a purposive sample of 
five States representing 35 percent of children served in licensed settings 
by the CCDF program in FY 2009.  Licensing is State permission required 
to operate a child care facility, which includes meeting specific standards 
depending on the provider type. Some States may call their regulatory 
processes certification or registration; for the purpose of this study, 
the terms licensing or licensed are used to represent all regulatory 
processes. Although a given State (e.g., New York) may have received 
more funding than the sampled States, we selected the States that served 
the most children in licensed settings.  We conducted an indepth review to 
determine those States policies and practices for monitoring child care 
providers compliance with licensing and health and safety requirements.  
We also reviewed the results of the monitoring activities conducted by the 
five States. We excluded in-home providers from our sample because 
most States do not require the licensing of in-home providers paid with 
CCDF funds.  We excluded group home providers from our 51-State 
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review because they represent only 5 percent of children in CCDF-funded 
care. 
Sample Selection 
We selected a purposive sample of five States (California, Florida, Illinois, 
Ohio, and Texas) representing 35 percent of all children receiving care 
from licensed providers in the CCDF program in FY 2009.  We obtained a 
list of all potential CCDF child care providers in FYs 2010 and 2011 and 
selected a stratified random sample of 125 licensed providers from each of 
the 5 States. See Table 1 for numbers of providers by State and type of 
provider.  
Table 1:  CCDF-Funded Licensed Child Care Providers  
in Sampled States 
Licensed  Licensed 
Licensed  Total  
Group  Family  
State   Center-Based  Home  Home  Licensed  OIG Sample  
Providers   Providers  
Providers   Providers  
California  4,910   6,518   13,853   25,281   125 
Florida  5,732   n/a*  3,661   9,393   125 
Illinois  2,637   364  8,125   11,126   125 
Ohio  4,266   287  8,489**  13,042   125 
Texas  6,620   807  1,771   9,198   125 
   Total   24,165  7,976   35,899   68,040   625 
*Florida does not have the group home provider type. 

**In Ohio, family  homes are certified.   Certification in Ohio is a form of regulation under a process that is
  
very similar to licensing; because these providers are still  regulated, we consider them to be licensed. 

Source:  OIG analysis of ACF data, 2011.  

Data Collection  
State Licensing Requirements, Health and Safety Requirements, and 
Monitoring Activities. To determine the licensing and health and safety 
requirements for child care providers in each State, we obtained listings 
from the NRC Web site and obtained State plans from State Web sites or 
ACF.   We reviewed the licensing and  health and safety information to 
identify the differences in licensing requirements by provider type and 
across States. 
We then surveyed in all 51 States the State staff who are responsible for 
licensing, health and safety, and monitoring.  We used the survey results to 
verify how States licensing and health and safety requirements apply to 
different provider types within a State.  We also used the survey results to 
identify how each State reports that it monitors providers for compliance 
with licensing and health and safety requirements.   
Monitoring of Individual Providers. We requested documentation from  
the five selected States to determine whether they comply with their own 
policies and procedures for monitoring child care providers.  
Documentation included licensing inspection reports, reported findings, 
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parental or other complaints, background screening verification lists, and 
proof of provider training. We worked with State staff to identify the 
specific types of documents used to support oversight.  
We received responses from the States for all 625 providers included in 
our sample.  In Florida, we excluded 46 providers from our sample 
because they had closed prior to our review period or were exempt from 
licensing requirements and excluded an additional 18 providers from our 
sample because they were under the purview of local licensing districts 
with unique standards.32   This resulted in an adjusted sample size of 561. 
ACF Monitoring Activities. We surveyed ACF headquarters and regional 
office staff about their monitoring of States licensing and health and 
safety requirements.  We asked for documentation supporting the extent to 
which ACF verifies State standards.  We also asked about methods that 
ACF uses to review States CCDF plans for policies and procedures 
related to monitoring of licensing and health and safety requirements.   
Analysis  
We used information from the NRC Web site, the collected State plans, 
and the State surveys to determine States compliance with Federal 
licensing and health and safety requirements.  We used these same data 
sources to compare States practices to the ACF and National Standards 
recommendations related to background checks and unannounced visits, 
respectively.  
We compared the monitoring information for the 561 sampled child care 
providers against the States own standards and the National Standards to 
determine the extent to which the States met these standards.  If sampled 
providers were not operating during our entire review period  
(FYs 2010 through 2011), we applied only those standards that applied 
while they were operational (e.g., if providers had been open for less than 
a year, we would not expect a yearly followup inspection if one was 
required by the State). When possible, we projected our results for the 
sampled providers to the population of all licensed CCDF providers in 
FYs 2010 and 2011 in each of the five States or for the five States 
combined.  Estimates and 95-percent confidence intervals for these 
projections are in Appendix A. 
We used the ACF survey results to determine the extent to which ACF 
monitored States compliance with licensing requirements and health and  
safety requirements. 
 
