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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St.

, Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

CHILD CARE LICENSING PROGRAM MEETING Presenters: KDHE & Johnson County Health Department July 18, 2013 Answers to Questions Submitted by Johnson County Child Care Providers Communication 1. How can providers be updated on the Kansas Department of Health and Environment’s (KDHE) activity with regards to public information (legislative matters, Best Team activity and regulatory updates)? The KDHE Child Care Licensing (CCL) program provides regulatory and initiative updates to health departments and local licensing surveyors. The local programs communicate directly with child care providers at the local level as the first point of contact for the program. This is how the system is designed and most effective due to: 1) local surveyors’ knowledge of local ordinances and requirements that affect providers in any given county/community; and 2) the health department’s ability to maintain updated email distribution lists/contact information for providers. Legislative matters concerning child care may be found through bill locators or by searching the Kansas Legislature website at http://www.kslegislature.org. Monitoring the House and Senate calendars as well as Committee agendas targeted to health and human services will also keep you up to date on bills Committees are working. The CCL Program uses the same process during legislative session. The Child Care Licensing website http://www.kdheks.gov/bcclr is the best place to track child care updates, activities/initiatives, regulatory information, and Best Team activity. When there are proposed changes to regulations, the CCL website also has this information and local surveyors often send messages, updates, and notices to providers. KDHE relies on agency partners in addition to surveyors (food program, resource and referral agencies, etc.) to assist with distributing information to licensees. 2. How do I contact KDHE child care licensing staff? KDHE Child Care Licensing staff members can be reached by phone at 785-296-1270 or by email at cclr@kdheks.gov. This contact information is available on the website. The call or the email message will be routed to the appropriate staff member, based on county assignment, to answer questions or address concerns. 3. Communication and implementation regarding Lexie’s Law once open and educational has become more confrontational and defensive. Why? The passage of Lexie’s Law was not the first time the Department developed amended or new regulations. The Department worked closely with local health departments and child care surveyors to ensure providers were aware of the upcoming changes and worked to answer questions. Training on the new and amended regulations resulting from Lexie’s Law was held across the state prior to full implementation of the regulations. With the implementation of any new policies or regulations, there is an information/outreach time period followed by training and implementation. During the information/outreach period, guidance is given for the upcoming changes and licensees are encouraged to make changes necessary for compliance as soon as possible. Training and guidance supports providers’ understanding and ability to comply with new or revised requirements. Once changes are in effect, noncompliance with any regulation must be cited or the Department is not in compliance with the Child Care Act. Surveyors do not have the authority to only provide consultation once regulations are in effect. Providers should always request clarifications on regulations from the surveyor if there are questions or concerns. 4. How is the Child Care Licensing Best Team membership determined and can there be more home providers on the team?

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

Members were appointed by former Secretary Bremby (previous administration) in an effort to form a team representative of the early care and education profession, not just the regulated provider community. Representatives from the major provider groups including the Child Care Provider Coalition of Kansas, Kansas Association for the Education of Young Children, and Child Care Providers Together (AFSCME) were appointed. Over time there has been some change in membership, particularly with providers, as members have left the profession. Changes have also occurred with representation for parents, agencies, business industry and higher education. As part of the ongoing process, the Department reviews the role of the Team and membership. General Facility 5. Why can’t licensed day care homes or group day care homes use “center” or “preschool” in their name? Regulations specifically define programs such as a licensed or group day care home, child care center, school age program, preschool, maternity center, etc. With the categories defined in regulation, day care homes (licensed or group) cannot contain the term “center” or “preschool” in the name. Centers or preschools cannot use “day care home” in the facility name. KDHE Office of Legal Services references Kansas statute K.S.A. 50-626 Deceptive Acts and Practices as the rationale for this CCL program policy [Chapter 50. Unfair trade and consumer protection; Article 6. Consumer protection]. The statute specifically addresses misrepresentation of goods and services to the public. Allowing “center” or “preschool” in facility names for which programs/services are not providing according to the definition is a false representation of the program as defined by regulations. Day care homes may state that they offer preschool activities or curriculum to children in care but cannot advertise themselves as a center or preschool program. 6. How many facilities are licensed in Johnson County? As of July 25, 2013, Johnson County facility counts (by license type):       660 Licensed Day Care Homes 184 Group Day Care Homes 184 Child Care Centers (includes Head Start Centers 7 Preschools 116 School Age Programs 0 Drop-In Program (School Age only)

