Solution: more inspections, better care

By Andrew Garber

At right: Jacob Rediker, left, joins Devon Fitzgerald for a climb at Catherine Morrill, one of only a dozen day-care centers in Maine to be accredited by the National Association for the Education of Young Children.Staff photo by John Ewing

There's no secret to making day-care home safer.

Licensing workers and child-care experts have known the answer for years: frequent inspections.

''Just showing up does more to help the kids than anything,'' says Jim Chaplin, the supervisor of day-care licensing for the state Department of Human Services.

Leading child-care experts agree. Some states, notably Oklahoma, inspect day-care providers several times a year and say there are big payoffs as a result.

Yet Maine is moving in the opposite direction.DHS recently adopted a policy allowing inspectors to visit day-care homes once every two years. Currently the state is required to visit licensed homes annually.

In addition to relaxing the scrutiny of day-care homes, DHS also recently adopted regulations that could lead to homes taking in too many children, licensing inspectors say. That could create additional safety problems.

These steps were taken despite evidence showing that the state already is doing too little to ensure the safety of children in day-care situations.

A five-month examination of child care in Maine by the Portland Press Herald and Maine Sunday Telegram found that DHS has repeatedly failed to take disciplinary action against day-care providers after state investigators uncovered incidents of abuse, neglect and hazardous conditions.

Since 1990, The state has recieved more than 2,000 complaints against day-care operators, yet DHS cannot cite a single case where the department revoked a provider's license.

State day-care inspectors say enormous caseloads prevent them from adequately overseeing 3,600 providers that are operating or applying for permits to open.

DHS currently has nine inspectors. Each has a caseload of about 400 day-care providers, in business or seeking permits to open. The caseloads are four times higher than levels recommended by licensing experts.

Kevin Concannon, the commissioner of DHS, acknowledges his department does not have enough inspectors and should be taking more aggressive action to protect children in day-care facilities. But Concannon says his office is correcting the problems.

For example, he said, the Legislature has given DHS permission to use federal funds to hire two additional inspectors and a full-time supervisor.

Licensing inspectors say the new staff will help, but not cure the problem.

''If you really want to maintain the (inspection) program, you need to double the staff,'' said Paul Bright, a day-care inspector and former supervisor of the program.

COMPARING PROGRAMS IN OKLAHOMA AND MAINE

The National Association for the Education of Young Children, an advocacy group that accredits high-quality day-care providers, recommends similar levels of inspections.

In Oklahoma, which child-care experts consider to have one of the best inspection programs in the country, regulators visit day-care operators at least three times a year.

Kathy Calvin, the supervisor for Oklahoma's inspection program, said she couldn't contemplate doing less.

Her office used to do four inspections a year. When they went down to three inspections ''we saw a significant increase in (violations) and in the number of complaints we received,'' she said. Oklahoma has day-care regulations that are comparable to Maine's.

The state has about twice as many day-care providers - roughly 6,000, compared to 3,200 in Maine. However, Oklahoma has a budget and inspection staff about 10 times the size of Maine's. They have 106 inspectors and a budget of $5.3 million.

Maine currently has nine inspectors and a $577,000 budget. The move to hire two additional inspectors in Maine will help some, but workers will still have caseloads of more than 300 day-care providers each.

Oklahoma inspectors have caseloads of around 60 each.

Maine DHS officials said its licensing department would need a staff of 20 workers to inspect all regulated day-care providers once a year. It would cost an additional $374,186 to hire the people, create additional office space and buy computers.

Calvin said there's a good reason to inspect homes frequently.

''If we go there three times unannounced, at a minimum, it really reduces chances that kids will be put at risk,'' she said.

When inspectors find violations, they require the provider to submit a plan of correction. Frequent follow-up visits are made to ensure compliance.

Inspecting day-care operators several times a year allows licensing workers to identify problems early and either get them to improve, or put them out of business, Calvin said.

The frequent visits also help her office document problems and build strong cases to take disciplinary action if needed, she said.

Calvin said her department closes 40 to 50 day-care operations annually. In 1997, 21 providers had their licenses revoked and 27 were denied license renewals, she said.

In comparison, Maine officials cannot cite a single case where a day-care provider has had a license revoked.

DHS does refuse to renew permits of day-care providers. Yet providers that challenge the state's efforts have always stayed in business, licensing officials admit.

Oklahoma officials said they feel it is important to have strong legal support for the state rules to protect children in day-care situations.

''There are always going to be people who are going to mistreat children or do not know how to take care of children,'' said Nancy vonBargen, who oversees part of Oklahoma's child-care program. ''We close them sooner because of the (strong) enforcement.''

BULGING CASELOADS FRUSTRATE INSPECTORS

Maine's multimillion-dollar day-care industry has grown from about 1,600 day-care providers in 1987 to roughly 3,200 today. But the size of the licensing staff has not kept pace.

Bonnie Chait, a day-care inspector for 13 years in Maine, says she worries at night about what might happen in the day-care operations she oversees.

Chait worries because she has an impossible job - making sure 400 day-care operations in York County are safe and healthy places for children.

''Some nights I leave work and wonder if something will happen,'' Chait says. ''Am I going to be liable?''

