In Virginia, thousands of day-care providers receive no oversight

In Virginia, thousands of day-care providers receive no oversight

The Post found there were at least 43 child deaths in such settings in the past decade in the commonwealth.

Published on August 30, 2014

On the edge of Roanoke, at the dead end of a blacktop road, Teresa Atwood’s small home doubled as a bustling day-care business. On Sept. 23, 2010, the house was crowded with infants and toddlers. Some were watching cartoons in the living room. Others, including 1-year-old Andy Ngo, were supposed to be sleeping in a bedroom.


Unregulated Day Care in Virginia

Part One | Read Part Two

ABOVE: Robert Ngo’s son, Andy, was found unresponsive at a Roanoke home day care in 2010. The 1-year-old died after being swaddled and flipping onto his stomach. Timothy and Teresa Atwood were caring for 10 kids that day. The state limit for unlicensed day cares is five. (Ryan Stone for The Washington Post)

But Andy was restless and screaming. So Atwood, 44, swaddled him in a blanket, which pinned his arms against his body, and put him on a queen-size mattress.

In a dark and cramped room, out of sight of his caregivers, Andy flipped onto his stomach. When Atwood checked on him 45 minutes later, he was facedown under a pillow, his body limp.

Atwood began CPR, but she was frantic and her training was out-of-date. Her husband searched for a cellphone to call 911 and tried to take over, but he was completely untrained.

“Help me do this ’cause she, she’s panicking,” he told a dispatcher.

Andy’s accidental asphyxiation occurred within Virginia’s unregulated child-care industry, where several thousand people who run home day cares operate in an environment without rules or standards. If they care for five children or fewer, they are exempt from licensing and regulations, including training requirements and inspections. There is no mechanism for anyone to check to see if they abide by the five-child limit — the day Andy died, Atwood was watching 10. By contrast, licensed day-care providers face two inspections a year, criminal background checks and mandatory training, including up-to-date CPR certification.

The state’s approach has left some children in disproportionate danger:

A Washington Post investigation found that Andy Ngo is one of at least 43 children who have died in unregulated child-care homes in Virginia since 2004, compared with 17 during that period in regulated settings. No state agency tracks how many children are in unregulated settings, but experts say that more children are in regulated care.

In Chesterfield, a 15-month-old boy died in 2006 when his neck was pinned under a 33-pound dog crate that his unregulated caregiver had placed on top of his crib to keep him from crawling out. In Virginia Beach, a 14-month-old girl drowned in a swimming pool in 2007 after she wandered through an unsecured door while her unregulated caregiver was doing laundry upstairs. Just over two weeks ago in York County, a 16-month-old girl was strangled by a car-seat strap after her unregulated caregiver allegedly left her unattended for hours to go to a veterinary appointment.

Lynne Williams, director of the Virginia Department of Social Services’ licensing division, which regulates child care, said she is always concerned by the number of fatalities among unregulated providers but not entirely surprised given the absence of rules or standards of care.

“We know children receive care in unregulated settings and that some of those settings are unsafe,” Williams said. “These facilities are not inspected or monitored in any way, and unfortunately there’s little we can do to prevent incidents from happening. For unregulated facilities, we are only able to investigate after a complaint is filed or if we receive an allegation of an illegal operation.”

A Washington Post investigation found that 60 children have died in Virginia day cares since 2004.

Cause of death:
Illness or natural causes
Unknown circumstances *

Nearly three quarters of the children died in unregulated child-care homes, where providers face no inspections, training or background checks.

The vast majority of children who died in Virginia day cares are under 1 year old.

About half of the children died in sleep-related cases.

Abuse cases accounted for nearly a quarter of deaths in unregulated day cares. In licensed day-care facilities, no deaths were linked to abuse.

* Seven of these cases were classified as sudden infant death syndrome (SIDS) or sudden unexpected infant death (SUID), but with no other details publicly available. They could have been sleep-related. SOURCES: Local and state Child Protective Services’ reports of abuse and neglect; rulings by the state medical examiner’s office; civil and criminal court records; police reports; news reports; obituary listings; social media; and state Department of Social Services licensing records. Link directly to this graphic.