Online Compliance Information 7. What statute or regulation allows information from survey findings to show on the online facility compliance search? K.S.A 65-534 (effective July 1, 2010) required KDHE to establish an online information dissemination system for the public. The system was required to include, at a minimum, information regarding the names of licensees, applicants, and history of citations and substantiated findings. All information stated on the Notice of Survey Findings (NOSF) is displayed through the online search so it’s a reflection of what was given to the licensee following the visit. The information displayed from an online search is the same information contained in the file and what would be provided if requested from the Department pursuant to the Kansas Open Records Act (KORA) (K.S.A. 45-215 et seq.). The only difference is the method of delivery. Disclosure of certain information is prohibited pursuant to K.S.A. 65-525 and other statutes regarding confidential information and is not displayed or distributed under KORA. The online facility compliance search page offers a number of documents and detailed guidance information about the law, what is displayed, how to request additional information from a file, and how to read the report. Technical assistance and consultations are noted on the NOSF and part of the official record/file; however, they are not displayed online via the “View Findings” link .

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

Research has demonstrated that posting of licensing information on the Internet has a positive effect on compliance with licensing rules. (Source: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs.3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Chapter 10: Licensing and Community Action, 10.4 Facility Licensing, 10.4.2 Facility Inspections and Monitoring, Standard 10.4.2.1: Frequency of Inspections for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes. Also available at http://nrckids.org.)

8. When a consultation is noted on my Notice of Survey Findings (NOSF) is it a finding, a recommendation or general information? Consultations listed on the Notice of Survey Findings are not violations. Consultations are health and safety related education and information provided by the licensing surveyor during the survey. Consultations can be anything related to the health, safety, well-being and care of children and/or early care and education effective practices, recommendations, etc. Technical assistance and consultation provided by licensing inspectors on an on-going basis are essential to help programs achieve compliance with the rules and go beyond the basic (foundation) level of quality. These positive strategies are most effective when combined with other pieces of the early care and education system which promote quality (such as professional development, quality and improvement rating systems, accreditation, peer support, and consumer education). (Source: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs.3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Chapter 10: Licensing and Community Action, 10.4 Facility Licensing, 10.4.2 Facility Inspections and Monitoring, Standard 10.4.2.1: Frequency of Inspections for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes. Also available at http://nrckids.org.) 9. If a potential family or a current parent had questions regarding the findings found from an online search what should I do? Providers should explain the licensing requirements for the particular license type and encourage parents to review the facility’s compliance history so they can feel more comfortable about the setting their child will be in while they are away. If the parent has questions you can’t answer, refer them to the local child care surveyor or KDHE if additional information from the facility file and/or interpretation of the findings is desired. The CCL website offers a document (CCL.036) titled Selecting Child Care: A Guide for Parents that you can refer the parent to for more information about reviewing facility compliance. The link available on the CCL website, Understanding the Online Compliance Information (http://www.kdheks.gov/bcclr/online_comp_report.htm) has several help documents to assist parents with understanding the information displayed. There is a link to Reading the Child Care Facility Report which walks a reviewer through the sections of the report. The link Child Care Licensing Survey Process outlines the Department and Child Care Provider responsibilities, authority/laws, purpose of surveys, and the different types of on-site surveys. The Child Care Licensing Enforcement Process explains the philosophy and protocol related to administrative reviews of facilities with substantial (imminent risk violations) and /or ongoing or repeat noncompliance. 10. In 2010 a complaint was made regarding my facility. A complaint survey was conducted and the complaint was unsubstantiated. I did not have any other findings. Why does it state that the findings are “Not Available”?

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

“Not Available” simply means the survey findings are not available online/electronically via a web link. This is because the survey was conducted on site using the paper-based survey process versus the automated survey. The coding for the online system does not support pdf or image file types, so there is no way to display findings that were cited on paper and prior to implementation and application of the online survey tool. A copy of survey findings not available online may be requested through the CCL program. 11. How far back does the compliance history show for my facility? Three years of compliance history is provided for each facility through the online compliance portal. Therefore, information contained in the report may not reflect the complete history of a facility’s compliance unless the facility has been in operation for less than three years and all surveys were conducted using the online survey tool. Additional information and records may be available and can be requested from KDHE. Disclosure of certain information is prohibited pursuant to K.S.A. 65-525 and other statutes regarding confidential information. 12. There was an incorrect citing on one of my Notice of Survey Findings and they corrected the notice. What will show when a search is done? Notices of Survey Findings (NOSFs) are posted as soon as the survey information is completed in the licensing database. If a change or correction was made, the new, corrected NOSF overwrites the previous record and displays online as soon as it is completed in the system. The Department has the ability to delay posting of findings if a review or appeal of findings is in process until a final determination is made. 13. How can I opt out of having my address information display online? All facilities were set to “opt-out” status by default when the online system went live. The new and renewal licensing applications (paper and online) have a question related to displaying the address. If a provider wishes to change the status at times other than renewal, they can contact KDHE and request the Opt In/Out form. The change will be made when the form has been returned to KDHE. Regulation Book 14. When searching child care regulations on-line, I have to look at several sections and search each individually. Can the sections be merged into one document for ease of searching? Yes, the sections of the regulation book can be merged to ease the search process. The Child Care Licensing staff are working on the document for posting on the website in the near future. However, the individual sections will also remain posted on the website along with the full text version so users have an option on how they would like to search requirements. Quick tip for searching: If you select the control key “Ctrl” and then the letter “f” key, the find box will pop up in the document you are in. Just enter the key word into the box and hit “Enter” the search process will start. Surveys 15. Why are surveys required? Pursuant to K.S.A. 65-512 child care facilities (facilities are defined in regulation and effective July 1, 2010 includes all types of child care) must be inspected once every 12 months. Licensing inspections are important to assist facilities to achieve and maintain full compliance with licensing rules. Supervision and monitoring of child care facilities are critical to facilitate continued compliance with the rules in