32 In  7  of  Floridas 67 counties, licensing is overseen by the county, rather than  by the 
Department of Children and Families.   
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Standards 
This study was conducted in accordance with the Quality Standards for 
Inspection and Evaluation issued by the Council of the Inspectors General 
on Integrity and Efficiency.   
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FINDINGS 
All States complied with the Federal requirement to 
have health and safety requirements for licensed child 
care providers in three basic areas 
All of the 51 States had requirements designed to protect the health and 
safety of children served by licensed child care providers in 3 areas:   
(1) prevention and control of infectious disease, (2) building and physical 
premises safety, and (3) minimum health and safety training.  The Act 
does not contain minimum requirements within the three areas; States 
reported various methods through which they met Federal requirements.   
State licensing regulations provide a framework for ensuring health and 
safety in three areas for licensed child care providers.  States reported 
meeting the requirements in many different ways.  See Table 2 for an 
example of how two States met Federal health and safety requirements for 
licensed child care providersone with many requirements and one with 
fewer requirements. 
Table 2:  Examples of Two States Reported Health and Safety Requirements  
for Licensed Providers 
Federal 
Health and  State A   State B  
Safety  
Requirement  
1. Child immunizations  1. Child immunizations 
Prevention 
2. Physical exam for children  2. Physical exam for children  
and Control 
3. Physical exam for providers  3. No admittance if serious transmissible  
of Infectious 
4. Tuberculosis check for providers  infection or communicable 
Disease 
5. Health care plan  diseases present 
1. Fire inspection 
Building and  2. Building inspection  1. Fire inspection 
Physical  3. Environmental health inspection   2. Building inspection 
Premises  4. Safe sleep policy  3. Lead-safe or lead-free facility  
Safety   5. Smoking ban   
6. Transportation policy  
1. CPR certification every 12 months 
1. Current CPR certification  
2. First aid certification every 36 
Health and  2. Current first aid certification 
months 
Safety   3. Completion of medication 
3. Twelve annual hours of training  
Training   administration training by at least one 
4. Bloodborne pathogens training  
center employee present 
within 6 months of initial hire  
Source:  OIG Survey of States, 2011. 
We considered all States to be compliant with Federal health and safety 
requirements for licensed child care providers because they reported at 
least one licensing regulation related  to each requirement.  ACF does not 
distinguish between States that have instituted many regulations in a given 
area and States that have fewer regulations per area.     
   
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States monitoring requirements did not always meet 
ACFs recommendations for background screening 
and the recommended National Standards for 
unannounced inspections  
ACF requires States to certify that they have procedures to ensure that 
licensed child care providers comply with all applicable health and safety 
requirements.  A principal way that States enforce health and safety 
requirements of licensed providers is through monitoring for compliance 
with State regulations. States reported that monitoring consists largely of 
background screenings and inspections, yet these do not always meet 
ACFs recommendations or the recommended National Standards.   
Although all States reported screening child care workers, 
many reported not checking FBI fingerprint databases or 
sex-offender registries in accordance with ACFs  
recommendations 
Not all States check all sources that ACF recommends in its  
September 2011 memorandum.  Given the lack of a national system for 
checking criminal history and child abuse records, multiple checks are 
necessary.  As part of the 2011 memorandum, ACF strongly encouraged 
States to conduct a comprehensive criminal background screening that 
includes a fingerprint-based check of State criminal records, 
fingerprint-based check of FBI criminal records, and a child-abuse registry 
check for all prospective child care staff and for any other persons who 
have regular access to children in these child care settings.  Only 15 States 
reported performing checks sufficient to be considered comprehensive 
background screenings for both center-based and family home providers. 
Even in States that reported checking all of ACFs recommended sources,  
the checks did not always apply to all child care staff.  Michigan reported 
that fingerprint-based checks of FBI criminal records were required for 
directors and owners, but not for child care providers.  In Washington 
State, fingerprint-based checks of FBI criminal records are done on 
potential providers only if they have lived 3 years or less in the State.   
The sources least often checked by States were FBI criminal records and 
sex-offender registries.  See Table 3 for sources that States reported 
requiring for background screenings and Appendix B for specific 
requirements States reported related to the sources checked and 
individuals subject to background screenings. 
   
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Table 3:  Number of States Checking Background Screening Sources  
Source for Background Screening   Number of States  Number of States 
Checking Source for  Checking Source for 
Center-Based  Family Home 
Providers   Providers  
State Criminal Records   49  48 
FBI Criminal Records   35  33 
Child-Abuse Registry    45  48 
Sex-Offender Registry    28  28 
Source:  OIG survey of States, 2011. 
Twenty-one States did not report requirements for routine 
unannounced inspections that met recommended National 
Standards 
Routine unannounced inspections are one way to determine whether 
providers are operating healthy and safe environments for children who 
qualify for public funds. The National Standards recommend that each 
provider undergo at least two inspections each year, with at least one of 
the inspections being unannounced. Ten States failed to meet that 
standard for center-based providers and 21 failed to meet it for family 
home providers.33    
Although some States require routine unannounced inspections, their 
frequency did not meet the National Standards.  Additionally, two States 
did not require any unannounced inspections for family home providers 
and one State did not require any unannounced inspections for 
center-based providers. See Appendix B for specific requirements States  
reported related to the frequency of routine unannounced inspections.  
In selected States, monitoring was not conducted in 
accordance with States own requirements  
States did not always conduct unannounced inspections when 
required by State law, missing opportunities to identify and 
correct health and safety deficiencies 
Four of the five selected States required unannounced inspections at least 
annually to ensure provider compliance with State licensing requirements, 
yet they failed to comply with their own requirements.  None of the four 
States conducted all the required unannounced inspections.34   Texas and 
 
33 Although the  National  Standards do  not differentiate among provider types, States have  
different requirements for different types of child care providers.  Thus, the findings of  
this report  differentiate between center-based  providers and family home providers. 
34
 Because our review period included only 2 years, we could not review Californias 
requirement for an unannounced inspection every 5 years. 
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Florida had the lowest noncompliance rates, missing less than 1 percent 
and 10 percent of required inspections, respectively.  Illinois had the 
highest noncompliance rate, missing 82 percent of its required inspections; 
it conducted many inspections, but failed to record whether they were 
unannounced. See Table 4 for details on States requirements for 
unannounced monitoring inspections and percentages of missed 
inspections and Appendix A  for the confidence intervals.  
Table 4: Unannounced Monitoring Inspections in Five States  
Requirements for  Percentage of 
State  Unannounced Monitoring   Missed Inspections   
Inspections  FYs 20102011  
California  Every  5 years   n/a 
Every 4 months for centers;  
Florida   10.3%  
every 6 months for family homes  
Illinois  Annually  81.6%  
Ohio  Annually  25.6%  
Annually for centers; 
Texas   <1% 
every 2 years for family homes 
Source:  OIG analysis of State data and documents related to inspection requirements and 
compliance, 2012. 
 