Most states have stricter regulations than Virginia for in-home day-care providers. Child Care Aware of America, a national child resource group, ranks Virginia in the bottom eight states, based in part on the number of children who can be watched without a license. The District, Maryland and 10 other states require licenses if a provider cares for any child who is not a relative. Eleven states have limits equal to or less-stringent than Virginia’s, with South Dakota allowing up to 12 children in an unregulated home.

On their own initiative, Fairfax and Arlington counties and the city of Alexandria require that day-care providers — regardless of size — have a permit, a background check, training and an inspection. The three Northern Virginia jurisdictions are the only ones in the state that regulate all day cares. The fatality rate for children in day care in those jurisdictions is less than half the rate of comparable counties in the Hampton Roads area of southeastern Virginia, The Post found.

It is difficult to compare Virginia’s 43 deaths in unregulated settings over 10 years with fatalities in other states, because of variations in state laws and spotty tracking by state and federal authorities. No government agency in Virginia tracks day-care deaths in both regulated and unregulated settings, but The Post was able to document 60 fatalities since 2004 by using public records requested from state and local agencies, including annual child fatality summaries, along with police reports, court filings, local news accounts, social-media sites and interviews.

“They are rare but important events, largely because so much of infant child death is both premature and preventable,” said Virginia Powell, fatality review program manager for the state’s medical examiner.

For decades, Virginia has struggled with how to regulate day care. The shortage of licensed day-care providers complicates the issue. Critics have pushed for more regulation, but others fear it would exacerbate the problem. The unregulated help provide affordable and convenient day-care options for struggling families.

“In general, there is a reluctance in Virginia to impose excessive regulatory burdens on anyone,” former lieutenant governor Bill Bolling said in a recent interview with The Post. “You need to be able to justify it with a compelling argument.”

Video: 'Everything she said was a lie'

Play Video

In 2012, Elly Lafkin's daughter, Camden, died while in the care of an unregulated child-care provider. Though she conducted a background check, it was not until after the funeral that Lafkin learned about the provider's criminal past. Now, Lafkin is among those leading the fight to change Virginia's laws regarding unregulated caregivers. (Whitney Leaming/The Washington Post)

Sudden, unexplained

Of the 43 deaths in unregulated homes, The Post’s review found that 22 were sleep-related, 10 involved physical abuse, three were accidental and one was natural. In seven cases, the causes were unclear in the available records. All but one of the sleep-related deaths involved risky actions taken by caretakers, records show. These included leaving infants to sleep in an unsafe setting or failing to check on them for extended periods.

In 2010, 7-month-old Finnigan Bales was found unresponsive in an upstairs bedroom in a Virginia Beach townhouse where Deborah Blaney ran an unregulated day-care operation. He had not been “checked on or fed for hours,” according to an investigation by the local branch of Child Protective Services.

Blaney had too many children in her care — seven — and eventually was convicted of operating a day-care program without a license, a misdemeanor. She was sentenced to serve 10 days in jail.

In 2010, 7-month-old Finnigan Bales was found unresponsive at a Virginia Beach home day care. (Family photo)

Finnigan’s mother, Megan Bales, said she and her husband interviewed Blaney and checked her references, but they learned that Blaney had no license only after Finnigan died.

“They don’t even know what time Finn passed away,” Bales said.

A cause of death was never found, and Finnigan’s case was classified as sudden unexplained infant death (SUID), an umbrella category that covers several types of sudden death for children younger than 1.

Nationwide, about 4,000 infants die each year with a SUID diagnosis, according to the Centers for Disease Control and Prevention. These include deaths due to the better-known diagnosis of sudden infant death syndrome (SIDS), in which the death remains a complete mystery.

A SUID ruling can indicate risk factors present at the time of death, such as leaving children unattended, using loose bedding or placing infants in a dangerous sleeping position that could lead to accidental suffocation or strangulation.

State officials consider sleep-related deaths to be largely preventable. A recent state study of sleep deaths concluded that 95 percent were preventable, with the vast majority linked to an unsafe sleep environment.

To this end, regulators prohibit licensed providers from placing infants facedown to sleep or letting them sleep with pillows or in adult beds. Caregivers also are required to check on sleeping infants every 15 minutes or use remote baby monitors.

Charisse Black, a former senior assistant commonwealth’s attorney in Virginia Beach who handled the Finnigan Bales case, had questions about how often Blaney checked on Finnigan. But Black said Blaney was not subject to the state laws that require licensed providers to monitor infants.

