TABLE 1.

Indicators of High Quality7

State licensing and program accreditationThe requirements for licensing generally ensure basic health and safety of a program but not necessarily high quality; state licensing requirements can be found online at http://nrc.uchsc.edu
Staff-to-child ratio and group size
    For centers
        Birth to 12 mo1:3 with groups ≤6
        13–30 mo1:4 with groups ≤8
        31–35 mo1:5 with groups ≤10
        3 y1:7 with groups ≤14
        4 and 5 y1:8 with groups ≤16
    Family child careIf there are no children <2 y: 1 adult/6 children; when there is 1 child <2 y: 1 adult/4 children; and when there are 2 children <2 y (the maximum), no other children are recommended
Director and staff experience and trainingCollege degrees in early childhood education
Child development associate’s credential
Ongoing inservice training
Parent’s first-hand observations of care
Low turnover rate
Infection ControlHand-washing with soap and running water after diapering, before handling food, and when contaminated by body fluids
Children wash hands after toileting and before eating
Routinely cleaned facilities, toys, equipment
Up-to-date immunizations of staff and children
Emergency proceduresWritten policies
All staff and children familiar with procedures
Up-to-date parent contact lists
Injury preventionPlay equipment safe, including proper shock-absorbing materials under climbing toys
Universal Back-to-Sleep practices
Developmentally appropriate toys and equipment
Toxins out of reach
Safe administration of medicines