When States do not conduct monitoring, they miss opportunities to 
identify deficiencies and recommend provider improvements.  Across all 
five States that conducted one or more inspections during our review 
period, States identified deficiencies for 62 percent of providers.  Of all 
providers with at least 1 inspection, 11 percent had more than 
10 deficiencies. Examples of deficiencies cited during unannounced 
monitoring inspections included: number of children in care significantly 
differing from the number of children recorded on the sign in/sign out log, 
not enough staff for the license capacity, expired CPR and first aid 
certification, and bleach in an unlocked cabinet in the classroom. 
States have different methods of categorizing the number and severity of 
deficiencies. For example, in Florida a single deficiency in the area of 
Outdoor Equipment could include peeling paint on play equipment (a 
Class 2 violation) and ill-maintained ground cover under play 
equipment (a Technical Support violation).  In Texas, the area of safety 
was more narrowly defined.  For example, the State found a provider to 
have two deficiencies: one in the area of SafetyAreas Free From  
Hazard for a red tricycle missing a pedal (Medium High weight) and 
another in Safety Requirements for Active Play Equipment for a toy car 
that had a crack on the seat (High weight).   
   
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States missed opportunities to identify unscreened individuals 
or individuals with expired background screenings   
None of the five sampled States adhered to their own frequency 
requirements for reviewing providers  compliance with State requirements 
for background screening.  When States did review providers compliance 
in this area, they found that 22 percent of providers had not initiated or 
renewed their background screenings as required by the State.  In all five 
States we reviewed, a single deficiency related to background screening 
could account for multiple individuals, making it difficult to determine the  
extent to which individuals have missing or expired background 
screenings.  
Deficiencies in background screenings ranged from overdue screenings to 
unscreened persons living in the house.  Texas had the highest 
noncompliance rate for reviewing background screenings when required 
by State law, but Texas also required the most frequent reviews.  In 
Florida, Illinois, and Ohio, the States review provider compliance with 
background screening as part of their routine inspections.  Therefore, 
when the States failed to conduct routine inspections, provider compliance 
with the background screening could not be checked by the State.  See 
Table 5 for details on States reviews of provider compliance with 
requirements for background screening and for details on States missing 
reviews; see Appendix A for the confidence intervals.  
Table 5: Background Screening Monitoring in Five States  
Percentage of 
Inspections During Which Monitoring  
State  Missing Reviews  
of Background Screening Is Required 
FYs 20102011 
Prelicensing inspections,  
California  annual/random/5-year inspections,  7.5%  
followup inspections (if pertinent)  
License renewal inspections (all individuals),  
Florida   11.0%  
routine inspections (new employees) 
Illinois  Every  unannounced annual inspection  13.1%  
All inspections except inspections for a specific 
Ohio   8.4%  
purpose  
Texas  Any  inspection  20.3%  
Source:  OIG analysis of State data and documents related to  compliance with monitoring of background  
screening requirements, 2012. 
ACF did little to monitor how States were overseeing 
CCDF providers 
Federal law allows States to self-certify that their licensed and 
license-exempt child care providers meet health and safety requirements in 
three areas. For our review period (FYs 20102011), ACF did not require 
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States to describe how their licensing regulations covered these three areas 
for licensed providers. ACF did require States to describe how they meet 
health and safety requirements with regard to providers that are exempt 
from licensing.  All States met this requirement except Mississippi. 
Mississippi failed to describe to ACF how it met health and safety 
requirements for license-exempt providers.  ACF did not identify this 
failure by Mississippi and therefore did not require Mississippi to submit 
health and safety requirements for license-exempt providers before the 
State could receive CCDF block grant funding.  ACF data from FY 2010 
show that 23 percent of children receiving CCDF subsidies in Mississippi 
are in license-exempt care.   
States self-certify monitoring procedures to ACF.  For our review period, 
ACF asked States to describe, at a minimum, whether they enforce health 
and safety requirements through routine unannounced site inspections, 
through background screenings, and/or by requiring providers to report 
serious injuries that occur while a child is in care.  Six States submitted 
descriptions of enforcement policies that lacked routine unannounced site 
inspections, and two States lacked a requirement to report serious injuries.  
ACF did not report to us whether it required these States to incorporate 
such oversight into their monitoring procedures before they could receive 
CCDF block grant funding. 
   
