New York DOH-5166 CACFP Monitor Checklist, Day Care Homes

Enter the Provider's information: Provider Name, CACFP Number, Phone Number, Address and Capacity.

The Approval Year Begin Date should correspond to the date that the Continuous Application and Agreement for Day Care Home Participation (DOH-5160) was signed.

Select the license/registration category: Enrolled, Licensed or Registered.

This form must be completed during the on-site monitoring visit to the Day Care Home Provider's (Provider) home.

Enter date/time of visit and type (announced, unannounced, or initial).

Two of the three required visits must be unannounced.

A new Provider must have their initial monitoring visit within 28 days from beginning of participation (during the Provider's first month of claiming).

A meal or snack must be observed during at least one of the unannounced visits for the year.

If meals are claimed on weekends or evenings (supper or evening snack), monitoring visits should be scheduled during these times at least once per year.

Under Meal Component, list food items observed or reported by component, and indicate if the meal was observed or reported.

If monitor missed seeing meal, record what was served as reported by the Provider.

Up-to-date enrollment, attendance, menus and meal count records must be available for review.

The meal observed must meet requirements of the Child or Infant Meal Pattern.

The monitor should observe if the kitchen, food preparation area, and storage facilities appear clean and sanitary.

List all children PRESENT at time of visit and their age.

Review the Provider's files for enrollment documentation. Check if children are enrolled in care.

Enrollment information must be updated annually. Attach additional sheets if needed.

Children Absent: The monitor should ask the Provider if additional children are expected to arrive and receive the meal being observed. This will be useful to know when comparing observations of attendance to the Provider's records.

Provider's Own/Resident: Indicate the name, age and enrollment status for Provider's own or resident children present at time of review. NOTE: All of the Provider's children participating in CACFP must be enrolled.

A Provider that is not eligible to claim their children in CACFP must still report their children on attendance records when they are under school age (not yet enrolled in kindergarten) as they count toward the licensed/registration capacity.

Enrolled Provider Information: The Enrolled Provider, Legally Exempt or Informal Family Day Care Provider must care for at least one non-resident child for each month claimed. The Enrolled or Informal Provider cannot care for more than two non-resident/non-related children.

There is a capacity of eight when the Provider cares for eligible resident (Provider's own) and/or relative children while also caring for up to two non-resident, non-related children.

Corrective Action or Follow-Up Needed: The Sponsor should develop a corrective action plan for a Provider to follow when CACFP program requirements are not met during monitoring visits; i.e., require the Provider to submit enrollment forms by a certain date, or disallow meals when meal count and attendance records were not up to date.

If a previous visit found problems, indicate if they have been corrected by the Provider.

The form has a Monitor Signature with a Date and a Provider Signature with a Date, and the Provider marks Owner or On-Site Provider.

Post-Visit Review: When the Provider submits the monthly menu, meal counts and attendance record, Sponsors must review what was recorded for the date of the visit.

Disallowance or other Action: If there is a difference between what the monitor observed and what the Provider recorded for that date, meals should be disallowed accordingly.

Corrective action should be taken to prevent such discrepancies in the future.

CIPS Update: The monitor should obtain updated information on enrollment, hours of operation, meals claimed, etc. If there are changes, CIPS must be updated.