In addition to visiting day-care providers for routine health and safety checks, Maine's inspectors are responsible for investigating complaints and acting as consultants to people contemplating opening day-care operations.

Yet DHS officials estimate licensing workers have only 150 days a year they can spend on the road. The rest of their time is mostly eaten up by paperwork and answering phone calls.

Chait says she drives 20,000 miles a year, crams in as many visits as possible and still cannot inspect all day-care operators in her caseload even once a year.

Sharon Rankin, an inspector who covers Cumberland County, says administrators tell licensing workers to deal with the heavy caseloads by setting priorities and looking for ways to streamline work.

''They're saying, 'What can we cut out?' We've already cut everything,'' she said.

When Rankin started work as an inspector nine years ago, she would visit each day-care provider twice a year. On each visit she would spend a half-day talking to the owners and observing how they cared for children.

Today, like Chait, she finds it difficult to get in for an annual inspection.

To keep up with her caseload of 450 providers, Rankin tries to visit as many as six day-care operations each day.

Visiting so many places means she has to cut her visits short; they generally last 45 minutes.

That doesn't leave much time for an inspection. ''I could do a much better job if I had a lower caseload,'' Rankin says.

All the state licensing workers interviewed felt their work was poorly understood and little appreciated - by legislators, their own bosses, even parents.

The public doesn't see the tricks day-care providers play, the licensing workers say. Like scooting children out the back door as the inspector enters through the front - so they won't be cited for having too many children.

Bright, the inspector and former supervisor of the licensing division, said parents tend to have only superficial knowledge of the places that care for their children.

That's because they only see the center for a few minutes in the morning as they head to work. And again for a few minutes in the afternoon, when they pick the children up.

It is up to state licensing inspectors to see what parents do not, he said. And to make sure that day-care operations are safe for children. ''The more we can monitor children, the safer they will be,'' he said.

EVEN GOOD PROVIDERS REQUIRE OVERSIGHT

Maine currently has a two-tiered system of ''licensed'' and ''registered'' day-care homes. Licensed homes must be inspected annually and comply with a thick book of regulations. Registered homes are not inspected and have no standards to comply with.

There are about 1,100 licensed homes and 1,300 registered homes in the state.

The new rules, which take effect in July, will eliminate the two types of permits and require all day-care providers to be ''certified.''

DHS officials say the rules will improve quality because registered homes that want to continue in business will have to be inspected to get a state certficate.

But to accommodate the increased number of homes DHS workers must inspect, the department will only require homes to be inspected once every two years.

Concannon, commissioner of the state Department of Human Services, says the move should not affect the safety of day-care operations.

He said DHS will focus more attention than it has in the past on day-care providers with multiple complaints or reports of abuse and neglect.

But, he said, the department ''can prudently and safely'' visit day-care providers without complaints once every two years.

William Gormley, a professor of public policy at Georgetown University, says his research shows the type of system described by Concannon ''is a bad strategy.''

Gormley studied Vermont's child-care licensing system, which adopted a similar approach several years ago.

Vermont went to a system where large day-care centers with a history of complaints were inspected once a year and centers with good records were inspected once every two years, Gormley said.

Although the centers with track records of complaints improved because of increased scrutiny, ''the centers that were inspected less frequently deteriorated over time.''

The centers inspected less frequently started having more safety problems in the playground, they enrolled more children than allowed, and children were neglected more often. Gormley said he expects day-care homes would follow the same pattern.

Gormley said even good day-care providers need to be inspected regularly because they have high turnover among staff. The quality of the work force can decline and problems crop up, he said.

OVERENROLLMENT TROUBLES LICENSING INSPECTORS

Provisions that concern Bright and other inspectors the most deal with day-care enrollment.

For example, one rule lets homes take in more children than they are licensed for when ''unpredictable circumstances, not under the provider's control'' occur.

The ''unpredictable circumstances'' provision means the day-care operator could take in additional children and blame it on almost anything, state inspectors said.

Licensing inspectors say the loophole would make it difficult for them to keep homes from taking in too many children. They worry that could lead to dangerous conditions where children are not supervised properly.

Lack of supervision was the leading complaint made against child-care providers that received multiple complaints bewteen 1994 and the middle of 1997, according to state records.

For example, at Sharon Cieslak's home in Windham, a boy's leg was sliced by a lawnmower in 1995 when Cieslak was not watching, according to DHS records. His lower right leg had to be amputated as a result.

That case did not involve overenrollment, according to state records, but it demonstrates what can happen when children get out of sight of a day-care provider.

Rankin, a licensing inspector, said the rule gives an excuse to day-care providers who already routinely take in more children than the law allows.

''The people who are out of compliance now are going to be the ones giving us excuses,'' she said. ''There's absolutely no way we can enforce that.''

Concannon disagrees.

The provision allowing homes to take in more children during''unpredictable circumstances'' should work fine as long as inspectors keep a close watch on the homes.

The licensing staff's concern ''doesn't pass the straight-face test with me,'' he said.

If he's wrong, Maine's children will pay the price.

''Regulatory neglect leads to terrible tragedies,'' Gormley said. ''Unfortunately, it sometimes takes a death or serious injury to galvanize political action on child-care regulatory enforcement.

''We shouldn't have to sacrifice the life of a child in order to establish a decent protective regulatory system for children in child care.''