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CONCLUSION AND RECOMMENDATIONS 
Legislation governing the CCDF program  allows States to establish their 
own requirements related to (1) the prevention and control of infectious 
diseases, (2) building and physical premises safety, and (3) minimum  
health and safety training.  States complied with the Federal requirement 
to have health and safety requirements for licensed child care providers in 
three basic areas.  However, States requirements for monitoring licensed 
providers did not always meet ACFs recommendations for background 
screenings and the recommended National Standards for unannounced 
inspections. In the States we reviewed, monitoring was not conducted in 
accordance with the States own requirements.  ACF did little to monitor 
how States were overseeing CCDF providers.   
Many of our concerns are addressed in ACFs NPRM issued on  
May 20, 2013. We recommend that ACF consider the findings and 
recommendations of this report when finalizing the proposed rule.  
Specifically, we recommend that ACF: 
Seek authority to develop health and safety standards and to 
ensure that States requirements meet them 
During the next reauthorization of the CCDBG Act and/or through 
finalizing the proposed rule, ACF should use the recommended National 
Standards to require States to meet minimum health and safety standards 
for all CCDF providers. Only by requiring States to meet these standards, 
either through licensing or through regulation, will ACF be able to protect 
the health and safety of all children in the CCDF program.   
Develop requirements for States to conduct mandatory  
background screenings 
We recognize that ACF has taken steps to encourage States to institute 
comprehensive background screenings; however, some States are likely to 
fall short in this area unless they are required to conduct these checks.  
Mandatory comprehensive background screenings of both licensed and 
license-exempt providers would better ensure that individuals caring for 
vulnerable children did not themselves present risks to the safety and  
well-being of those children. 
Develop requirements for States to conduct periodic  
unannounced inspections 
Periodic unannounced inspections both of licensed and license-exempt 
providers should enable States to better ensure that health and safety 
standards are met by all providers receiving CCDF funds.  ACF could 
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require States to conduct at least two inspections per year of each provider,  
with at least one of the inspections being unannounced.   
Conduct periodic reviews of States compliance with their own 
requirements related to minimum health and safety standards 
To ensure that States monitoring efforts provide for the health and safety 
of all children in licensed settings, ACF should periodically assess States  
compliance with their own monitoring requirements.   
Ensure that State plans comply with health and safety  
requirements, and take action when States do not comply  
We recognize that ACFs review of State plans is an important part in 
ensuring that States comply with statutory requirements.  ACF needs to 
ensure that, as a result of the review, States are brought into full 
compliance with all requirements. 
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
ACF concurred with all five of OIGs recommendations.  ACF stated that 
it has already taken initial steps towards meeting the recommendations 
through its NPRM, which was published on May 20, 2013, and made 
available for public comment through August 5, 2013. 
In response to our first recommendation, ACF proposes to define health 
and safety standards in areas where the regulations were previously silent.  
ACF noted that having a clearly defined minimum standard for State 
health and safety standards would make it much more feasible to monitor 
State compliance with the requirement. 
In response to our second recommendation, ACF states that the NPRM 
requires that States standards include comprehensive criminal background 
checks on child care providers that include use of fingerprints for both 
State checks of criminal history records and FBI criminal history records, 
as well as clearance through child abuse and neglect and sex offender 
registries.  
In response to our third recommendation, ACF stated that although the 
NPRM would add new provisions, such as unannounced onsite monitoring 
of all CCDF providers, it does not specify a frequency of monitoring.  
Despite ACFs recommendation that  child care providers caring for 
children receive an initial onsite monitoring visit and at least one annual 
unannounced onsite monitoring visit, the rules will not meet the National 
Standards until periodic unannounced inspections are required in every 
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State. ACF stated that it specifically requested public comment regarding 
whether this recommendation should become a requirement. 
In response to our fourth recommendation, ACF stated that it is exploring 
options to conduct periodic reviews of States compliance.  ACF hopes to 
build on OIGs approach and experience in conducting this study. 
In response to our fifth recommendation, ACF stated that it uses the 
biennial CCDF State Plans to ensure compliance with health and safety 
requirements.  ACF went on to say that it has strengthened its internal 
control procedures for reviewing the FY 20142015 Plans by establishing 
a new validation checklist to ensure all States comply with CCDF 
requirements. 
The full text of ACFs comments is provided in Appendix C.   
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APPENDIX A 
Point Estimates and Confidence Intervals Based on Case File 
Reviews 
We calculated confidence intervals for key data points for the selected 
States monitoring activities.  The sample sizes, point estimates, and  
95-percent confidence intervals are given for the each of the following:  
 
Table A-1: Confidence Intervals for States Noncompliance in Conducting 
Unannounced Inspections  
Unannounced   Sample  Point  95-Percent 
Monitoring Size  Estimate  Confidence  
State 
Inspection  (percentage)   Interval 
Requirements 
California  Every  5 years   125  n/a  n/a 
Every 4 months for centers;  
Florida   every 6 months for family   61  10.3%   3.5%17.2%  
homes 
Illinois  Annually  125  81.6%   75.9%87.2%  
Ohio  Annually  125  25.6%   18.6%32.6%  
Annually for centers; 
Texas   every 2 years for family   125  0.4%   0.1%3.0%  
homes 
Source:  OIG analysis of State data and documents related to inspection requirements and compliance, 2012. 
 
 
Table A-2: Confidence Intervals for States Deficiencies  
Sample  Point  95-Percent 
Data Element 
Size  Estimate  Confidence Interval 
Description  
(percentage) 
Providers cited for at least 
561  62.5%   58.1%66.7%  
one deficiency 
Providers cited for more 
561  11.1%   8.7%13.5%  
than 10 deficiencies 
Providers cited for at least 
one deficiency  related to  561  22.3%   18.8%25.9%  
background screenings 
Source:  OIG analysis of State data and documents related to inspection requirements and compliance, 2012. 
 
 
 
   
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Table A-3: Confidence Intervals for States Compliance Conducting 
Background Screening Reviews  
Inspection Types 
During Which  Point  95-Percent 
Sample 
State  Monitoring of   Estimate  Confidence  
Size 
Background Screening  (percentage)   Interval 
Is Required 
Prelicensing inspections,  
annual/random/5-year 
California  inspections,   125  7.5%   3.5%11.4%  
followup inspections (if 
pertinent)  
License renewal inspections 
(all individuals), 
Florida   61  11.0%   4.1%17.8%  
routine inspections (new  
employees)  
Every unannounced annual 
Illinois   125  13.1%   7.3%18.9%  
inspection  
All inspections except 
Ohio   inspections for a specific  125  8.4%   4.0%12.9%  
purpose  
Texas  Any  inspection  125  20.3%   13.8%26.9%  
Source:  OIG analysis of State data and documents related to  compliance with requirements for  monitoring of  
background screening, 2012. 
 
