TWIN FALLS — Clairissa Granquist pulled her daughter out of a child care center that smelled strongly of peanut butter.

It was a hazardous environment for 2-year-old Nora, who has a nut allergy.

The home-based day care provider wasn’t licensed by the state, but was recommended by her then-husband’s coworkers. She pulled her daughter from the facility after only one month.

“There were about 20 children under the age of 3, which I know for a fact is not legal,” said Granquist, a Shoshone resident.

She declined to disclose the name of the center, but said it’s not in Shoshone. For the past year, her daughter has attended a licensed child care center in Jerome.

“I really like to do state-certified day cares, which is really difficult to find in the Magic Valley unless you go to Twin Falls,” she said.

When a provider is licensed by the state, Granquist said she knows kids are getting adequate attention there. But more providers are needed — especially, in small, rural communities.

“You can’t drive kids all the way to Twin Falls just to turn around to go back to work,” Granquist said.

For parents who are working and need child care, weighing options and choosing a provider can be a significant hurdle. Providers also face obstacles like cumbersome state requirements, low pay and frequent employee turnover. When looking at inspection results for centers in the region, those challenges show. 

At least 65 percent of south-central Idaho’s 114 child care providers have received at least one critical violation during an inspection since 2011, a Times-News investigation revealed.

South Central Public Health District, a subcontractor of the Idaho Department of Health and Welfare, posts results on its website. Community members can search by the name of the business or street name, but there's no complete list of licensed providers.

Child care facilities must meet 31 requirements set by the Idaho Administrative Code during inspections. Those requirements cover topics such as adult-to-child ratio, immunizations, general safety, food temperatures and hand-washing facilities. There are no tiers to classify the severity of violations; they are all identified as "critical violations."

The good news: 36 south-central Idaho providers haven’t received a single violation since the beginning of 2011 — the oldest inspections included in the online database. And no local child care center has had its license revoked or suspended in recent years.

If a child care provider receives a critical violation during an inspection, they’re given a deadline by which to comply. Oftentimes, the providers fix the problem within a week — sometimes, even by the next day. Inspectors will often return for a follow-up inspection if there are several violations, according to Melody Bowyer, environmental health division director for South Central Public Health District.

There’s nearly a 100 percent compliance rate by the return visit, as the facility has a lot at stake.

”They are very highly motivated,” Bowyer said. 

Beyond just the regular inspection, Bowyer said the health district tries to provide education for child care providers on how they could improve. They are typically receptive, and she added that in some cases, conducting an inspection "is like visiting a longtime friend."

Assistant Teacher Kevin Kramer helps Rhett Brubaker put his shoe back on during recess Sept. 13, 2017, at the Twin Falls Reformed Church Kids Zone in Twin Falls. The Brubaker family has two children enrolled. Madison Brubaker got on the waiting list when she was 12 weeks pregnant with her son. He didn’t get in until he was 10 months old.

Across south-central Idaho, when a center receives a violation, it's typically for just one or two mistakes.  But over the years, eight have received three violations during a single inspection: Tots to Teens (2013), Right on Track Child Care (2017 and 2013), More Sunshine & Rainbows (2012), Little Einstein’s Christian Academy (2015), Lillypad Child Care Center & Preschool (2013), Doodle Bugs Daycare (2017), Boys & Girls Clubs of Magic Valley (2011) and All About Kids Preschool (2017 and 2015).

The largest number of violations during a single inspection was four: Binky to Backpack Daycare in Twin Falls in 2012 for hand-washing facilities, water supply/private wells/samples, fire safety and evacuation plans and general safety.

Since then, the number of violations at Binky to Backpack has dropped significantly, down to just one each year in 2015 and 2016.

Sherri Richens, the manager for the child care center, moved to Magic Valley 2 1/2 years ago — a few years after the inspection that resulted in four violations. The daycare center opened about five years ago — about the time of the 2012 inspection.

Big day cares like Binky to Backpack are inspected by many people, she said, and they come in unannounced during business hours. But she noted that "the inspections are not really a scary thing.”

In addition to regular inspections by the health district, the center’s food program also receives inspections. A lunchroom worker prepares homemade breakfasts, lunches and snacks every weekday.

