Comptroller Stringer Audit Reveals DOHMH Skipped Mandatory Inspections at Hundreds of Child Care Centers

73 centers did not receive either of two required annual inspections in FY17

Over half of centers did not receive one of the two required annual inspections in FY17

  New York City Comptroller Scott M. Stringer released a troubling new audit revealing that the Department of Health and Mental Hygiene (DOHMH) failed to conduct required inspections of over half of the child care centers that served the City’s Universal Pre-Kindergarten (UPK) program in Fiscal Year 2017 (FY17).  Under its own rules, DOHMH is supposed to conduct two types of inspections each year at each center — one by an Early Childhood Education Consultant (ECEC), focused on staffing and curriculum, and another by a Public Health Sanitarian (PHS), focused on physical conditions.  Both types are called “initial inspections,” which trigger further investigation if deficiencies are found. Yet the audit uncovered that in FY17, DOHMH skipped both of those inspections at 73 centers and that hundreds of other centers received just one initial inspection, in direct violation of DOHMH protocols.

“For the safety and well-being of our children, DOHMH’s own rules require it to comprehensively inspect every child care center at least twice every year.  Skipping inspections at hundreds of child care centers is unacceptable,” said Comptroller Stringer.“As a parent of young children, I find this audit extremely disturbing. As Comptroller, what’s even more alarming is that DOHMH refuses to acknowledge the problem and fix it. When it comes to protecting our city’s children, we cannot allow any agency to deny the facts.”

The Comptroller’s audit investigated whether initial inspections—DOHMH’s term for comprehensive annual inspections—were conducted across the City’s 1,035 group child care centers serving the UPK program in FY17.

Findings from the audit include:

Records Show 73 Centers Did Not Receive an Initial Inspection in FY17

• In a review of DOHMH records, auditors found that 73 group child care centers did not receive an initial inspection by a PHS or an ECEC during FY17.
• 53 of the 73 uninspected centers had previously been issued 324 violations in the preceding year – ranging from 1 violation per center to 21 and including:
• 41 violations classified as public health hazards (imminent threat to health and safety, needing immediate attention); and
• 116 classified as critical (serious violations needing correction within 14 days).
• DOHMH reported in its response to the audit that it conducted what it refers to as monitoring and compliance inspections at all of the centers where violations were cited or for which complaints were received. Nevertheless, under DOHMH’s protocols and according to its staff, monitoring and compliance inspections are not substitutes for the two mandatory initial inspections. As noted in the audit report, DOHMH’s “initial inspections” are complete program reviews to determine whether child care centers are in compliance with the City Health Code. As such, they are more comprehensive than compliance and monitoring inspections, which focus on specific issues raised by prior inspections, complaints, or administrative actions.

Hundreds of Centers Failed to Receive Required Inspections

DOHMH records show that during FY17, a total of 531 of the 1,035 audited group child care centers failed to receive at least one required inspection, in violation of DOHMH protocol. Specifically, in addition to the 73 centers that received no initial inspection:

• 312 centers did not receive an inspection from an Early Childhood Education Consultant; and
• 146 centers did not receive an inspection from a Public Health Sanitarian.
• A further review of DOHMH inspection records for Fiscal Years 2015 through 2017 revealed a widespread and long-standing lack of oversight as DOHMH failed to perform all inspections at between 48 and 60 percent of audited centers in each year.

Fiscal Year	Number of Total Centers Inspected	Number of Centers Lacking Either a PHS or an ECEC Inspection	Percentage of Centers Lacking Either a PHS or an ECEC Inspection
FY 2017	958	458	48.00%
FY 2016	927	496	54.00%
FY 2015	933	561	60.00%

Deficient Oversight at DOHMH

Although DOHMH claimed that its information system enabled its supervisors to track inspections across multiple child care centers, DOHMH supervisors interviewed during the audit said that they were unfamiliar with the system’s tracking functions and generally did not use them. After the auditors informed the agency, DOHMH officials developed a new reporting system which, though improved, still lacks necessary information and is effectively bypassed by supervisors who instead continue to create their own Excel spreadsheets to attempt to track inspections of the centers they oversee.

Auditors also found that DOHMH employed just 18 PHS staff and 18 ECEC staff to inspect roughly 2,749 group child care and school-based child care centers – and just seven supervisors responsible for overseeing inspections citywide. Moreover, inspectors and supervisors were concerned not just about understaffing but about the lack of consistent necessary training. In each borough, staffing levels breaks down as follows:

Borough	Number of GCC Centers	Number of School Based Child Care Centers	Number of PHS staff	Number of ECEC staff	Number of PHS Supervisors	Number of ECEC Supervisors
Brooklyn	816	224	6	5	2	1
Manhattan and Staten Island	628	123	5	4	1	1
Queens	494	91	4	5	1
Bronx	312	61	3	4	1
TOTAL	2250	499	18	18	7

These combined deficiencies weaken DOHMH’s ability to ensure that inspections are conducted in accordance with agency guidelines and increase the risk that centers with non-compliant, potentially hazardous conditions were allowed to operate without those conditions being corrected.

In response to these deeply concerning findings, the Comptroller called on DOHMH to immediately inspect the 73 centers auditors uncovered – and further inspect every single center that did not receive an initial inspection within the last three years. Additionally, the Comptroller recommended:

• DOHMH should reform its inspection tracking protocol and overhaul its reporting mechanism to ensure that reports and oversight processes do not allow initial inspections to be skipped or records to go missing.
• DOHMH should ensure that supervisors who require accurate and adequate management reports have input in the overhaul.
• DOHMH should determine the adequacy of its staffing 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.

This is the third audit Comptroller Stringer has conducted of DOHMH’s oversight of group child care centers, and the third in which notable deficiencies were found.

• A 2016 audit of DOHMH’s permitting of Group Child/Day Care (GDC) providers found that DOHMH had not ensured that all of the GDCs had tested the water at their facilities for lead, as required by the City Health Code, and, even more alarming, that management instructed staff to enter into a DOHMH computer system an inaccurate statement that a report of a water lead test with acceptable results had been received in cases where no such test had been performed, or where there was no evidence that an acceptable result had been reported.
• In a 2018 audit of DOHMH’s follow-up on violations found in Group Day Care Centers, auditors found that:
  • DOHMH’s weak controls decreased its ability to ensure that interim corrective actions were appropriately implemented by the GDCs to protect the children’s health and welfare pending implementation of permanent corrective actions. For example, auditors reviewed all 1,892 Public Health Hazard-related citations issued between February 1, 2016 and February 23, 2017 and found that the records for 19 percent—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.
  • Further, the audit found that in some instances DOHMH lacked evidence that the actions the centers took to correct violations were adequate. Specifically, in a sample of 73 citations that were cleared, auditors found insufficient evidence that the violations relating to approximately one-fifth of them were adequately corrected.