   
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APPENDIX B 
State-Reported Specific Requirements 
Table B-1:  Background Screening Sources for Licensed Center-Based 
Providers 
Background Screening Type  
State    State Criminal  FBI Child Abuse   Registry Sex Offender  Registry Other  
Alabama   X    X   
Alaska   X  X  X  X   
Arizona   X  X       
Arkansas  X  X  X   
California   X  X  X  X   
Colorado   X    X  X   
Connecticut  X  X  X   
Delaware   X  X  X  X   
District of Columbia  X  X  X  X   
Florida  X  X  X  X   
Georgia   X  X       
Hawaii   X  X  X  X   
Idaho   X  X  X  X   
Illinois  X  X  X  X   
Indiana   X  X  X  X   
Iowa   X  X  X  X   
Kansas   X  X  X   
Kentucky   X    X  X   
State Central Registry if the individual discloses or it becomes known that the individual is recorded on the State central  
Louisiana   X       
registry. 
Maine  X    X    Motor vehicle records.  
Maryland   X  X  X   
Massachusetts   X    X   
Michigan   X  X  X  X  FBI fingerprint background checks are  required for directors and owners.  
Minnesota   X    X    FBI and juvenile records are reviewed when there is a reasonable  cause. 
Mississippi   X  X  X  X   
Missouri   X    X  X   
Department of Motor Vehicles.  Tribal  checks are conducted if the individual has lived on a reservation within the last  
Montana   X  X  X 
5 years.  FBI checks are conducted only if individual has lived out of State in  the last 5 years. 
Nebraska       X     Adult Protective Services Central Registry. 
Nevada   X  X  X   
New Hampshire  X  X  X  X   
New Jersey   X  X  X  X   
New Mexico   X  X    X  Job references, personal  references. 
New York   X    X    References on each employee. 
North Carolina  X  X  X   
North Dakota   X  X  X  X   
Ohio   X  X       
Oklahoma   X    X  X  Child Abuse Registry check required for owners only.  Other checksChild  Care Restricted Registry. 
Oregon   X  X  X    Sex offenders are identified through criminal background  check. 
Pennsylvania   X  X  X   
Rhode Island   X  X  X   
South Carolina  X  X  X  X   
South Dakota   X    X  X   
Tennessee   X  X  X  X  State Vulnerable Persons Registry. 
Texas   X  X  X  X   
Utah  X  X  X    In Utah the Sex Offender Registry is a  secondary source of information.  Utah  checks the primary  source. 
Vermont  X    X    Adult Abuse Registry.  
Sworn statement disclosing criminal charges and convictions and founded child abuse/neglect complaints inside and  
Virginia   X    X 
outside Virginia. 
Washington   X  X  X  X  FBI fingerprints are currently done on  potential  providers if  they have lived 3 years or less in  the State. 
West Virginia   X  X  X     
Wisconsin   X    X  X  Other professional licenses; child abuse and neglect information maintained by the department; Nurse Aide Registry.  
A prescreening is  conducted using the  Child Abuse Registry in Division of Criminal Investigation (DCI), and if warranted, 
Wyoming       X  X 
a fingerprint check through DCI is required. 
   Total  49  35  45  28   
Source:  OIG survey of States, 2011.  
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Table B-2:  Background Screening Sources for Licensed Family Home Child 
Care Providers 
Background Screening Type  
State    State Criminal  FBI Child Abuse   Registry Sex Offender  Registry Other  
Alabama   X  X  X     
Alaska   X  X  X  X   
Arizona   X  X  X   
Arkansas  X  X  X  X   
California   X  X  X  X   
Colorado   X    X  X   
Connecticut  X  X  X   
Delaware   X  X  X  X   
District of Columbia  X  X  X  X   
Florida  X  X  X  X   
Georgia   X  X  X   
Hawaii   X  X  X  X   
Idaho   X  X  X  X   
Illinois  X  X  X  X   
Indiana   X  X  X  X  FBI background check is required for the licensee only.  
Iowa   X    X  X  May check dependent adult abuse registry. 
Kansas   X    X   
Kentucky   X    X  X   
Louisiana   X         
Maine  X    X    Bureau of Motor Vehicles  check. 
Maryland   X  X  X   
Massachusetts   X    X   
FBI fingerprint background checks are  required for providers.  State background checks are required for all 
Michigan   X  X  X  X 
employees and household members 18 years and older. 
Minnesota   X    X    FBI and juvenile records are reviewed when there is a reasonable  cause. 
Mississippi   X  X  X  X   
Missouri   X    X  X   
Department of Motor Vehicles.  Tribal  checks are conducted if the individual has lived on a reservation within the  
Montana   X  X  X 
last 5 years.  FBI checks are conducted  only if individual has lived out of State in the last 5 years. 
Nebraska       X     Adult Protective Services Central Registry. 
Nevada   X  X  X   
New Hampshire  X  X  X  X   
New Jersey       X  Criminal conviction  self-disclosure.  
New Mexico   X  X  X   
New York   X    X  References. 
North Carolina  X  X  X   
North Dakota   X  X  X  X   
Ohio   X  X       
Child Abuse Registry check required for owners and adults signing the application only.  Other  checksChild Care  
Oklahoma   X    X  X 
Restricted Registry.  
Oregon   X  X  X    Sex offenders are identified through criminal background  check. 
Pennsylvania   X  X  X   
Rhode Island   X  X  X   
South Carolina  X  X  X  X   
South Dakota   X  X  X  X   
Tennessee   X  X  X  X  State Vulnerable Persons Registry. 
Texas   X    X  X   
Utah  X  X  X   
Vermont  X    X    Adult Abuse Registry.  
Sworn statement disclosing criminal charges and convictions and founded child abuse/neglect complaints inside  
Virginia   X    X 
and outside Virginia. 
Washington   X  X  X  X  FBI fingerprints are currently done on  potential providers if  they have lived 3 years or less in  WA. 
West Virginia   X  X  X  X   
Other professional licenses; child abuse and neglect information maintained by the department; Nurse Aide 
Wisconsin   X    X  X 
Registry. 
A prescreening is  conducted using the  Child Abuse Registry  in Division of Criminal Investigation (DCI), and if 
Wyoming       X  X 
warranted, a fingerprint check through DCI is required. 
   Total  48  33  48  28   
Source:  OIG survey of States, 2011.  
 