Under its license, Binky to Backpack can accept up to 145 children. But right now, it averages between 60 and 70, and numbers drop during the summertime.

Since 2012, the day care — which has 10 teachers and one lunchroom worker — has modernized its processes, Richens said, such as using automatic withdrawal to accept payments instead of checks.

Parents sign their own children into the daycare, and have code numbers to get in and out of the building. A new computer system also provides a warning if more children are at the center than usual and if more employees are needed to keep the ratio of adults to children in check.

In Burley, Doodle Bugs received three violations during a routine inspection in June: immunizations, food temperatures/thermometers and postings.

Lacey Belliston started the day care out of her home two years ago so she could stay home with her youngest child while he was in therapy for hearing difficulties.

“I didn’t want to hire a nanny to do my job,” she said.

She has five full-time children enrolled, plus her two children and a few more children in part-time care. She doesn’t have any employees and does all of the work herself.

Preparing for an inspection entails making sure her home is safe for children, much like the process of becoming a new parent. That includes making sure cords are out of the way and electrical outlets are covered — the small things for which centers often receive inspection violations.

After gaining her state license as a daycare provider two years ago, Belliston posted on Facebook about her new daycare. All of the slots were filled within an hour.

“From then," Belliston said, "I have not had to advertise."

When is an inspection required?

Child care providers must have a license from Health and Welfare if they care for seven or more children and are paid to take care of at least one of them. 

Additionally, all child care centers must receive inspections if they participate in the Idaho Child Care Program, regardless of how many children they serve.

The program — which provides federal money administered by Health and Welfare — covers a portion of child care expenses for low-income families who are U.S. citizens or legal immigrants who are working, going to school or participating in approved training.

Assistant Teacher Kevin Kramer helps Rhett Brubaker put his shoe back on during recess Sept. 13, 2017, at the Twin Falls Reformed Church Kids Zone in Twin Falls. The Brubaker family has two children enrolled. Madison Brubaker got on the waiting list when she was 12 weeks pregnant with her son. He didn’t get in until he was 10 months old.

Day care providers who are certified to accept ICCP subsidies — and that’s about 90 percent of those licensed in Idaho — must undergo an inspection once a year. Others are inspected every two years.

South Central Public Health District inspects and oversees compliance for licensed daycare centers in south-central Idaho’s eight counties.

The health district also investigates complaints it receives via IdahoSTARS, a project that provides training for child care providers and resources for curious parents. Community members can call 2-1-1 to report a complaint to IdahoSTARS.

If inspection violations or complaints arise and a provider fails multiple times to make changes, IDHW could revoke their license, but that’s extremely rare.

In 2016, the health district conducted 150 child care inspections and 19 investigations. In all, the environmental health division employs 12 people — eight in Twin Falls, one in Blaine County, one in Jerome, one in Cassia County and one in Minidoka County — and more than half of them conduct inspections.

The health district rarely calls in advance of inspections, and will typically only do so if a provider has hours that vary. 

“In general, it’s unannounced,” Bowyer said. “We just show up.”

Common inspection violations

Some of the inspection requirements set by South Central Public Health District are self-explanatory and easy to meet. Others require a more difficult level of maintenance, and pop up frequently as violations.

The most common violations committed by child care providers are not having up-to-date immunization records for every child, not having a refrigerator thermometer or complying with food temperature requirements, and general safety, such as not covering electrical outlets.

When complaints come in, Bowyer said they're often from parents who are worried about a high child-to-staff ratio. The health district uses a point system to gauge whether a center has an adequate number of adults on site.

One of the toughest requirements day care providers have to meet — and something that often leads to a violation — is having up-to-date immunization records for every child.

“Immunizations are a dinger,” Eden said. But as of September, Twin Falls Reformed Church's Kids Zone hasn't received any inspection violations.

Child care providers must rely on parents to provide the latest vaccination information for their children, and vaccinations don't happen at a uniform time each year.

If there’s a violation for immunization records, the child care provider is asked to send records to SCPHD for a computer review, and they generally don’t receive a follow-up visit.

Another common challenge for providers is meeting the requirement of having regular fire drills.

At Twin Falls Reformed Church’s Kids Zone, the noise and the strobe lights terrified some of the children during the first-ever drill, Eden said. Some were scared and shaking, and didn’t want to come back into the building again.

