Department of Health and Human Services

Department of Health and Human Services OFFICE OF

INSPECTOR GENERAL

SOME LOUISIANA FAMILY CHILD DAY CARE HOME PROVIDERS DID NOT ALWAYS COMPLY WITH STATE

HEALTH AND SAFETY REQUIREMENTS

Inquiries about this report may be addressed to the Office of Public Affairs at Public.Affairs@oig..

Gloria L. Jarmon Deputy Inspector General

for Audit Services August 2014 A-06-13-00037

Office of Inspector General



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.

Notices

THIS REPORT IS AVAILABLE TO THE PUBLIC at

Section 8L of the Inspector General Act, 5 U.S.C. App., requires that OIG post its publicly available reports on the OIG Web site.

OFFICE OF AUDIT SERVICES FINDINGS AND OPINIONS

The designation of financial or management practices as questionable, a recommendation for the disallowance of costs incurred or claimed, and any other conclusions and recommendations in this report represent the findings and opinions of OAS. Authorized officials of the HHS operating divisions will make final determination on these matters.

EXECUTIVE SUMMARY

The 20 providers that we reviewed did not always comply with applicable State requirements to ensure the health and safety of children.

WHY WE DID THIS REVIEW

The Administration for Children and Families provides Federal grants through several programs, including Head Start and the Child Care and Development Fund (CCDF). In a recent report summarizing the results of 24 audits of Head Start grantees, we described multiple health and safety issues that put children at risk. To determine whether similar health and safety risks exist at childcare providers who received CCDF funding, we audited 20 registered family child day care home providers (providers) who received CCDF funding in Baton Rouge and New Orleans, Louisiana. We conducted this review in conjunction with our review of four child day care centers (report number A-06-13-00036).

The objective of this review was to determine whether providers in Louisiana who received CCDF funds complied with State requirements and standards related to the health and safety of children in their care.

BACKGROUND

The CCDF, authorized by the Child Care and Development Block Grant Act and the Social Security Act, section 418, assists low-income families, families receiving temporary public assistance, and families transitioning from public assistance to obtain childcare so that they may work or obtain training or education. Combined funding for the CCDF program for fiscal year 2012, including the block grant's discretionary fund and the CCDF mandatory and matching funds, was approximately $5.2 billion.

The State's Department of Children and Family Services (State agency) is the lead agency and sponsor of the Child Care Assistance Program (CCAP), which helps low-income families in Louisiana pay for childcare. Parents may select a childcare provider that satisfies the applicable State and local requirements, including basic health and safety requirements.

As the lead agency, the State agency is responsible for registering providers. According to the Child Care and Development Fund Plan for Louisiana FFY [Federal fiscal year] 2012 ? 2013, the State agency registers providers after verifying that applicable requirements are met, including a passed State Fire Marshal inspection, criminal background checks, current certifications for cardiopulmonary resuscitation and first aid training, and a physician's statement of good health.

WHAT WE FOUND

Providers in Louisiana who received CCDF funds did not always comply with applicable State requirements on ensuring the health and safety of children in their care. Specifically, each of the

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20 providers who we reviewed did not comply with at least 1 of the applicable registration requirements, and 7 providers did not comply with required criminal background checks. The State issued disqualification notices to eight providers after we notified them of our results. The State agency's oversight was not adequate to ensure that providers complied with State health and safety regulations.

WHAT WE RECOMMEND

We recommend that the State agency perform periodic onsite visits to providers to ensure compliance with registration and program requirements, including compliance with criminal background checks.

STATE AGENCY COMMENTS AND OUR RESPONSE

In its comments on our draft report, the State agency described actions that it has taken to address our findings. The State agency also said that contractors monitor providers on site. However, the State agency did not provide any documentation to support that the monitoring covered health and safety requirements. In addition, the State agency said that it cannot implement our recommendation because the State is currently transitioning authority over CCDF to another State department. However, the State agency said that it would share the recommendation with the succeeding department.

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TABLE OF CONTENTS

INTRODUCTION ......................................................................................................................1

Why We Did This Review ...............................................................................................1

Objective ..........................................................................................................................1

Background ......................................................................................................................1 Louisiana Childcare Services ...............................................................................2 Related Office of Inspector General Work...........................................................2 Child Care Aware of America..............................................................................2 Administration for Children and Families Proposed Regulations........................3

How We Conducted This Review ....................................................................................3

FINDINGS .................................................................................................................................. 3

Providers Did Not Always Comply With State Registration Requirements....................4 State Requirements...............................................................................................4 Providers Did Not Comply With State Registration Requirements .....................4

Providers Did Not Always Comply With Required Criminal Background Checks ........6 State Requirements...............................................................................................6 Providers Did Not Comply With Required Criminal Background Checks..........6

Provider Disqualifications and Terminations...................................................................6

State Agency Oversight Did Not Ensure That Providers Complied With Health and Safety Regulations ......................................................................................7

RECOMMENDATION ..............................................................................................................7

STATE AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL RESPONSE.............................................................................................................................. 8

OTHER MATTERS....................................................................................................................8

State Requirements ..........................................................................................................8

Providers Had Outdoor Play Areas With Hazardous Conditions ....................................8

Providers Had Indoor Areas With Hazardous Conditions...............................................8

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APPENDIXES A: Audit Scope and Methodology ...............................................................................10 B: Federal and State Requirements..............................................................................11 C: Photographic Examples of Noncompliance With Physical Conditions Requirements .......................................................................15 D: Instances of Noncompliance at Each Family Day Care Home...............................19 E: State Agency Comments .........................................................................................20

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INTRODUCTION

WHY WE DID THIS REVIEW

The Administration for Children and Families (ACF) provides Federal grants through several programs, including Head Start and the Child Care and Development Fund (CCDF). In a recent report summarizing the results of 24 audits of Head Start grantees,1 we described multiple health and safety issues that put children at risk. To determine whether similar health and safety risks exist at childcare providers who received CCDF funding, we audited 20 registered family child day care providers2 (providers) who received CCDF funding in Louisiana.3 We conducted this review in conjunction with our review of four child day care centers (report number A-06-1300036).

OBJECTIVE

Our objective was to determine whether providers in Louisiana who received CCDF funds complied with State requirements related to the health and safety of children in their care.

BACKGROUND

The CCDF, authorized by the Child Care and Development Block Grant Act (CCDBG Act) and the Social Security Act, section 418, assists low-income families, families receiving temporary public assistance, and families transitioning from public assistance to obtain childcare so that they may work or obtain training or education. Combined funding for the CCDF program for fiscal year 2012, including the block grant's discretionary fund and the CCDF mandatory and matching funds, was approximately $5.2 billion.

The CCDBG Act and Federal regulations require the State to maintain a plan that certifies that the State has requirements in State or local law to protect the health and safety of children, and the plan must certify that procedures are in effect to ensure that childcare providers comply with these requirements (42 U.S.C. ?? 9858c(c)(2)(F) and (G) and 45 CFR ?? 98.15(b)(5) and (6)).

In addition, Federal regulations require States to designate a lead agency to administer the CCDF program (45 CFR ? 98.10).

1 Review of 24 Head Start Grantees' Compliance With Health and Safety Requirements (A-01-11-02503, issued December 12, 2011).

2 A "family child day care home" is any place, facility, or home operated by any institution, society, agency, corporation, person or persons, or any other group for the primary purpose of providing care, supervision, and/or guidance of six or fewer children (Louisiana Revised Statutes 46: ?1441.1 A.(4)). Each of the providers in our review was an individual.

3 The 20 providers who we audited received CCDF funds for 64 children from December 18, 2012, through April 30, 2013.

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