Audit Report on the New York City Department of Health and Mental Hygiene’s Follow-up on Violations Found at Group Child Care Centers

EXECUTIVE SUMMARY

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This audit was conducted to determine whether the New York City (City) Department of Health and Mental Hygiene (DOHMH) has adequate controls to ensure that it effectively follows up on violations found at DOHMH-permitted center-based group child care (GCC) centers.  DOHMH is authorized by Chapter 22 of the City Charter to enforce the provisions of the City’s Health Code.  Article 3 of the Health Code authorizes DOHMH to conduct inspections of any premises within its jurisdiction, including child care centers, to foster compliance with the code.

GCC programs provide child care to three or more children under six years of age for five or more hours per week and for more than 30 days in a 12-month period, primarily in non-residential space.  These programs are licensed by the City and regulated by Article 47 of the City Health Code.  The responsibility for ensuring that child care programs comply with the Health Code falls on DOHMH’s Bureau of Child Care (BCC).

BCC protocols call for GCC centers to be inspected annually for two separate purposes: one related to the GCC center’s physical premises—conducted by a Public Health Sanitarian (PHS); and the other one related to the GCC center’s program operations—conducted by an Early Childhood Education Consultant (ECEC).

The three types of violations that may be observed during an inspection for which a citation may be issued by either the PHS or the ECEC are:

• Public health hazards (PHHs) for those violations that may present an imminent threat to the health and safety of children (e.g., a missing window guard or inadequate supervision) and must be corrected by the GCC provider within 24 hours of citation or, if the violation is not corrected while the inspector is at the GCC, an “interim control” must be put in place to mitigate the risk of a PHH to stay open until the cited condition has been corrected;
• Critical violations for serious violations that must be corrected by the GCC provider within 14 days of citation (unless stated otherwise in this report, the term “day” refers to workday); and
• General violations for the least severe type of violations that do not pose a direct threat to children; however, they must be corrected by the GCC provider within 30 days of citation.

A GCC center found to have one or more PHHs, one or more critical violations, or six or more general violations during an inspection should be re-inspected within 45 days of the inspection to determine whether the violations have been corrected.  Depending on the nature of the violation, it is acceptable for the GCC provider to submit documents that establish that cited conditions had been corrected to clear violation within this timeframe.  In such cases, a re-inspection is not required.

The BCC inspection staff use handheld devices (tablets) in the field to access facility records and previous inspections information, to review notes and history, and to record investigation results.  Upon completion of the inspection, the inspector “synchs” the tablet to send the inspection results back to the Child Care Application Tracking System (CCATS), an in-house system developed by DOHMH to track permit applications, but which it also uses to record inspections and violations.^[1]

 

Audit Findings and Conclusion

This audit found that DOHMH has adequate controls to ensure that inspectors follow up on violations found at DOHMH-permitted GCC centers in a timely manner.  However, DOHMH needs to strengthen its controls to provide greater assurance that inspectors ensure that the interim controls implemented to address uncorrected public health hazards adequately mitigate the violating conditions.  This is of particular concern because interim controls are required in situations where violations are cited that may present an imminent threat to the health and safety of children.  DOHMH also needs to strengthen its controls to better ensure that inspectors take appropriate actions when conducting their follow-up so that they do not inappropriately deem violations to be corrected.

DOHMH has programmed CCATS to assign inspections of those providers that have outstanding citations, prioritizing those for whom DOHMH has received complaints as well as those that have citations open for 30 days or more, to help ensure that inspectors promptly follow-up on violations.  DOHMH supervisors may also use reports generated by CCATS to identify those providers that fit the criteria for re-inspection and have not provided evidence that the cited violations have been corrected.  CCATS data reflected that 90 percent of citations issued for PHH and critical violations during our review period that required follow-up action—either re-inspection or documentation that the violations were addressed—had undergone such action within DOHMH’s 45-day target.  CCATS data also shows that 98 percent of the citations were cleared as of February 23, 2017 (the last day of the audit scope period), meaning that inspectors deemed the associated violations to be corrected.

However, although the CCATS data indicates that the vast majority of the citations issued to GCC centers for PHH and critical violations were followed up within required timeframes, DOHMH lacked evidence that it adequately monitors its inspectors to ensure that violations are satisfactorily addressed.  Specifically, we found little evidence that supervisors either review the interim controls reportedly established in response to PHH violations to ensure that uncorrected conditions are adequately mitigated or that they review inspectors’ clearances to ensure that the cited violations are properly corrected.

In a review of the supporting information for 28 sampled citations for PHH violations for which interim controls were reportedly implemented, we found insufficient evidence to indicate that the conditions for more than half of them were adequately mitigated.  In fact, our review of CCATS for all 1,892 PHH-related citations issued between February 1, 2016 and February 23, 2017 revealed that the records for 19 percent of them—360 citations—had seemingly meaningless entries (e.g., punctuation marks with no other text, cryptic entries such as “NULL” and “N/A”) in the Interim Control field.  Additionally, our detailed review of 73 sampled citations that were cleared found insufficient evidence that the violations relating to approximately one-fifth of them were adequately corrected.

These weaknesses undermine DOHMH management’s ability to assess whether violations, especially those deemed critical or a public health hazard, have been satisfactorily addressed.  Consequently, the risk to the children cared for in the GCC centers is increased.

 

Audit Recommendations

Based on our findings, we make seven recommendations, including the following:

• DOHMH should require that adequate evidence is maintained in CCATS to support inspectors’ determinations that violations have been appropriately corrected.
• DOHMH should implement a method by which documented supervisory reviews of violation corrections can be recorded in CCATS.
• DOHMH should require that supervisors document their reviews of the interim controls established for PHH violations and ensure that the controls adequately mitigate the hazardous conditions cited.

 

Agency Response

Of the audit’s seven recommendations, DOHMH agreed with two (#1 and #3), partially agreed with one (#7), stated that two pertained to procedures already in place (#2 and #6), disagreed with one (#4), and did not directly address one (#5).  DOHMH also disagreed with the audit’s findings that weaknesses identified in DOHMH’s monitoring of inspectors increase the risk that cited conditions in GCCs will not be adequately corrected.  After a careful review of DOHMH’s arguments, we find no basis to change any of the audit’s findings.

[1] CCATS is also used to track and process permits and/or licenses for other City-regulated programs, such as School Based Child Care (i.e., preschools operated by an elementary school) and Summer Camps.  CCATS is not used for the State-regulated child care programs.  For those programs, DOHMH uses the State’s database, the Child Care Facility System (CCFS).