“That’s really what the problem was in this case,” Black said. “She wasn’t being inspected and she wasn’t being trained, as a result of not being licensed.”

Black said she viewed the 10-day jail sentence for Blaney as a “slap on the wrist.”

Blaney told The Post in a brief interview that she has never moved on from Finnigan’s death. “It bothers me every day of my life,” she said.

Blaney said she is no longer taking care of children.

“I don’t agree with social services and the way they license,” Blaney said. “They are only concerned with light bulbs and the area, not the person. . . . I’m 64 years old. I know what I’m doing. I love kids.”

Legislative hurdles

Virginia has long debated regulations for child care. In the late 1960s, the state required a day-care license for anyone caring for an unrelated child. But as the number of working mothers began to surge in the 1970s, lawmakers relaxed the rule, allowing up to three children and eventually five in unregulated care.

The debate peaked in Virginia in the late 1980s, with high-profile cases drawing outrage and calls for reform. A Woodbridge caregiver was caught with 16 children in her home. In Fairfax, a 10-month-old girl died of a drug overdose in a caregiver’s home. Statistics on overall day-care deaths are unavailable for that era, but the state estimated that 100,000 children were in unregulated day-care settings.

Gov. Gerald Baliles, a Democrat, prioritized the issue and called a conference of the state’s leading child-care experts, who laid out a goal of universal licensing. In 1989, the Virginia General Assembly’s oversight agency recommended a major overhaul for the system.

“If the State’s primary goal for regulation of child day-care is protection of children in care, the reasons for not regulating all day-care providers should be compelling,” the Joint Legislative and Audit Review Commission concluded.

But the forces against change were strong.

“There was always pushback, always. From Day One,” Eva Hardy, then the state secretary of health and human resources, said of the opposition from churches, which were exempted from licensing in 1979, and private providers.

The governor’s office was peppered with letters. “I wish to remind you — again — that proposing any part of our government to intervene in private business does nothing other than decrease our level of living!” a man from Woodbridge wrote.

In an 11-page letter, a child-care advocate detailed her concerns about the proposed overhaul. “I prefer for parents to oversee the care of their children, where possible, rather than increased government regulation,” she wrote.

In February 1990, the Virginia House was on the verge of regulating caregivers who watched even one child, but lawmakers eliminated the proposal before the bill could go to the Senate.

“They just didn’t want to regulate sitters,” Del. Mary A. Marshall (D-Arlington) said at the time. “. . . There was a feeling that there’s just too much state intervention.”

The issue keeps coming up. In 2011, the Virginian-Pilot wrote about child abuse and neglect cases in day-care settings. The newspaper reported 16 fatalities statewide from 2005 to 2010, most of them occurring in the care of unregulated providers.

Other states have grappled with how far to go in regulating day care. All but 12 states permit some form of unregulated care.

In 2011, the St. Louis Post-Dispatch documented 45 deaths over four years in child-care settings in Missouri, where providers do not need a license if they care for four children or fewer, one less than Virginia’s limit.

Most of the Missouri deaths occurred in unlicensed settings and were sleep-related.

The stories sparked protests at the state capitol and bills to increase oversight. But the legislation did not pass. Carol Scott, head of Child Care Aware of Missouri, said opponents argued that licensing would hurt small family operations and that the state should not be telling women how to raise children.

“It was too controversial,” Scott said. “It’s a don’t-tread-on-me mind-set.”

The warning signs of a risky day care

Hover over a warning sign for information

SOURCES: State regulations and interviews.

High costs, high demand

One of the great stumbling blocks for change in Virginia is the high cost of affordable and reliable child care. For regulated child care, costs can exceed $300 a week per child. That cost reflects the background checks; mandatory training and certifications; mandatory staffing ratios; and child-proof facilities that meet state standards for square footage and safety.

Even at those prices, waiting lists for licensed providers can stretch beyond a year. Some parents sign up for care prior to conceiving a child.

There are about 7,700 regulated providers in Virginia, with slots for about 364,000 children. The number of children who need day care is more than double the licensed supply, according to census data. No one tracks the number of unregulated providers or how many children are in their care. Sharon Veatch, head of Child Care Aware of Virginia, estimates that nearly 200,000 children are in unregulated settings.

Statewide, more than 10,000 children who qualify for government child-care subsidies are on waiting lists. Military families face similar delays for spots in federally run facilities.