But it’s helpful to have emergency drills, Eden said, particularly, to practice how to evacuate a building with infants.

At the day care, there are written protocols for different emergency situations. It’s so thorough it includes just about every situation imaginable — even a zombie apocalypse, a joke among the staff.

‘More challenging than I ever thought it would be’

Child care providers face hurdles to maintaining functionality, from ever-changing state requirements to frequent employee turnover.

Anyone hoping to obtain a day care license must fill out an application that accompanies additional requirements, including a criminal background check, proof of liability and fire insurance, an approved fire safety inspection, and proof of compliance with local ordinances. As of October 2016, providers who accept ICCP subsidies must also take online training classes.

But beyond the state requirements, Richens says the biggest challenge with operating a day care is retaining employees.

“The in-and-out in a year is unbelievable," Richens said. "We can’t keep a good staff.”

Between relatively low pay and it being a demanding job that keeps workers on their feet, employees must love the work in order to stay in the field.

Richens said she has heard complaints or comments from parents when another new teacher takes over.

Child Care Provider Kennedy Bell feeds a baby in her care Sept. 8, 2017, at St. Luke’s Magic Valley Medical Center Infant Day Care in Twin Falls. The day care accepts children up to 18 months.

“You never want that to happen, but you have no control,” she said.

Those retention issues are hardly unique to Binky to Backpack. Twin Falls Reformed Church, which operates preschool and after-school programs in addition to its day care, faces the same challenges.

Tiffany Eden, early childhood ministries director at Twin Falls Reformed Church, said frequent turnover is not good for parents, but admitted the position is "not a huge paying position" for day care workers. 

She said Twin Falls Reformed Church tries to ensure employees enjoy their job and pays at a rate higher than the state’s minimum wage of $7.25 per hour, though Eden declined to disclose the church's specific pay scale.

Sadie Adams, left, and Matthew Kaperleris, right, look at their books during reading time Sept. 13, 2017, at the Twin Falls Reformed Church Kids Zone in Twin Falls.

The church also offers a continuity of care bonus twice a year, in December and June, as an incentive for employees who stick around.

As a result of ensuring employees are compensated fairly, there are more costs in running the program. Those costs are inevitably passed down to families.

“We’re not a cheap child care,” she said. The church charges up to $600 each month per child for full-time, depending on the child’s age.

When Belliston first opened Doodle Bugs in Burley, she charged less than many bigger day cares. But over time, she has raised rates depending on demand.

“Pricing is hard because a lot of centers get a much larger volume of kids, so they can charge quite a bit less,” she said.

The purpose of in-home day care is to keep it smaller and give children more one-on-one attention, Belliston said, but that comes with a higher price tag.

Belliston plans meals and activities one month in advance. When she purchases anything for the day care, she sticks to a budget.

"It does take a lot of patience to do it because it’s definitely a lot more challenging than I ever thought it would be,” Belliston said.

‘We just knew the community needed a child care’

At Twin Falls Reformed Church, the decision to start a day care ministry came after several years of discussion and planning.

A church strategic health team began meeting in 2006, long before St. Luke’s opened its new hospital across the street in 2011.

The group saw a need for more child care options in Twin Falls and, specifically, in its blossoming northwest side of the city.

“We just knew the community needed child care,” Eden said.

First, the church built a wing for children's programming. Now, the church is in the midst of another financial campaign as it seeks to build additional space for the children's ministry.

Kids Zone is licensed to accommodate 101 children. Thirty more families are on the outside hoping to get off the waiting list and into the program. 

“We get calls all the time,” Eden said.

New this year, TFRC offers after-school care for first through third graders. As of September, 10 children were enrolled.

To prepare for health district inspections, Eden has contacted local emergency preparedness officials and the IdahoSTARS local office for advice on meeting state requirements, such as the evacuation plan and drills.

For all the challenges child care providers face, parents have their own set of complications to consider.

When deciding on a provider, they’re left to weigh factors such as safety and cost, and potentially compromise if they’re looking for something in a particular location. That makes the monumental decision of where to leave your child an even more complicated one.

“You have to make a choice and it sucks,” Granquist said. “It is not a fun choice to make, especially because it’s your children and you want what’s best for them.”