   
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Table B-3:  Types of Individuals Subject to Background Screenings in Licensed 
Center-Based Child Care Providers 
Individual Type  
 aff  on
State    Directors  Owners hild Care St ransportati  Janitorial Other  
C T
Alabama   X  X  X  X  X   
Alaska   X  X  X  X  X  Individuals specified in Alaska State Code 7 AAC 10.900(b). 
Arizona   X  X  X  X  X   
Arkansas  X  X  X  X  X   
California   X  X  X  X    Any person who provides care and  supervision. 
Colorado   X    X  X  X   
Connecticut  X  X     
Delaware   X  X  X  X  X   
District of Columbia  X  X  X  X  X   
Florida  X  X  X  X  X   
Georgia   X    X  X  X   
Hawaii   X  X  X      Any individuals used to meet  the staff/child ratios. 
Idaho   X  X  X  X  X  All individuals 13 and older who have direct contact with children.  
Illinois  X    X  X  X  Any person who has unsupervised access to children. 
Indiana   X    X  X  X   
Anyone used to meet the staff/child ratio; anyone with access to, or left alone  with, child; anyone 
Iowa  
X  X  X  14 or older living in the facility. 
Kansas   X  X  X  X  X  All individuals over 10 years of  age residing or working at the facility. 
Kentucky   X  X  X  X  X   
Louisiana   X  X  X  X  X  Each paid and nonpaid staff person. 
Maine  X  X  X  X     
Maryland   X  X  X  X     
Massachusetts   X  X  X  X    Interns and anyone with the potential for unsupervised contact with children.  
Michigan   X  X  X       
Minnesota   X  X  X       
Mississippi   X  X  X  X  X   
Missouri   X  X  X  X  X   
Background  checks required for administrative staff, aides, kitchen staff, and all persons over the 
Montana  
X  X  X  X  X  age of 18 who reside or stay at the facility regularly or frequently. 
Nebraska   X  X  X  X  X  Owners only if working directly with children. 
Nevada   X  X  X  X     
New Hampshire  X  X  X      All child care personnelanyone who has regular/daily contact with children.  
New Jersey   X  X  X  X  X   
New Mexico   X  X  X  X     
New York   X  X  X  X  X  All employees who have regular and  substantial contact with children. 
North Carolina  X  X  X  X  X   
North Dakota   X  X  X  X  X  All positions require at least some level of background check. 
Ohio   X  X  X  X  X  All center staff. 
Oklahoma   X  X  X  X    Others with unsupervised access to children. 
Oregon   X  X  X  X  X   
Pennsylvania   X  X  X      An employee who works with children and is used to meet staff/child ratio must have clearances. 
Rhode Island   X  X  X  X  X  Consultants and anyone coming in regular contact with children. 
South Carolina  X    X  X  X  Owners are required to undergo background screening if  they  work within the facility. 
Owners who work at the center; employees who have contact with children  or who are used  to meet 
South Dakota  
X  X  X      the staff/child ratio.  
Tennessee   X  X  X  X    Based upon determination of any individuals access to children. 
A name-based criminal history check and a Department of Family and Protective Services Central 
Texas  
X  X  X  X  X  Registry check for  each person employed at the operation. 
Utah  X  X  X  X  X  Assistant Directors, substitutes, and members of the governing body. 
Vermont  X  X  X  X     
Anyone involved in the day-to-day operation or alone with, in control of, or  supervising one or more  
Virginia  
X  X  X      children.  
All staff must have a background check, and the person applying for the license must have a 
Washington  
X  X  X  X  X  background check. 
West Virginia   X  X  X  X  X   
Wisconsin   X  X  X  X  X  Any  person who meets the statutory  definition of a caregiver. 
Wyoming   X  X  X  X  X   
   Total  51  44  51  43  33   
Source:  OIG survey of States, 2011.  
 
