Health and safety of Connecticut early care and education programs: An analysis of licensors' reports of unannounced inspections

Attendance in out-of-home child care is a necessity for most children and poses both risks and benefits.The US DHHS, Maternal Child Health Bureau in partnership with APHA and AAP have supported multiple initiatives to promote access to healthy, safe, and developmentally appropriate child care programs. While most states conduct unannounced licensors' inspections of child care programs to monitor compliance with regulations to reduce the risk of harm to children, few report findings in aggregate form or utilize the data for planning to improve child care quality. The purpose of this study was to identify the frequency of compliance with regulations as determined by unannounced, random inspections of child care centers and the influence of NAEYC accreditation, source of funding, and access to health consultation on compliance. The study sample (N=676) included all routine, biannual inspections of Connecticut child care centers between 2006-2008. Findings revealed that the most frequent violations of compliance were reported in the categories of: 1) Safety (playground hazards 48.4% of sites, indoor hazards 38.2%, maximum hot water temperature 33.9%,), 2) Health records (staff health records 36.2%, child health records 21.6%), 3) Medication administration written order 27.4%, labeled container 15.5%, trained person 14.1%). Though medication administration compliance ranked lower than some items, risk of errors poses a significant threat to child health. Increased frequency of compliance was associated with accreditation, source of funding, and a trained child care health consultant. Implications for designing a state monitoring system and efforts to promote child care quality will be discussed.