Public Health Committee

JOINT FAVORABLE REPORT

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To require the Department of Public Health to conduct annual inspections of day care centers, group day care homes and family day care homes.

RESPONSE FROM ADMINISTRATION/AGENCY:

Ellen Blaschinski, Chief, Regulatory Services Branch, DPH: SB 373 mandates DPH to complete annual inspections of licensed child day care programs. Currently the Department does not have the resources to meet this inspection frequency. Funding for the bill has not been allocated to DPH in either the enacted budget or the Governor's budget and passage of this bill would result in an unfunded mandate to DPH.

Licensed family day care homes are currently inspected every three years and child day care centers and group day homes are inspected once every two years. Current resources enable DPH to meet the inspection frequency of every third year for family day care homes and every other year for child day care centers and group day homes.

Elaine Zimmerman, Executive Director, Commission on Children: Connecticut has excellent standards in health and safety for our child care settings, ranking 10^th in the nation by National Association of Child Care Resource and Referral Agencies. However, our implementation and oversight of these standards ranks 49^th in the nation. There are no written guidelines for health and safety regulations to assure reliability, fidelity to goal or consistency in implementation.

The Child Health and Development Institute of Connecticut corroborates our low performance. They found serious noncompliance in health and safety regulations. The highest frequencies of noncompliance were in the areas of outdoor safety, indoor safety, indoor health, documentation of child and staff health records, emergency preparedness and medication administration.

Establishing regulatory oversight advances program quality for all children. We suggest the following language be added to Section 1 (a) Line 3-5:

Also, written guidelines should be made available for inspectors, so interpretative differences can be avoided.

NATURE AND SOURCES OF SUPPORT:

Jillian Gilchrest, Early Care Policy and Education Policy Analyst, Connecticut Association for Human Services (CAHS): CAHS promotes family economic security strategies that empower low-income working families to achieve financial independence. CAHS also host a forum for center-based and family childcare providers that are publicly and privately funded. From speaking with childcare providers across the state, we firmly believe that Connecticut's childcare providers want to be in compliance but they struggle to find accurate information on what is expected of them as it pertains to licensing.

We urge the committee to amend the bill to include:

Judith Meyers, PhD; President & CEO, Child Health and Development Institute of CT (CHDI): CHDI's mission is to promote primary and preventive health and mental health care for all children in Connecticut with a particular focus on the underserved. To better understand the importance of health issues in early and education settings, we provided a grant to researchers at Yale School of Nursing and Yale School of Medicine to conduct a study for the results of unannounced licensing inspections in licensed child care centers and family day care homes.

Our study offered the following recommendations:

We also recommend producing sound interpretation guides and procedures manuals to help providers and inspectors apply the rules correctly, fairly and consistently. Along with this, effective provider support services should be available to promote provider knowledge, compliance, and accountability. Finally, DPH inspections should be reliable, consistent in measurement, and valid, measures are actually measuring what we want to know.

Marjorie S. Rosenthal, M.D., Yale University School of Medicine: Along with Angela Crowley, Associate Professor at the Yale School of Nursing, I conducted an analysis of the unannounced licensing inspections in licensed child care centers and family day care homes. We examined reports for over 600 licensed child care centers and over 700 family day care homes, together which serve approximately 44,000 children, ages 0-5 years old.

We found that 90% of child care sites are in compliance with two-thirds of regulations. However, child care center were non-compliant in indoor safety, outdoor safety, indoor health, documentation, emergency preparedness, and administration. Family child care homes were non-compliant in indoor safety, documentation, emergency preparedness, and administration of medications.

The bill addresses many of these areas by increasing the frequency of inspections. However, the bill does not address improving quality of child care sites. Child care sites with low compliance were located in areas with lower median income or had less educated providers or had no access to trained health consultants. We need to provide support services for child care providers to improve their knowledge and ability to comply with regulations.

Tina Pascoe, R.N., Synergy Health Care Services: I am a registered nurse and hold a J.D. with a concentration in healthcare. During the past 6 years, I have been employed as a child care health consultant in various areas of the state: New Haven, Norwalk, Stamford, Waterbury, and Hartford. The annual inspection requirement in this bill is the first step in promoting quality.

However, the lack of written guidelines for licensing specialists presents a significant problem for childcare providers who are striving to maintain a healthy and safe program for young children. Because of the inconsistency of expectations and interpretation of child care regulations among inspectors, child care providers find the process of inspections and efforts to improve health and safety, ambiguous, frustrating, and challenging.

Finally, adoption of a best practice medication administration training curriculum and system of dissemination as well as health consultation are all vital elements to ensure health and safety in child care sites.

NATURE AND SOURCES OF OPPOSITION:

None presented.