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Am J Public Health. 2013 Oct;103(10):e52-8. doi: 10.2105/AJPH.2013.301298. Epub 2013 Aug 15.

Health and safety of child care centers: an analysis of licensing specialists' reports of routine, unannounced inspections.

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Angela A. Crowley and Sangchoon Jeon are with Yale University School of Nursing, Yale University, New Haven, CT. Marjorie S. Rosenthal is with the Department of Pediatrics, Yale University School of Medicine, and the Robert Wood Johnson Clinical Scholars Program, New Haven.



We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance.


We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations.


The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance.


Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts.

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