Audit Report on the Department of Health and Mental Hygiene’s Oversight of Universal Pre-Kindergarten Group Child Care Centers

Executive Summary

The Department of Health and Mental Hygiene (DOHMH) is responsible for protecting and promoting the health and well-being of all New Yorkers.  Among the agency’s many varied responsibilities, DOHMH licenses and regulates child care facilities in New York City (City).  As part of that function, DOHMH inspects certain child care facilities on a regular basis to ensure that they are in compliance with applicable health and safety-related rules and regulations.  The Bureau of Child Care oversees inspections and permitting of City-regulated child care centers.  The majority of these child care centers operate group child care (GCC) programs, which provide child care to three or more children under six years of age.  GCC programs can include Universal Pre-Kindergarten (UPK) programs, which provide access to preschool education to children ages three and four in a fashion similar to the way that kindergarten is available to all children ages five and six.

Inspections of all child care centers, regardless of whether or not they offer a UPK program, are conducted by DOHMH’s Public Health Sanitarians (PHSs) and Early Childhood Education Consultants (ECECs).  According to DOHMH’s Field Activity Protocol (DOHMH protocols), both the PHS and the ECEC inspections, referred to as initial inspections, are required to be conducted annually by PHS and ECEC inspectors, respectively.  If a violation is cited during an initial inspection, a compliance inspection is required within 45 days of the initial inspection to ensure that the cited condition has been corrected and to assess whether the center is in compliance with the health codes.  The inspectors are also required to conduct monitoring inspections following a program’s involuntary closure and suspension or revocation of its operating permit, to ensure the center is in compliance with the order of the closure.  In addition to conducting initial inspections, PHS and ECEC inspectors also conduct preliminary inspections of new child care centers prior to DOHMH issuing permits that will allow them to operate.  This audit focused on the initial inspections undertaken by DOHMH at GCC facilities that offered UPK programs (UPK GCC centers).

DOHMH reported that during Fiscal Year 2017 through April 30, 2018, it was responsible for overseeing 1,035 UPK GCC centers, which were among a total of 2,250 GCC centers open during that same period.  As of April 30, 2018, DOHMH reported that it employed 18 PHSs, 18 ECECs, and 7 supervisors in the Bureau of Child Care for this function.

The objective of this audit was to determine whether DOHMH has adequate controls to ensure that initial inspections at UPK GCC centers are conducted in accordance with the agency’s policies and procedures.

Audit Findings and Conclusions

The audit found that DOHMH needs to strengthen its controls to ensure that initial inspections at UPK GCC centers are conducted in accordance with DOHMH protocols.  During the scope of our audit, DOHMH management did not provide a mechanism that effectively enabled its supervisors to track the UPK GCC centers that had received an initial inspection, the status of those inspections, and the centers for which initial inspections were due.  Although subsequent to our commencing this audit, DOHMH made some procedural changes in an attempt to remedy this deficiency, additional improvements are still needed to enable supervisors to efficiently track the inspection status of the UPK GCC centers.

During Fiscal Year 2017, DOHMH records reflect that it failed to ensure that any initial inspections were conducted in 73 of the 1,035 UPK GCC centers in operation that fiscal year and further failed to ensure that both of the initial inspections (one by an ECEC and one by a PHS) required as per DOHMH protocols were conducted for 531 of the 1,035 centers.  Further, a review of DOHMH inspection records for Fiscal Years 2015 through 2017 reveal that the percentage of UPK GCC centers for which DOHMH failed to perform at least one of the two required inspections ranged from 48 to 60 percent.

