Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

CHILD CARE AND 

DEVELOPMENT FUND: 

MONITORING OF LICENSED 

CHILD CARE PROVIDERS 

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 State’s 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 ACF’s 

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 ACF’s 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 ACF’s 

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 ACF’s 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 State’s 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 State’s 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 provider—defined as a provider licensed or 

otherwise authorized to provide child care services in a 

nonresidential setting, 

	 group home child care provider—defined as two or more 

individuals who provide child care services in a private residence 

other than the child’s residence,4 

	 family home child care provider—defined as one individual as the 

sole caregiver in a private residence other than the child’s 

residence,5 and 

	 in-home child care provider—defined as one individual who 

provides child care services in the child’s 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 providers—center-based 

providers and family home providers—together 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 2010–2011: 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 Administration’s (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 State’s 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 2010–2011. 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 HRSA’s 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 2010–2011. Accessed 

at http://www.acf.hhs.gov/ on February 1, 2011. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 3 
 

 

 

 

 

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 children’s 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 State’s 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 ACF’s 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 2012–2013 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 2010–2011. 

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 2012–2013. 

Accessed at http://www.acf.hhs.gov/ on October 15, 2012. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 5 
 

 

 

 

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 children’s 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 Children’s 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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 7 
 

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 

State’s 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 State’s licensing and health and safety 

requirements, (2) the results of selected States’ monitoring activities, and 

(3) ACF’s 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 

State 

Licensed 

Center-Based 

Providers 

Licensed 

Group 

Home 

Providers 

Licensed 

Family 

Home 

Providers 

Total 

Licensed 

Providers 

OIG Sample 

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 Florida’s 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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 11 
 

 

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 providers—one 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 

Safety 

Requirement 

State A State B 

Prevention 

and Control 

of Infectious 

Disease 

1. Child immunizations 

2. Physical exam for children 

3. Physical exam for providers 

4. Tuberculosis check for providers 

5. Health care plan 

1. Child immunizations 

2. Physical exam for children 

3. No admittance if serious transmissible 

infection or communicable 

diseases present 

Building and 

Physical 

Premises 

Safety 

1. Fire inspection 

2. Building inspection 

3. Environmental health inspection 

4. Safe sleep policy 

5. Smoking ban 

6. Transportation policy 

1. Fire inspection 

2. Building inspection 

3. Lead-safe or lead-free facility 

Health and 

Safety 

Training 

1. CPR certification every 12 months 

2. First aid certification every 36 

months 

3. Twelve annual hours of training 

4. Bloodborne pathogens training 

within 6 months of initial hire 

1. Current CPR certification 

2. Current first aid certification 

3. Completion of medication 

administration training by at least one 

center employee present 

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 

ACF’s 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 

ACF’s 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 ACF’s 

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 ACF’s 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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 13 
 

 

 

 

 

 

Table 3: Number of States Checking Background Screening Sources 

Source for Background Screening Number of States 

Checking Source for 

Center-Based 

Providers 

Number of States 

Checking Source for 

Family Home 

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 California’s 

requirement for an unannounced inspection every 5 years. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 14 
 

 

 

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 

State 

Requirements for 

Unannounced Monitoring 

Inspections 

Percentage of 

Missed Inspections 

FYs 2010–2011 

California Every 5 years n/a 

Florida Every 4 months for centers; 

every 6 months for family homes 10.3% 

Illinois Annually 81.6% 

Ohio Annually 25.6% 

Texas Annually for centers; 

every 2 years for family homes <1% 

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 “Safety—Areas 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). 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 15 
 

 

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 

State Inspections During Which Monitoring 

of Background Screening Is Required 

Percentage of 

Missing Reviews 

FYs 2010–2011 

California 

Prelicensing inspections, 

annual/random/5-year inspections, 

followup inspections (if pertinent) 

7.5% 

Florida License renewal inspections (all individuals), 

routine inspections (new employees) 11.0% 

Illinois Every unannounced annual inspection 13.1% 

Ohio All inspections except inspections for a specific 

purpose 

8.4% 

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 2010–2011), ACF did not require 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 16 
 

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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 17 
 

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 ACF’s 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 ACF’s 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 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 18 
 

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 ACF’s 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 OIG’s 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 ACF’s 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 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 19 
 

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 OIG’s 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 2014–2015 Plans by establishing 

a new validation checklist to ensure all States comply with CCDF 

requirements. 

The full text of ACF’s comments is provided in Appendix C. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 20 
 

 

 

 

 

 

 

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 

State 

Unannounced 

Monitoring

Inspection 

Requirements 

Sample 

Size 

Point 

Estimate 

(percentage) 

95-Percent 

Confidence 

Interval 

California Every 5 years 125 n/a n/a 

Florida 

Every 4 months for centers; 

every 6 months for family 

homes 

61 10.3% 3.5%–17.2% 

Illinois Annually 125 81.6% 75.9%–87.2% 

Ohio Annually 125 25.6% 18.6%–32.6% 

Texas 

Annually for centers; 

every 2 years for family 

homes 

125 0.4% 0.1%–3.0% 

Source: OIG analysis of State data and documents related to inspection requirements and compliance, 2012. 