Unregulated providers have a role in reducing this burden, at a more affordable price for families — about $100 a week.

Many balk at regulating what has often been an informal sideline for women experienced in child-rearing. Some are young mothers who want to earn cash while staying at home with their own children. Others are grandmothers.

“The argument I often hear is, ‘Why should we regulate Grandma?’ ” Veatch said. “I truly don’t believe that licensing in and of itself makes someone a better provider. But licensing does give that basic health and safety baseline. And it does put them on the radar screen.”

The rules for licensed family day homes appear in an exhaustive 120-page manual that encompasses everything from washing hands after changing a diaper, to cutting up hot dogs and grapes for snacks, to securing firearms.

Licensing is no guarantee of safety. In 2009, a 1-year-old boy died of heat exposure after he was left unattended by his caregiver for more than seven hours inside a day-care center van in Richmond.

In Maryland, where caregivers who care for even one unrelated child must be licensed, the overall fatality rate in day-care settings is comparable to Virginia’s, according to data compiled by officials at the request of The Post. In the District, officials said they have kept no statistics on day-care deaths.

This year, new federal rules will force Virginia and all other states to increase oversight of providers who receive federal subsidies, which are available to licensed and unlicensed providers. About 1,300 unlicensed providers in Virginia received subsidies last year, records show. But the vast majority of the unregulated — estimated to be in the thousands — will remain off the radar.

In Virginia, the unregulated are expected to police themselves on the one and only rule that applies to them: the five-child limit. At least seven of the deaths in the Post study were at homes with more children than the providers could legally watch.

On March 8, 2012, police in Prince William County found 23 children at the unregulated Little Angels of the World in Bristow after caretakers called 911 to report a dying infant, 10-week-old Teagan Sample. Police saw toddlers wandering the halls, babies sitting on couches and infants in cribs.

“It was almost like a child-care factory. They were trying to fit as many kids in there as they could,” said Paul Ebert, the commonwealth’s attorney for Prince William. “That child may very well be alive had there not been so many children there.”

Teagan was found in one of the 10 cribs that filled a windowless basement room of the 3,400-square-foot residence. Rescue personnel said she was cold. Two caregivers said they had been checking on her regularly.

The medical examiner could not find a cause for Teagan’s death and classified it as undetermined. Prosecutors said the autopsy revealed “that asphyxiation was a possible cause of death.”

One of the Little Angels owners, Rocio Del Pilar Chavez Pacheco, claimed on a Web site that her day care was “state licensed” and “met or exceeded all health and safety guidelines.” But prosecutors alleged in court that the operation was “unlicensed, understaffed, and illicitly operated.” Pacheco and her husband, Joan Carlo Barra, were not there the day Teagan died.

Pacheco, 39, was convicted of felony counts of obtaining money by false pretenses and child neglect. Barra, 40, was convicted of misdemeanor charges of operating an unlicensed day-care center. Both received suspended sentences and probation. Neither agreed to an interview.

Prosecutors also charged the two women who had cared for Teagan. “With only two day-care workers, our point was these children were not even getting the minimal care,” said Sandra Sylvester, an assistant commonwealth’s attorney in Prince William who prosecuted the case.

But the judge dismissed the case against one of the caretakers after her attorney argued that Pacheco and Barra were to blame. Prosecutors then dropped the second case.

The caregivers had complained to the owners that they had too many children, prosecutors said.

Some parents were angry at the prosecutors. “They said they got great care and couldn’t imagine why we’d shut them down,” Sylvester said.

‘I lost it’

Ten of the children who died in unregulated settings had signs of physical abuse, including broken bones, brain injuries and internal bleeding. No abuse fatalities were found in licensed homes during the time of the Post study.

Several of the caregivers admitted to acting out of frustration.

In Virginia Beach, Brenda Kay Garner was paid $100 a week by a neighbor to watch 2-year-old Garrett King.

Brenda Kay Garner was convicted of murder in 2012 in the death of Garrett King, 2, in Virginia Beach. (Virginia Department of Corrections )

On Nov. 14, 2012, Garner, who had been taking care of Garrett for six months, called 911 to report that he had suddenly started gasping for breath. The back of his skull had a jagged, 3.5-inch fracture. He died the next day.

Garner soon confessed. As she changed his diaper, Garrett began to scream. She stood him up and knocked his feet out from under him, over and over. A “swoop to the legs,” she called it.