   
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   25   
   
Table B-4:  Types of Individuals Subject to Background Screenings in Licensed 
Family Home Child Care Providers 
Individual Type  
r  n 
be g ie 
State   Provider mily Mem ose LivinResidenc Other  
a h
F T
Alabama   X    X  Adult family members; and adults living in residence. 
Alaska   X  X  X  Individuals specified in Alaska State Code 7 AAC 10.900(b). 
Arizona   X  X  X   
Arkansas  X  X  X   
California   X  X  X  Any person who provides care and  supervision. 
Colorado   X  X   
Connecticut  X  X  X   
Delaware   X  X  X  Volunteers,  substitutes, and others with direct access. 
District of Columbia  X  X  X   
Florida  X  X  X  Volunteers working 10 or more hours per month in home or left to supervise children. 
Georgia   X  X  X   
Hawaii   X  X  X  All household members over 18 years old. 
Idaho   X  X  X  All individuals 13 and older who have direct contact with children.  
Illinois  X  X  X  Members of the household who are age 13 years or older. 
Indiana   X  X  X  Volunteers. 
Iowa   X  X  X  Substitutes; anyone over 14 living in the residence. 
Kansas   X  X  X  All individuals over 10 years of  age living, working, or volunteering at  the facility. 
Kentucky   X  X  X   
All adults living at  the providers residence or employed by the provider in their home or on  their  
Louisiana  
X  X  X  property. 
Maine  X  X  X  Anyone frequenting the home.  
Maryland   X  X  X  Paid substitutes and the additional adult if caring for three to  four infants. 
Massachusetts   X  X  X  For individuals regularly on the premises. 
Michigan   X  X  X   
Minnesota   X  X  X  When there is reasonable cause, individuals who may have unsupervised access to  children.  
Mississippi   X  X  X   
Missouri   X  X  X   
Background  checks required for administrative staff, aides, volunteers, kitchen  staff, and all persons 
Montana  
X  X  X  over the age of 18  who reside or stay at the facility regularly or frequently. 
Nebraska   X  X   
Nevada   X  X  X   
New Hampshire  X  X  X  Anyone who has regular/daily contact with children. 
New Jersey   X  X   
New Mexico   X  X  X  Any person over the age of 18 and spouse of the provider. 
New York   X  X  X  Volunteers. 
North Carolina  X  X  X   
North Dakota   X  X  X   
Ohio   X  X  X   
Oklahoma   X  X  X   
Oregon   X  X  X   
Household members age 18 and over who reside in  the family home 30 or more days in  the calendar 
Pennsylvania  
X  X  year. 
Rhode Island   X    X  Anyone having routine contact with children (volunteers, drivers, consultants). 
South Carolina  X  X  X   
South Dakota   X  X    Any adult living in the home who has contact with the children in  care. 
Tennessee   X  X  X   
Texas   X  X  X  Each household member who is 14 years or older and who will regularly or frequently be present. 
Utah  X  X  X  Substitutes and volunteers. 
Vermont  X  X  X   
Virginia   X  X  X   
Washington  X  X  X   
West Virginia   X  X  X   
Any  volunteer, substitute or other person meeting the  definition of a "caregiver" is required to have a 
Wisconsin  
X  X  X  caregiver background check. 
Wyoming  X  X  X   
  Total  51  44  51   
Source:  OIG survey of States, 2011.  
 
   
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   26   
   
Table B-5: Unannounced Inspections for Licensed Center-Based Child 
Care Providers 
Interval  
State   Annually   Every 6Months or More quentFre Other Frequency 
Alabama       Every 2 years. 
Alaska   X    All complaint investigation inspections are unannounced. 
Arizona   X    To follow up on complaints and previous compliance issues. 
Arkansas  X   
California       Not less than once every 5 years. 
Colorado       Inspections occur, on average, every  2 years. 
Connecticut      At least every 2 years. 
Delaware   X    As needed  to  inspect condition of the facility. 
District of Columbia  X    Additional unannounced visits are made as part of a followup to a complaint. 
Florida    X 
Georgia    X   
Hawaii   X    To conduct complaint investigations and to monitor as a result of  corrective action plans. 
Idaho   N/A   
Illinois  X   
Indiana   X     
Iowa   X   
Kansas   X   
Kentucky   X    At time of application. 
Louisiana   X    During compliance visits, after construction or renovation, and in response  to complaints. 
Maine  X     
Maryland   X   
Massachusetts       Complaint investigation or monitoring. 
Michigan   X     
Minnesota       Every 2 years, and  unannounced visits are made for licensing complaint investigations. 
Mississippi    X  Complaint investigations. 
Missouri    X   
Montana   X    Facilities may receive inspections every 1-3 years depending on the type of license. 
Conducted annually for centers licensed for fewer than 30 children; every 6 months for those licensed for  
Nebraska   X  X 
30 or more children. 
Nevada    X   
New Hampshire  X    More often if needed (e.g.,  in response to a complaint).  
New Jersey   X     
New Mexico     X 
New York       As needed  for monitoring, complaints, and child  abuse reports. 
North Carolina  X   
North Dakota   X    At least annually, more frequently if concerns  exist. 
Ohio   X    At the receipt of  complaints and for monitoring as  needed. 
Oklahoma     X 
Oregon   X   
Pennsylvania       Each licensor must conduct six allocated unannounced inspections each year. 
Rhode Island     X  To follow up on any complaints received against a provider. 
South Carolina    X  Investigations of complaints. 
South Dakota   X    Additional visits are made to verify correction of noncompliance or to address complaints. 
Tennessee    X   
Texas   X    Other inspections can be announced or unannounced. 
Utah  X    Followup inspections and complaint investigations are conducted mostly unannounced as  needed. 
Vermont  X    When a complaint is received. 
Virginia     X 
Washington       Followup visits are  made to respond  to complaints and to ensure  that compliance issues have been resolved. 
West Virginia   X     
For child care  centers licensed  to care for 50 or fewer children or operating part-day programs at least  
Wisconsin  X  X  1 unannounced visit per year is  conducted.  For full-day child care programs licensed to care for  51 or more 
children at least 2 unannounced visits per year are conducted.  
Wyoming  X     
   Total  29  14   
Source:  OIG survey of States, 2011. 
 
