Serious Deficiency for Family Day Care Homes

1. Serious Deficiency for Family Day Care Homes

2. Why Is This Important? • Because over the years, we’ve seen that… • There are serious and substantiveproblems in the implementation of the serious deficiency process for Family Day Care Home Providers

3. What Did CCAP Reveal? • In 80% of Sponsors: 1/5 of providers lacked up-to-date records on the day of the review • For some Sponsors: over 1/2 of provider’s records were not up-to-date

4. The Results of the Targeted Management Evaluations (TMEs) • It appears that obvious cases of false claims, missing records, consistently absent providers, etc. are being virtually ignored • The serious deficiency process is being under-utilized

5. TME Results Continued • Sponsors that do implement the SD process do so only for false claims • What usually constitutes “acceptable” corrective action for false claims: - “Try to do a better job keeping your daily records” - “Promise not to do it again” - “Prove you didn’t do it”

6. Why Are We Targeting Sponsors? • The Office of the Inspector General has called into question the current funding structure of the family day care home component of CACFP simply because sponsors have a financial incentive to keep providers on the program

7. The Importance of Serious Deficiency • Initiating the SD process is a serious step, but should not be reserved only for “hopeless” situations • Issuing a SD notice is not the end of the process, but the beginning of getting the problem resolved

8. Consequences for Sponsors • Failure to use the serious deficiency process appropriately, in itself, can be a basis for the State Agency to declare your organization seriously deficient

9. Discussion Question • Within your sponsorship, what do you consider to be a serious deficiency in a family day care home?

10. Declaring Serious Deficiency The serious deficiency process: • Fully identify all aspects of the problem(s) • Cite non-compliance with specific regulatory citations, instructions or policies

11. Corrective Action • Describe corrective action for a meaningful, long-term solution to the problem • Verify implementation of the corrective action and resolution of the problem

12. Serious Deficiency Notification Sponsors SD notices must: • list regulatory requirements for elements of a complete notice • list regulatory requirements for corrective action timeframe • be sent to the State for inclusion on the SD list and for technical assistance (if necessary)

13. Declaring SD vs. Terminating for Convenience • Terminating a provider for convenience is allowed but should NOT be used as a way to circumvent the serious deficiency process!

14. The Example of Ms. I. WontdoitAghen • On 01/27/10, Look D. Other-Way, the SO, reviewed the provider. • Last review was May 2009 - provider was not home for the previous 3 unannounced visits • Provider declared SD in October 2009…CAP due 11/30/09

15. Ms. I. WontdoitAghen • 01/27/10...CAP still not submitted • Provider had no meal count or attendance records for entire month • In March 2010, corrective action submitted and provider promises to be home and to keep proper records • Serious deficiency immediately rescinded

16. How Do I Know When an SD Declaration is Necessary? Consider: • Frequency of non-compliance • Nature of the non-compliance • Isolated error or a broader systemic problem with the operations of the program

17. Examples: Look at What’s Going on with the Provider • Day care home provider missing records for one day vs. 20 days • Provider not home once vs. multiple times • Meal component missing on the menu one day vs. many/all days • Child not in attendance claimed for one day vs. many months

18. Other Factors to Consider Take certain factors into account: • Frequency/Severity of the problem • Provider’s time with the program • Provider’s English proficiency • Training

19. Sponsor Discretion ≠ Optional • SO permitted to exercise some discretion with SDs • Too many cases of improper use or understanding of this discretion

20. Absolute Requirements There is no discretion when it comes to: • Declaring a home seriously deficient for a false claim • 30-day corrective action deadline • Adjusting claims for disallowed meals

21. Health and Safety Violations Examples of health & safety violations: • Fire code violations • Chemicals/cleaners in reach of children • Unsupervised children playing outside in the street

22. Responses to Health & Safety Violations Remember to: • Communicate with licensing staff • Immediately initiate the SD • process once a health and safety violation occurs • Move to terminate if no corrective action is completed

23. Let’s Quickly Review SD Regulations for Sponsors Homes: • Corrective action → 30 days • Suspensions for health/safety • May only appeal intent to terminate, not SD • Appeal hearings: In-person or an Administrative Review

24. That’s All Folks! • Serious Deficiency Process Steps • Using the SD process correctly • Meaningful corrective action • Discretion • Serious deficiency notices • Health & Safety violations

25. Questions? ?