Table A-2: Confidence Intervals for States’ Deficiencies 

Data Element 

Description 

Sample 

Size 

Point 

Estimate 

(percentage) 

95-Percent 

Confidence Interval 

Providers cited for at least 

one deficiency 561 62.5% 58.1%–66.7% 

Providers cited for more 

than 10 deficiencies 561 11.1% 8.7%–13.5% 

Providers cited for at least 

one deficiency related to 

background screenings 

561 22.3% 18.8%–25.9% 

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 

State 

Inspection Types 

During Which 

Monitoring of 

Background Screening 

Is Required 

Sample 

Size 

Point 

Estimate 

(percentage) 

95-Percent 

Confidence 

Interval 

California 

Prelicensing inspections, 

annual/random/5-year 

inspections, 

followup inspections (if 

pertinent) 

125 7.5% 3.5%–11.4% 

Florida 

License renewal inspections 

(all individuals), 

routine inspections (new 

employees) 

61 11.0% 4.1%–17.8% 

Illinois Every unannounced annual 

inspection 125 13.1% 7.3%–18.9% 

Ohio 

All inspections except 

inspections for a specific 

purpose 

125 8.4% 4.0%–12.9% 

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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 22 
 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 23 

 

 

 

 

 

 

 

 

 

 

APPENDIX B 

State-Reported Specific Requirements 

Table B-1: Background Screening Sources for Licensed Center-Based 

Providers 

State 

Background Screening Type 

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 

Louisiana X State Central Registry if the individual discloses or it becomes known that the individual is recorded on the State central 

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 

Montana X X X Department of Motor Vehicles. Tribal checks are conducted if the individual has lived on a reservation within the 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 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 checks—Child 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. 

Virginia X X Sworn statement disclosing criminal charges and convictions and founded child abuse/neglect complaints inside 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 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. 

Wyoming X X A prescreening is conducted using the Child Abuse Registry in Division of Criminal Investigation (DCI), and if warranted, 

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 

State 

Background Screening Type 

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 

Michigan X X X X FBI fingerprint background checks are required for providers. State background checks are required for all 

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 

Montana X X X Department of Motor Vehicles. Tribal checks are conducted if the individual has lived on a reservation within the 

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 

Oklahoma X X X Child Abuse Registry check required for owners and adults signing the application only. Other checks—Child 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 X 

Tennessee X X X X State Vulnerable Persons Registry. 

Texas X X X 

Utah X X X 

Vermont X X Adult Abuse Registry. 

Virginia X X Sworn statement disclosing criminal charges and convictions and founded child abuse/neglect complaints inside 

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 

Wisconsin X X X Other professional licenses; child abuse and neglect information maintained by the department; Nurse Aide 

Registry. 

Wyoming X X A prescreening is conducted using the Child Abuse Registry in Division of Criminal Investigation (DCI), and if 

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 

State 

Individual Type 

Directors

Owners

Child Care Staff

Transportation

Janitorial

Other 

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 

Iowa X X X 

Anyone used to meet the staff/child ratio; anyone with access to, or left alone with, child; anyone 

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 

Montana X X X X X 

Background checks required for administrative staff, aides, kitchen staff, and all persons over the 

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 personnel—anyone 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. 

South Dakota X X X 

Owners who work at the center; employees who have contact with children or who are used to meet 

the staff/child ratio. 

Tennessee X X X X Based upon determination of any individual’s access to children. 

Texas X X X X X 

A name-based criminal history check and a Department of Family and Protective Services Central 

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 

Virginia X X X 

Anyone involved in the day-to-day operation or alone with, in control of, or supervising one or more 

children. 

Washington X X X X X 

All staff must have a background check, and the person applying for the license must have a 

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. 
 

 

 

 

Table B-4: Types of Individuals Subject to Background Screenings in Licensed 

Family Home Child Care Providers 

State 

Individual Type 

Provider

Family Member

Those Living in

Residence

Other 

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 

Louisiana X X X 

All adults living at the provider’s residence or employed by the provider in their home or on their 

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 

Montana X X X 

Background checks required for administrative staff, aides, volunteers, kitchen staff, and all persons 

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 

Pennsylvania X X 

Household members age 18 and over who reside in the family home 30 or more days in the calendar 

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 

Wisconsin X X X 

Any volunteer, substitute or other person meeting the definition of a "caregiver" is required to have a 

caregiver background check. 

Wyoming X X X 

Total 51 44 51 

Source: OIG survey of States, 2011. 

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Table B-5: Unannounced Inspections for Licensed Center-Based Child 

Care Providers 

State 

Interval 

Annually 

Every 6Months 

or More

Frequent

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. 

Nebraska X X Conducted annually for centers licensed for fewer than 30 children; every 6 months for those licensed for 

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 

Wisconsin X X 

For child care centers licensed to care for 50 or fewer children or operating part-day programs at least 

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. 

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Table B-6: Unannounced Inspections for Licensed Family Home Providers 

State 

Interval 

Annually 

Every 6 Months 

or More

Frequent

Other Frequency 

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 

Pennsylvania Inspections are done on a random sample basis, upon complaint, at the request of the operator, or for 

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. 

South Dakota Once every 2 years with additional visits to ensure correction of noncompliance or to address 

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. 

Utah X All necessary followup inspections and complaint investigations are conducted mostly unannounced 

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. 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 28 
 

 

APPENDIX C 

Agency Comments 

Child Care and Development Fund: Monitoring of Licensed Child Care Providers (OEI-07-10-00230) 29 
 

 

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 OIG’s 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.