Based on our audit findings, we question whether DOHMH has applied sufficient resources to support the UPK GCC center inspection function and to handle the number of child care centers that the agency is responsible for overseeing.  We found that DOHMH had no evidence that it monitors the adequacy of its staffing levels.  Further, we found that DOHMH has not developed a uniform process for any ongoing training for its staff and supervisors to better help them carry out their day-to-day responsibilities.  These combined deficiencies weaken DOHMH’s ability to ensure that inspections are conducted in accordance with agency guidelines.  DOHMH’s failure to undertake all of the initial inspections required under its protocols and to ensure consistent training for its inspectional staff increased the risk that centers with non-compliant, potentially hazardous, conditions were allowed to operate without those conditions being corrected.

Audit Recommendations

To address the issues raised by this audit, we make the following five recommendations:

• DOHMH should ensure that PHS and ECEC inspectors immediately inspect those centers that have not received an initial inspection within the last three years.
• DOHMH should review its inspection tracking tools, including management reports, and make any necessary changes to those tools, reports and oversight processes in general to better ensure that all initial inspections required as per DOHMH protocols are performed.
• DOHMH should evaluate the needs and concerns of the supervisors with regards to management reports and should include supervisors’ input in designing management reports.
• DOHMH should conduct a study to determine the adequacy of its staffing, as well as its structure in relation to the number of child care centers it oversees and adjust staffing levels as warranted.
• DOHMH should conduct periodic surveys of its staff and solicit feedback regarding the training curriculum so that it can provide relevant training to its staff as the agency deem appropriate.

Agency Response

DOHMH stated that it agreed with two of the audit’s five recommendations and disagreed with the remaining three recommendations, claiming that the recommendations were not needed because they reflected the agency’s current practices.

In its response, DOHMH strongly objects to the audit findings, claiming that the auditors misinterpreted agency protocols and did not adequately consider DOHMH’s approach to carrying out its inspectional mandate.  The agency asserts that the audit, which focused on DOHMH’s initial inspections of UPK GCC centers, should have also included additional types of DOHMH inspections.  However, while DOHMH may have preferred a different audit scope that did not so clearly reveal its weaknesses, this audit, as explicitly stated in the audit objective, sought “to determine whether DOHMH has adequate controls to ensure that initial inspections at UPK GCC centers are conducted in accordance with the agency’s policies and procedures.” (Emphasis added.)  As such, the audit was based on DOHMH’s own protocols which establish an oversight structure that includes annual comprehensive initial inspections.  It is precisely because this audit focused on those initial inspections that the weaknesses in DOHMH’s systems and oversight were so clearly apparent.

DOHMH attempts to support its argument that different types of inspections should have been included in the audit scope by blurring the differences between each type of inspection, going so far as to say “[n]o matter the type of inspection, the inspector always assesses the same core health and safety requirements set out in the Health Code.”  However, this statement obscures the fact that while every inspection concerns some aspect of compliance with Health Code requirements, each type of inspection has a distinct scope and purpose.  As presented in DOHMH’s protocols and explained to auditors by DOHMH personnel, initial inspections are complete program reviews intended to ascertain whether child care centers are in compliance with the City Health Code.  They are more comprehensive than compliance inspections, which DOHMH acknowledges in its audit response, are conducted to follow up on specific deficiencies identified in prior inspections.  Similarly, monitoring inspections are performed in conjunction with a complaint or other administrative action and are focused on the subjects of those complaints or administrative actions.

While DOHMH argues that the auditors “misunderstand the Department’s protocol and mandate,” its focus on what it refers to as its “mandate” is an apparent reference to the City Charter requirement that the agency make at least one unannounced visit annually.  However, as noted in this report, DOHMH’s stated position is that a complete inspection as required by the Charter “must consist of both ECEC and PHS components.”  Consequently, we audited to assess whether both types of initial inspections were conducted in accordance with DOHMH’s written protocols and as understood by the agency’s staff.

We note that notwithstanding its disagreement with our audit findings, DOHMH has agreed to implement our recommendation to improve its inspection-tracking system, which would help alert the agency’s inspectional supervisors to GCC centers that are due or past-due for those comprehensive initial inspections.

After carefully reviewing all of DOHMH’s arguments, we find no basis to alter any of the findings of this report.