Child Day Care Facility Siting Review

State: NY Type: Model Practice Year: 2003

To ensure the health and safety of children attending day care facilities and the staff who care for them, the Nassau County Department of Health, Division of Environmental Health (NCDH) conducts a comprehensive review of all new or renovated child day care facilities. The process is designed to sustain regulatory compliance with all applicable environmental health programs and to prevent exposures to toxins in or around the facility. NCDH reviews each facility for food sanitation, lead hazards, air quality, general sanitation, and proximity to contaminated sites. This process prevents inappropriate siting of day care centers and identifies remediable hazards before children or staff are harmed.
The rising demand for child day care centers increases the risk that facilities will be located in non-residential buildings or in neighborhoods where a facility may be near a commercial or industrial property. In response to an Environmental Health Manual Item issued by the New York State Department of Health (NYSDOH) in February of 1998, NCDH began environmental inspections at child day care facilities. This item outlines the regulatory and consultant responsibilities of local health units to provide oversight and assistance to the New York State Department of Family Assistance, Office of Children and Family Services (OCFS) and child day care facility applicants to ensure compliance with the following environmental health programs: water supply, food protection, bathing facilities, sewage disposal, and lead paint hazards. The need for a greater NCDH role in the review process became apparent during the investigation of a child day care facility that had been sited in a former dry cleaning establishment prior to any Health Department involvement in the review process. In that case, children and staff were exposed to high levels of tetrachloroethylene (TCE). NCDH advised the applicant and provided guidance to resolve the problem. The applicant successfully reduced to levels of TCE and continued to operate. Recognizing the limitations of the review process, NCDH added additional elements, not currently mandated by New York State, as a part of the child day care facility siting review. Each location is mapped on a Geographic Information System (GIS) computer system. NCDH staff uses this map to conduct a complete and efficient record search and to aid in site inspections aimed to identify hazards in the following areas: air quality, community sanitation, toxic and hazardous material storage, and hazardous waste sites.
NCDH plays a critical role in the evaluation of a child day care facility site in order to insure compliance with environmental health programs and to provide guidance to OCFS and the applicant on the siting of facilities. Each application is reviewed by a day care coordinator and a file search and field inspections are conducted by individual programs. Mandated Program Reviews Drinking Water Supply – The public water system that serves the day care facility is identified and contacted to ensure that the water service is turned on and that the account is in good standing. If a facility has a private water system, NCDH collects samples for analysis of all constituents and contaminants found in the State Sanitary Code.  Food Protection – Site inspections are conducted for all food services at the facility.  Bathing Facilities – A day care center with a bathing facility must meet all the requirements of the applicable NCDH program and must maintain conditions to satisfy a separate bathing facility permit.  Sewage Disposal – Record checks are conducted to confirm that the facility is connected to the public sewer system. If the facility has an on-site sanitary sewer system, a field inspection is conducted to verify the integrity and proper operation of the system. If the facility is newly constructed with an on-site sanitary sewer system, an engineering plan review process is required.  Lead Paint Hazards – An on-site inspection is conducted to check for suspect surfaces using X-Ray Fluorescence (XRF) analyzers. Also, samples of water and dust are collected for laboratory analysis. Non-Mandated Program Reviews Air Quality – A record search and a site inspection are conducted to identify any potential interior or exterior sources of air contamination.  Community Sanitation - A site inspection is conducted to identify potential risks associated with general sanitation practices.  Toxic and Hazardous Material Storage – Record searches that use the Article XI database are made in order to identify any facilities near the day care center that are under permit to store toxic or hazardous materials. A survey of the surrounding neighborhood is also conducted to identify any facilities that are not under permit but may be using or storing such materials.  Hazardous Waste Sites – A record search is conducted to identify any State and Federal Superfund sites, State Voluntary Clean-up sites, and U.S. Environmental Protection Agency (USEPA) Underground Injection Control sites near the day care facility. Coordinator Review and Referrals - After each program review, the NCDH day care coordinator evaluates the information and conducts a final site inspection. This evaluation is forwarded to OCFS, which uses the report to determine whether to issue a license to operate a child day care facility. The total time expended on a typical facility review is 40 hours. The average NCDH staff cost for one facility review is approximately $1,330.00 (based on a mean cost of salary and benefits after NYSDOH reimbursement). The laboratory costs for lead sample analyses are typically $45.00 per facility. NCDH averaged 18 reviews a year from 1999 to 2002, for an annual cost of approximately $24,750. Because the review process uses existing staff and equipment, no additional or specialized costs are involved.  
Approximately one-third of the applications endorsed by NCDH are forwarded to OCFS with qualifications and/or recommendations. Qualifications may include requirements to meet food protection standards, electrical or plumbing upgrades, improved ventilation, and other general sanitary safety measures. These qualifications can result in the denial of a license or the withdrawal of the application until a more suitable site for the facility is located. The fact that 17% of facility sites were deemed to contain potential hazards significant enough to deny a license is noteworthy. The prevention of injury or adverse impact to the health of the children and staff attending a facility is paramount and preventing the siting of day care facilities in potentially hazardous settings saves considerable NCDH resources that would be expended to assess and abate adverse conditions.
Funding comes from the department’s normal operating budget and is easily sustainable.  Since the inception of the program, two day care facilities that were sited prior to NCDH involvement in the review process have been the subject of intense health investigation by NCDH and NYSDOH. Both of these sites were found to contain elevated levels of air contaminants. One of the sites was temporarily closed until a satisfactory solution could be found, and the facility was subsequently reopened. In the second case, the operator chose to suspend activity and abandon the site. Prolonged litigation among the concerned parties continues to affect NCDH resources. Had the Environmental Health program review and inspection process been active prior to the siting of the facilities, public health benefits would have been greater and costs would have been lower for all involved. The challenges of running this program are negligible compared to the challenges of dealing with the reactions of day care facility staff and the parents of children who suddenly find themselves coping with an existing or potential hazard. While conditions that warrant further investigation by NCDH may not inherently endanger life or health, the common perception among the public is often that they have been exposed to an unacceptable environmental condition and the damage has already been done. Environmental health professionals know that the children and staff at a day care facility are significantly more susceptible to unhealthy conditions resulting from poor personal hygiene and lax sanitary practices than from the chances of encountering an environmental hazard of a chemical nature. This is perhaps the greatest challenge for health professionals: to teach the staff the importance of proper sanitation and the implicit hazards of failing to take necessary steps to minimize the transmission of disease-causing organisms. The appeal of this program is that most of the required resources are already available to many health departments. It is not essential to use of technical equipment that can be costly to purchase and maintain, especially if it is not used for other programs. Even the difficulties of the two day care facilities that were found to have problems after they were sited could have been prevented with simple record reviews and site inspections. One facility was sited in a former dry cleaning establishment and the other was near a hazardous waste site. Certainly one of the key elements to the program is the thorough record search and site inspection of both the facility itself and the surrounding area. The use of computer systems and databases can dramatically reduce the research time; however, the databases must be kept current and be augmented with the institutional knowledge and field expertise of the inspectors. Another key element is the strong oversight of the coordinator, who ensures that all program elements are involved in the review process. The inspector in each NCDH program is required to sign the report form acknowledging the completion of that particular area of responsibility. Finally, there could not be an effective program without interagency cooperation. The license issuing agency, OCFS, the local health unit, NCDH, and NYSDOH must all understand the policies and procedures in order to ensure that child day care facilities are properly sited and that all preventable hazards are minimized.