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

order to prevent or correct problems before they become serious. (Source: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs.3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Chapter 10: Licensing and Community Action, 10.4 Facility Licensing, 10.4.2 Facility Inspections and Monitoring, Standard 10.4.2.1: Frequency of Inspections for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes. Also available at http://nrckids.org.) The ultimate responsibility for compliance lies with the licensed child care provider. The Department is responsible for conducting initial and annual inspections and complaint investigations, notifying the provider in writing of the noncompliance found, and giving the provider an opportunity to reach and maintain compliance. 16. If KDHE is responsible, why does the local health department make the visit? According to the Child Care Act/Licensing Law, the KDHE is responsible for administering the program. However, the agency contracts with local health departments to carry out the regulatory program and provide services at the local level including, providing new provider orientations, conducting inspections, providing training and technical assistance; therefore, surveyors are typically health department staff. All licensing and enforcement decisions are made at the state level in accordance with the law. 17. Is the surveyor supposed to inspect every area of my facility, even if a room/area is not used for day care, locked, or inaccessible to children? The law K.S.A. 65-512 requires the Secretary (surveyor as the agent) to inspect “every place in the premises”, including areas that are not used for child care. In the case of a Day Care Home, the entire premises is licensed, not just parts of the home. However, the provider determines what areas are designated for child care. KS.A. 65512 grants surveyors authority to inspect all areas of the premises (inside, outside, all records), and the provider is responsible for giving the surveyor access. All areas that are accessible to children are to comply with laws and regulations, so noncompliance may be cited. Rooms/areas the provider designates as “not used by children” (ex: private bedroom) are still evaluated for presence of children or hazards that 1) impact the children in care or 2) are life-threatening in nature. If a room is inaccessible at the time surveyors arrive (i.e. locked), the surveyor must be given access to observe for children; however, violations would not be cited. 18. On average how long does an annual survey normally take? Annual surveys vary depending on the size and organization/compliance of the facility. Johnson County survey average times are as follows: licensed day care home 2 hours; group day care home 2.5 hours; centers 4 hours. 19. Will surveyors conduct more than one annual survey per day? Surveyors may conduct more than one annual survey per day if time allows and/or a combination of other types of surveys if the schedule allows. Surveyors and health department supervisors set schedules and workload in response to survey requests from KDHE. Surveyors also perform initial surveys and courtesy walkthroughs/consultation for new facilities in addition to conducting compliance checks. The surveyors also conduct surveys to investigate and follow up on complaints including allegations of illegal care. 20. Are all surveys now conducted via computer? How can the provider know what questions are asked on a survey? All items reviewed during a survey are available to the provider. The survey tool is based on the current child care statutes and regulations. A copy of the survey tool used during a facility survey may be found on the Child Care Licensing website at www.kdheks.gov/kidsnet and selecting the “Application Packet & Forms” link. Choose the

