Utah child care providers that “continually violate” health and safety standards are not always penalized, and their licenses are not suspended.

The state’s assisted living centers — rapidly growing in number — are not regularly inspected, and delayed inspections are uncovering more serious violations.

Children with disabilities are not making the gains they once did with Baby Watch services. And that care is not being monitored — despite a policy requiring it since 2013.

Citing these findings and others, the state’s legislative auditor general called for reforms at the Division of Family Health and Preparedness in an 84-page audit released Tuesday.

The audit also criticized the division for its lack of transparency, such as failing to post inspection reports and policies online, as is common practice in other states.

The state auditor offered 21 recommendations, and, in a Nov. 7 letter, division Director Paul Patrick said the agency will implement each one. It was already revising some policies and procedures, he said.

The audit focused on three of the division’s six bureaus: Child Care Licensing, Health Facility Licensing and the Baby Watch Early Intervention Program.

‘Weak policies’ for child care

Child Care Licensing is supposed to examine childc are facilities twice a year. But when it finds repeated violations, it does not impose strong sanctions, the audit said.

In one example, an inspector recently found a child confined inside a portable crib that was covered with a trampoline inside a laundry room. The inspector called Child Protective Services, and officials recorded the finding, “but took no further action.”

The provider “had 14 cited findings and 16 repeat cited findings of the most severe level of violation during a four-year period,” the report said. “Stronger [Child Care Licensing] sanctions on these early violations may have prevented the child confinement violation.”

Auditors examined 20 providers that had received citations in at least three recent inspections. Half of them, the report found, had “a pattern of noncompliance that sanctions did not remedy, which is unsurprising due to the weak policies currently in place.”

In another case, inspectors repeatedly found children unsupervised at a different facility. “Despite the provider’s pattern of noncompliance since 2014,” the audit said, the bureau “imposed no sanctions in FY 2017 for three incidents in which children were left unsupervised.”

It also said the bureau needs policies to better protect children when a provider appeals sanctions. For example, the program does not increase monitoring of a facility while an appeal is underway, the report said. And other states have more clear, and publicly available, policies outlining the appeals process.

More ‘critical offenses’ in assisted living

The number of assisted living centers in Utah has grown by 18 percent in the past five years, the report said, and state officials are unable to perform regular inspections, or surveys, of the facilities.

In 2012, the Bureau of Health Facility Licensing and Certification did one survey per facility every 35 months, according to the report. By 2016, the duration had doubled to one every 70 months.

In the delayed surveys, inspectors are finding more frequent “critical offenses” than they were before, the report said.

In 2015, for example, a resident left a locked facility and was found dead in a courtyard due to weather exposure. A complaint was filed. Inspectors found staff had failed to monitor the resident or investigate the death; an in-depth survey of the facility had not occurred for five years.

“Utah lags behind other states in the number of surveyors and time between surveys,” the audit said. “As the elderly population is projected to nearly double by 2050, solutions are needed to provide protections to vulnerable aging adults.”

The report also discovered some providers weren’t submitting all names of new hires into the required screening system.

A ‘decline’ in children’s advances in Baby Watch

The Baby Watch Early Intervention Program provides services to children with developmental delays or disabilities, up to age 3. Care given by outside providers includes speech pathology, occupational therapy and physical therapy.

Children in the program are seeing fewer advances in their social and emotional skills, learning and behaviors, the audit said. And despite a 2013 policy requiring regular evaluation of services — interviews, observations and follow-up visits — that monitoring isn’t happening.

That makes it hard for state officials to evaluate the quality of services, auditors said.

“A lack of monitoring may have contributed to the recent decline in [Baby Watch] program performance,” auditors wrote.

The report also dinged the program for unclear and incomplete policies — for example, no requirement for background checks for providers.