“I lost it,” she told police.

Garner, then 34, was convicted at trial of second-degree murder and sentenced to 22 years in prison. She declined The Post’s request for an interview.

Garrett’s family had no reason not to trust Garner, said Paul Powers, an assistant commonwealth’s attorney in Virginia Beach who prosecuted the case. “She’s a churchgoing woman with five kids of her own,” he said.

In Virginia, mandated background checks keep people with criminal records in the state out of the regulated day-care industry. But nothing prevents felons from working as unregulated providers.

Cassandra L. Gray, now 32, was on probation from a felony conviction for forging a prescription for narcotic painkillers in 2008, according to court records. But she still cared for children at her home without a license.

On Sept. 15, 2011, 11-month-old Rick Alan Bodine Jr. was found dying inside Gray’s home in Loudoun.

Rick, called “P’Nut” by his family, was one of five children at the home. About 12:30 p.m., he was put in a portable playpen in the living room. He was found unconscious about 2½ hours later, records show. A doctor pronounced the boy dead at the hospital about 3:43 p.m., noting that he had been deceased “a while,” records show.

Cassandra L. Gray was not charged after an 11-month-old in her care, Rick Alan Bodine Jr., died in Loudoun County in 2011. (Loudoun County Sheriff’s Office)

The medical examiner said overheating or hyperthermia “cannot be excluded” as a factor in Rick’s death, according to an investigator’s report. When he was found, he was layered in clothing, wearing a onesie, terry-cloth pants and a Redskins sweatshirt, and was also covered by a blanket.

But the cause of death was ultimately ruled “undetermined.”

“There is no evidence to suggest any wrongdoing or criminal act on the part of anyone that [led] to the death,” Loudoun County sheriff’s investigators noted in their report. “There is nothing further that can be done.”

Gray declined to comment.

The boy’s father, Rick Alan Bodine Sr., said that in hindsight he realizes how little he knew about the universe of child care. He assumed all day cares were licensed and inspected. He did not find out about Gray’s background until after his son died.

“As a young adult, you don’t know what a caregiver is supposed to be like,” Bodine said. “At 24 years old, you don’t go, ‘Let’s see your tax books and let’s see if you have referrals.’ You just don’t do that. I had no idea.”

The boy’s grandmother, Deborah Santos, said she asked detectives repeatedly how Gray could be a felon and still care for children.

“They said they can’t do anything,” Santos said. “. . . There is no law saying that you can’t watch five kids if you are a felon.”

Roanoke police detective Holly Willoughby, at the house where 1-year-old Andy Ngo was found unresponsive in 2010, when it was a home day care. Willoughby recommended charges of felony child neglect, but the couple who ran the day care were not charged. (Ryan Stone for The Washington Post)


Robert Ngo said that he told Teresa Atwood not to swaddle Andy, a fact that Atwood later confirmed. Ngo, 29, was worried that his son was too big and could suffocate, he said. “She said she’s never done it and she’s not going to do it,” Ngo told The Post in a recent interview. “I just trusted her.”

Ngo, who emigrated from Vietnam as a child, worked at a tire factory in Roanoke. Atwood had cared for Ngo’s daughter years before.

Ngo said he assumed she had a state license and had undergone training.

Atwood did have a local business license that allowed her to operate a commercial enterprise out of her home in Roanoke. But she had never been licensed by the state to care for children. She had run the day care out of her 900-square-foot home since 1993. The house had three small rooms where she said she kept five to six children, according to court records.

After her husband, Timothy, lost his job as a truck driver, he began helping her. Atwood later said in a deposition that she then increased the number of children in her care.

The day that Andy died, Atwood said she and her husband were caring for 10 children, ranging in age from 4 months to 3 years. Andy’s grandfather had dropped him off at Atwood’s home at 9 a.m. Andy had taken his first steps that week and was restless, Ngo said. After lunch, one of the Atwoods laid him on a soft mattress with loose bedding and stacked pillows around him. When he cried and screamed and failed to fall asleep, she bound his upper body in a blanket, she later told police.

She then went to finish lunch and help her husband with the other children in another room.

When she returned, Andy was on his face under a pillow, “limp as a rag” and warm, she told police.