   
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   27   
   
Table B-6:  Unannounced Inspections for Licensed Family Home Providers 
Interval  
s 
h
State   nually   6 MontMore quent Other Frequency 
An ry or Fre
e
v
E
Alabama       Every 2 years. 
Alaska   X    All investigations inspections are unannounced as well. 
Arizona   X   
Arkansas    X  Unannounced visits three times per year. 
California       Not less than once every 5 years. 
Colorado       Visits occur, on  average, every 2 years. 
Connecticut      One-third of licensed family day care homes must be inspected annually. 
Delaware   X   
District of Columbia  X    Additional unannounced visits are made as part of a followup to a complaint. 
Florida    X  Does not include unannounced complaints and unannounced inspections. 
Georgia     X  Additional visits are made if necessary.  
Hawaii   X    For complaint investigations and  for monitoring as  a result of corrective action plans. 
Idaho   N/A     
Illinois  X   
Indiana       Every other year; alternates with the announced visits. 
Iowa       Monitoring target of 40%. 
Kansas   X   
Kentucky   X    At time of application. 
Louisiana   N/A     
Maine  X     
Maryland   X   
Massachusetts       Complaint investigation or monitoring. 
Michigan       10% of  family homes are inspected at time of  renewal. 
Minnesota       County agencies typically make unannounced visits to conduct investigations. 
Mississippi    X  Complaint investigations. 
Missouri    X   
Montana       Required to inspect 20 percent of  all family and group child care providers annually. 
Nebraska   X     
Nevada    X   
New Hampshire  X    More often if needed (e.g.,  in response to a complaint).  
New Jersey       Unannounced complaints, monitoring, and reinspections. 
New Mexico   X    Follow up to deficiencies. 
New York       As needed  for monitoring, complaints, and child  abuse reports. 
North Carolina  X   
North Dakota   X    At least annually, more frequently if concerns  exist. 
Ohio   X   
Oklahoma     X 
Oregon       Complaint investigation; compliance verification  
Inspections are done on a random sample basis, upon  complaint, at  the request of  the operator, or for 
Pennsylvania      
correction of regulatory violations. 
Rhode Island       Once every 2 years and as a part of  followup when a complaint is received. 
South Carolina    X  Investigations of complaints. 
Once every 2 years with additional visits to  ensure correction of noncompliance or to address 
South Dakota      
complaints. 
Tennessee     X  Each agency receives a minimum of four to six unannounced visits each year. 
Texas       Once every 2 years; frequency is based on compliance history.  
All necessary followup inspections and complaint investigations are conducted mostly unannounced  
Utah  X 
as needed. 
Vermont      Every 3 years and when a complaint is received. 
Virginia     X 
Washington       To respond to complaints and to  ensure that compliance issues have been resolved. 
West Virginia   X     
Wisconsin  X     
Wyoming     X   
   Total  19  10   
Source:  OIG survey of States, 2011.   
   
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APPENDIX C 
Agency Comments 
 
   
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Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   30   
   
 
   
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   31  Page4 
Again, ACF apprec:iales lhe opportunity to provide comments on the draft repon and welcomes 
any further qDestiODs that OIG may have regarding these issues. Please direct my follow-up 
inquines to our Office of Legislative Affairs and Budget OIG liaison, Scott Logan at (202) 401 
4529. 
Sill(erely, 
GeG~~ge H. Sheldon 
Aotrng Assistant Secretary 
tcr Children and Families 
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)  32   
   
ACKNOWLEDGMENTS 
This report was prepared under the direction of Brian T.  Whitley, Acting 
Regional Inspector General for Evaluation and Inspections in the Kansas 
City regional office.   
Teresa Dailey served as the project leader for this study.  Other Office of 
Evaluation and Inspections staff from the Kansas City regional office who 
conducted the study include Brian T.  Pattison and Dennis Tharp.  Central 
office staff who provided support include Kevin Farber, Christine Moritz, 
Debra Roush, Talisha Searcy, and Sherri Weinstein.  Office of Counsel to 
the Inspector General staff who provided support included 
Diana Merelman. 
Child Care and Development Fund:  Monitoring of Licensed Child Care Providers (OEI-07-10-00230)   33   
   
Office of Inspector General
http://oig.hhs.gov  
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as  
amended, is  to protect the integrity of the Department of  Health and Human Services  
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statutory mission  is  carried  out through  a nationwide network  of  audits, 
investigations, and inspections conducted by the  following operating components: 
Office of Audit Services 
The Office  of  Audit Services  (OAS) provides auditing services  for HHS, either by  conducting  
audits  with its own audit resources or by  overseeing  audit work done by others.  Audits  
examine the performance of HHS programs and/or its grantees and contractors in carrying  
out their respective responsibilities and are intended  to provide independent assessments of 
HHS programs and operations.  These assessments help reduce waste, abuse, and  
mismanagement and promote economy and efficiency  throughout  HHS. 
Office of Evaluation and Inspections 
The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
HHS, Congress, and the public with timely, useful, and reliable information on significant 
issues.  These evaluations focus on preventing fraud,  waste, or abuse  and promoting  
economy, efficiency, and effectiveness of departmental programs.  To promote impact, OEI 
reports also present practical recommendations for improving program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative investigations  
of  fraud and misconduct  related to HHS programs, operations, and beneficiaries.  With 
investigators working in all 50 States and the District of Columbia, OI  utilizes its resources 
by actively  coordinating with the Department  of Justice  and other Federal, State, and local 
law enforcement authorities.  The investigative efforts of OI often lead to  criminal 
convictions, administrative sanctions,  and/or  civil monetary  penalties.  
Office of Counsel to the Inspector General 
The Office of Counsel to the  Inspector  General (OCIG) provides general legal services to 
OIG, rendering  advice and opinions on HHS programs and operations and  providing all  
legal support for OIGs  internal operations.  OCIG represents  OIG in all civil and 
administrative fraud and abuse cases involving HHS programs,  including False Claims Act, 
program exclusion, and civil monetary penalty cases.  In  connection with these cases, OCIG 
also negotiates and monitors corporate integrity agreements.  OCIG renders advisory 
opinions, issues compliance program  guidance, publishes fraud alerts, and provides other  
guidance  to  the health care industry concerning the anti-kickback statute and other  OIG  
enforcement authorities.