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

appropriate program type (ex: licensed or group day care home, child care center, preschool) and then under the “Informational” section you will find the survey tool for initial and annual surveys. The tool was previously included with renewal packets but is no longer copied and mailed since it’s on the website. With the exception of school age programs and drop in programs, all annual surveys are conducted and documented directly in the licensing database (online). The survey findings are provided to the licensee or director of the facility at the end of each visit. 21. Must all survey findings be listed on the Notice of Survey Findings (NOSF)? K.S.A. 65-513 requires surveyors to document all non-compliance with statutes and regulations. All violations must be documented clearly by the surveyor on the NOSF. The NOSF specifies the regulation number/subsections requirement not met, and provides a description of the noncompliance cited. 22. Do I sign the NOSF if I don’t agree with the findings? When you sign the NOSF, it is only an acknowledgment that you were provided with the findings/document. Signing does not equate to agreement with what was cited on the NOSF. 23. I had no violations cited last year; during my inspection this year, I had findings but did not change anything from the year before. Why do I have findings this year? All surveyors do their best to be consistent and observe every area, record, and practice when conducting surveys. Inspection of the facility may have different results due to a slight environmental change, communication with provider, interactions with children, change in records/missing information, or because of additional training surveyors receive to help clarify situations and regulations. 24. My surveyor has taken pictures during her visit, is this allowed? Yes, K.S.A. 65-512(a) states that for purposes of inspection surveyors shall make and preserve a record of every inspection. The record of the visit is documented on the Notice of Survey Findings and part of that record could also include pictures. The surveyor procedure manual directs surveyors to take pictures of the environment, records, or any other item/area that relates to a regulation, cited or not cited, to better depict the state of the item/area and noncompliance (scope and severity) at that point in time. At times this is really a protection for the provider since it’s an alternative way of describing what the surveyor saw and what’s in question. 25. Can I get copies pictures taken during the survey? There are times when pictures are not saved, rather, simply taken to assist review/staffing/decision making prior to citing a violation. These images may not be kept as part of the official file/record. Any pictures that are taken and attached to an online survey or kept in the file can be released as part of an open records request. 26. Can I take pictures for the surveyor to show I corrected a finding? Pictures that clearly indicate a permanent change, such as ground cover, fence, or locked installed on a door, may be accepted. Other pictures may be submitted; however, they will not necessarily take the place of a followup onsite visit that would be necessary to ensure environmental, capacity, or other violations were corrected and compliance is being maintained. 27. What do I do when there are conflicts with my surveyor? If the conflict is regarding a noncompliance finding, ask the surveyor to clarify the requirement and provide the rationale that supports the cite. Surveyors can also assist with acceptable corrections for the noncompliance,

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Bureau of Family Health Child Care Licensing Program Curtis State Office Building 1000 SW Jackson St., Suite 200 Topeka, KS 66612-1274

Phone: 785-296-1270 Fax: 785-296-0803 cclr@kdheks.gov www.kdheks.gov/kidsnet

unique to each provider’s facility, resources, and timeframe. If you still do not agree with the cite, licensees have the option to request an administrative review of the NOSF from KDHE within 15 days from the date of the NOSF. Concerns regarding the professionalism of a surveyor should be directed to the health department supervisor. Resource and Referral Agencies 28. What is the difference between resource and referral agencies and provider networking? Pursuant to K.S.A. 65-503 Definitions relating to child care facilities: (b) “Child care resource and referral agency” means a business or service conducted, maintained or operated by a person engaged in providing resource and referral services, including information of specific services provided by child care facilities, to assist parent to find child care. The state of Kansas requires all resource and referral entities to be licensed. Resource and Referral agencies are instrumental in referring parents to licensed child care as well as offering required and other approved trainings to providers. Licensure is a consumer protection for families utilizing the services. Informal discussions at the community level regarding child care and recommending provider’s to families is not considered a referral service as long as formal notification of facilities/services provided are not given to assist parents with finding child care. By definition this is considered a regulated service. 29. Who oversees resource and referral agencies? Resource and referral agencies are considered child care facilities by statutory definition (K.S.A. 65-503) and are required to be licensed by KDHE. Rules and regulations governing referral agencies are available on the CCL website. Training 30. Why do providers have to show their core classes each time, other than the first aid and CPR? If the surveyor has previously documented “lifetime” training and it’s on record, it’s not required to review it again unless the regulation states the documentation must be “on file” at the facility. The regulation determines the expectation and requirement. 31. How many hours does a day care home provider need annually? Pursuant to K.A.R. 28-4-114a(e),a provider can meet the annual training requirement three ways: (1) Complete 5 clock-hours of professional development; (2) maintain current accreditation by the national association for family child care; or (3) hold a current child development associate credential. All training must be KDHE approved which means the training was: 1) approved by KDHE and has an approval number; 2) approved by Child Care Aware of Kansas and offered by a local Child Care Aware resource and referral agency; 3) training offered by a Child Care & Adult Food Program sponsor; or 4) approved for college credit or early childhood CEUs. 32. What training does my substitute need annually? Any substitute providing care more than 3 hours in a day must meet the same qualifications as a primary care provider as required under the regulations which would be completing one of the options noted in #30 and regulation K.A.R. 28-4-114a(e).

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