Sue Houck's child care business in Wilkinsburg is a rarity -- a small, home-based facility that consistently receives the highest marks from a voluntary statewide rating system.
But it also has something in common with Bray's Family Day Care, the Garfield home where, according to police, a 7-year-old girl fatally injured an infant on June 6 when the caregiver was out of the room.
Both businesses have seen almost four years elapse without a visit from a state Department of Public Welfare health and safety inspector.
"Four years? Four years? That defies logic," said Linda Smith, executive director of the National Association of Child Care Resource & Referral Agencies, or NACCRRA. "At the end of the day, the finger needs to be pointed at the oversight of all this."
In April, the Arlington, Va.-based organization released a report -- "Leaving Children to Chance" -- that gave Pennsylvania's inspection system a dismal ranking.
It is one of just nine states that does not require family child care homes -- or those that can have no more than six unrelated children at one time -- to be inspected regularly. The NACCRRA report gave it zero points out of a possible score of 140.
The report also criticized the state for not sending inspectors to view the family child care homes before granting a certificate of registration.
"Would you go into a restaurant that didn't have to have an inspection?" Ms. Smith said.
There are 9,076 registered child care facilities in Pennsylvania. The Department of Public Welfare, with 59 inspectors for the whole state, does annual inspections at large facilities, but the department performs random checks at just 15 percent of the state's 4,180 family child care homes each year.
Inspectors will make extra visits to the small facilities if there is a complaint. The homes also have to send copies of occupancy permits from local authorities before they can receive registration certificates. Any adults working or living in the homes must send proof of criminal background checks from the state police and, starting July 1, the FBI.
The state has the voluntary Keystone STARS program, started in 2003, which rates child care facilities. It awarded Mrs. Houck's home four stars for meeting high standards of care, but many facilities don't participate.
Jennifer R. Lau, licensing director for DPW's Office of Child Development and Early Learning, said Pennsylvania's inspection standards are set by the Legislature and date back to 1981, when there were far fewer care homes in the state (and fewer working mothers).
Only lawmakers can revise the system, she said. And any mandate to hire new inspectors would be costly.
Smaller, but more flexible.
Denise Cressman, president of the Pennsylvania Home Based Child Care Providers Association, said she thinks all care facilities should be inspected regularly.
Her organization has as many as 700 members across the state.
Like Mrs. Houck, Ms. Cressman runs a child care business at her home, in Danville, Montour County, that has earned four stars under Keystone STARS (an acronym for standards, training, assistance and resources.)
That means she reaches a set of state standards -- verified by regional program representatives -- for her skills as a caregiver and a provider of a rich learning environment, with puzzles, blocks, reading games and other tools that force children to exercise their minds.
But a DPW health and safety inspector last visited her home in 2001, Ms. Cressman said.
Most parents are unaware of the inspection disparity between family child care homes and larger facilities. But that shouldn't stop them from choosing the smaller homes for their children, advocates and caregivers say.
"The most important inspector is the parent," said Terry Casey, president of the Pennsylvania Child Care Association. "Get a sense of the environment. Most importantly, get a sense of the provider's interaction with the children.
"All children should be supervised by an adult at all times.".
Ms. Cressman, a care provider for 23 years, said parents choose family child care homes because they prefer to put their children in a "family environment.
"It looks like a home," she said. "Kids learn here through things that are done in homes every day."
The smaller care homes also provide a flexibility that can't be found at larger, commercial facilities with fixed hours. Up until several years ago, Ms. Cressman operated 24 hours a day, seven days a week. A single mother who was a medical resident at a nearby hospital would often leave her son there overnight.
Also, Ms. Cressman has flexible pricing, charging about $140 a week for infants and younger children and $125 for older children. But she voluntarily cuts her prices at times, including situations where the state's subsidy program for low-income parents pays only up to $125.
A large child care facility can cost about $200 a week for a young child or an infant.
Not a 'baby sitter'
Mrs. Houck, 53, the Wilkinsburg care provider, also prides herself on running a top-rated facility in the house she has lived in since she was in the first grade.
"People call me a baby sitter, and I just grip my chair," she said as she cared for four children last week. "We're not just baby-sitting. I do not use a TV. I do not use videos. I let the kids use their imaginations."
She said her family child care home was one of the first to receive four stars when the Keystone program was launched in 2003 because she is accredited by the National Association for Family Child Care.
The care center occupies only the first floor of her two-story, four-bedroom brick house. (Mrs. Houck lives upstairs with her husband.) The walls are lined with books, board games, puzzles and a detailed daily calendar of activities.
"I'd like to take you Downtown for questioning," 9-year-old Elijah Jones told 7-year-old Shaleese Jackson, as he sat on the floor and played with a wooden car driven by a Bert figurine (one of "Sesame Street's" duo Bert and Ernie) in the role of a police officer.
Mrs. Houck also participates in the federally funded Head Start program, which does send inspectors, at least twice a year. That means she posts almost every imaginable list of safety procedures, covering medical emergencies, dental emergencies, first aid for choking, an "action plan" for asthma and another plan for reducing the risk of sudden infant death syndrome.
She even posts the federal Department of Homeland Security's color-coded "National Threat Advisory" for terrorist attacks.
Mrs. Houck, with more than three decades of experience, charges about $125 per week per child. She, too, accepts state subsidies for low-income families.
Sally Janis, a magazine writer who lives in Forest Hills with her husband, has been bringing her two children, Logan and Riley, to Mrs. Houck's (or, as they call it, "Miss Sue's") since 2005.
"I was looking for a day care facility that had Keystone stars," she said. "I love that there's no TV here."
Mrs. Houck tries to bring the children outside frequently to nearby parks. On Friday, she was planning a trip to the National Aviary.
Unlike the state's inspection program, STARS receives praise from many national and local child care advocates. It's one of only 14 similar programs nationwide.
Some, including Ms. Smith, of NACCRRA, think it should be mandatory.
But Harriet Dichter, deputy secretary for the state's office of child development, said such a move likely would be controversial, especially since almost 5,000 child care centers -- including both large and family care homes -- already participate, reaching about 177,000 children.