Report No. 2008-03
January 2008
Complete Audit Report
More Could Be Done to Protect Children at Child Care Providers
The Department of Health and Senior Services (DHSS) has responsibility for the licensing of certain family day care homes, group day care homes, and child day care centers. Because of the importance of ensuring the safety of children cared for by day care providers, we followed up on selected recommendations in our 2002 report titled Child Care Facilities Inspections and Licensing (Report no. 2002-52), and related issues. Specific review objectives included determining whether (1) all children are subject to licensing requirements set forth in state law and/or DHSS regulations, (2) improvements are needed in the department's oversight of illegal daycare providers, and (3) improvements are needed in the department's oversight of complaint monitoring and legal referral process.
Exempting related children may increase risk of some children at licensed day cares
Some children may be at risk while being cared for in licensed day care facilities. Family day care home providers licensed to care for up to 10 children and group day care homes licensed to care for 11 to 20 children may actually be caring for an unlimited number of children. This situation has occurred because DHSS regulations have not included related children in the number of children in care. Children may also be at risk because providers caring for related children have not been subjected to other licensing regulations. As a result, children may have experienced increased exposure to illnesses and public records may not always exist of physically punished children that are related to providers. Department officials are considering changes that would ensure all children are subject to state licensing regulations that apply to day care providers. (See page 7)
Improvements needed to reduce risk at illegal providers
Some children may also be at risk at illegal day care providers because (1) periodic follow-up visits have not occurred to ensure illegally operating providers become compliant, or remain compliant with regulations, and (2) complaint investigation procedures have not always been adequate. In addition, penalties imposed by the General Assembly have not always deterred illegal providers. (See page 12)
System information not always complete or accurate, and management reports lacking
Our review of data obtained from the complaint tracking system for complaints received July 2005 through June 2007, showed some incomplete complaint investigations and complaints with incorrect data entered into certain data fields. We also found officials have not made use of the complaint tracking system to produce periodic management reports that could be used to help manage and evaluate the effectiveness of the complaint program. (See page 19)
Complaints not always completed in timely manner
Our review of complaints disclosed staff did not complete 42 percent of complaint investigations within 30 days. For example, we found 542 (20 percent) of 2,722 complaints took more than 60 days to complete, 277 (10 percent) complaints took over 90 days to complete, and 60 (2 percent) completed during the 2 years reviewed took more than 6 months to complete. Department procedures generally require complaint investigations to be completed within 30 days. (See page 20)
Improvements needed in legal referral process
Our review of 92 cases referred to the department's legal office disclosed that the department took action on the majority of those cases. However, we found some cases had not been resolved in a timely manner. As a result, some providers continued to operate with no disciplinary action, and officials did not take action on two cases because the cases had been outstanding for an inordinate length of time. We also found the department had not established written goals for the timeliness of the administrative penalty process. (See page 21)
Complete Audit Report
Missouri State Auditor's Office
moaudit@auditor.mo.gov