She began CPR, which she had learned 17 years earlier. If she had been licensed, she would have been required to update her CPR training every two years. As Atwood tended to Andy, Timothy spent three to four minutes searching for a cellphone, though he later said it “seemed like forever,” court records show. They had no land line, a safety requirement for licensed facilities.

“Babe, you can’t just stop the CPR,” Timothy told Teresa while he was on the phone with a 911 dispatcher, according to a recording of the call at 3:09 p.m. “Don’t blow so hard, babe. . . . Oh my God. Babe, that’s not how you do the CPR.”

911 call

This is the audio of the 911 call Timothy Atwood made on Sept. 23, 2010, when 1-year-old Andy Ngo was found unresponsive at his wife’s unregulated day care in Roanoke.

By the time help arrived at 3:13 p.m., Andy’s lips were blue.

He was pronounced dead at the hospital at 3:49 p.m.

He died from a lack of oxygen to the brain, due to the combined impact of the swaddling, his sleeping position in an adult bed and the sedative effects of an antihistamine, according to the autopsy report. The autopsy report described the level of antihistamine in his 20-pound body as a “therapeutic concentration for adults.” The medical examiner ruled the death an accident.

Police never determined how Andy ingested the antihistamine. Both the Atwoods and the Ngos denied giving the medicine to him.

“The little fellow didn’t give it to himself,” said Roanoke police detective Holly Willoughby, who investigated the case. She said she recommended that prosecutors with the commonwealth’s attorney’s office file charges of felony child neglect.

“It was the totality of it. . . . She had too many kids. She didn’t have a license. She had swaddled a child that was too old to be and who she was asked not to swaddle,” Willoughby said. “He was probably fighting and struggling. . . . He ended up facedown, and he smothered himself in the pillow.”

But Roanoke Commonwealth’s Attorney Don Caldwell said there was not enough evidence to prove the case beyond a reasonable doubt.

“You can have the worst circumstances in the world, but sympathy doesn’t equate to proof,” he said. “Not every tragic event is going to find its relief in a criminal court. . . . The criminal justice system cannot fill the void. You can’t bring anyone back from the dead.”

The local Child Protective Services found that Teresa and Timothy Atwood had neglected Andy, records show.

“It was an awful incident. I don’t want to relive it,” Teresa Atwood said in a brief telephone conversation.

The Atwoods’ insurance company denied a claim that they filed over Andy’s death. Only months before, the insurance company had told them to reduce the number of children in their care to comply with state law — or get a state license, records show. Ngo filed a wrongful-death lawsuit, but the case stalled after the Atwoods filed for bankruptcy.

Part Two: The story of 3-month-old Logan, who died in an unregulated home day care in Portsmouth, Va.

Ngo said Andy had just begun to talk. “Daddy” was his first and only word.

“He never got to say ‘Mommy,’ ” Ngo said.

Julie Tate, Jennifer Jenkins and Caitlin Gibson contributed to this report.

About this series

In Virginia, there is no central registry of child deaths in unregulated or regulated child-care settings. The Department of Social Services’ licensing division is aware of deaths only in licensed facilities, which report to the agency.

Local Child Protective Services agencies investigate only the deaths in which abuse or neglect is suspected. A recent state study found no record of a review for more than half of sleep-related deaths. Child-fatality review teams affiliated with the state medical examiner study only the deaths that are reviewed. Local police generally investigate all child deaths, but those records are not centralized.

To identify deaths, The Washington Post obtained 10 years of electronic inspection records from the Department of Social Services. The Post also examined abuse and neglect reports from the state’s Child Protective Services. Records requests were also filed with social-service and police agencies in dozens of localities. Reporters reviewed news reports, court cases, social media and obituaries. The Post excluded fatalities in one-time babysitting scenarios.

No one knows the number of children in unregulated settings. In the late 1980s, state officials estimated 100,000 children were in unregulated care. The Post examined census data and workforce statistics and consulted on estimates with Sharon Veatch of Child Care Aware of Virginia, a nonprofit agency serving parents. In Virginia, there are 364,000 regulated child-care homes and facilities. Veatch estimates that nearly 200,000 children are cared for in unregulated settings.

Editor’s picks

5 states that have grappled with day-care regulations

Lawmakers have debated how much day-care regulation is enough, and how much is too much.

Questions to ask a potential home day-care provider

In the search for child care, a list of questions for caregivers can guide parents as they make decisions.