A Jacked-up system makes for messy childcare....

I am not one to get on soap-boxes (typically), but there is so much ignorance about Childcare.
I love that there is a department that makes it their business to see that children are kept safe.  I love that there are rules that people have to follow in order to be "licensed".  Rules are important.  Rules save lives and keep kids safe.
But, please understand that rules for the sake of rules and taken out of context niether protect children, nor reflect accurately what happens in a facility.
Many people (in Texas) are uninformed about the role of State licensing - and exactly how they go about enforcing thier "minimum standards". Things are going to happen when there are children in a facility.  Let's face it, things happen at home when they are with mom.  How many times do children fall down and hit their heads, or get scratches on their knees - at the park - with their mom's who love them and are watching them carefully.  How many times do children get bitten while playing at a local fast food place with perfect strangers.  It happens.  Children are children, and that in and of itself means there will be incidents.
If a center is honest, they will "self-report" when things happen.  That means, even though no one else is going to "tell" on you - you call State when something happens at the center that is outside of the minimum standards.  Self-reporting is a minimum standard - and again, I highly approve of that.  However, most centers do not self report.  And, I will tell you why.  There is no benefit in doing so.  Other than a personal moral belief system that would dictate honesty, there is really no good thing that comes from reporting yourself as a center.  The center is thus "investigated" and typically cited with high non-compliances that stick with the center for 2 years.  The teacher typically does not have any accountability for her actions - but no matter the course of action the center takes against that teacher, they will hold the center liable for 2 years.  There is no difference in the penalty when a center reports itself (which shows honesty and integrity in the leadership), and when a center does not report an incident - but gets "caught" when a parent or other staff member (with integrity) reports it.  At this moment, let me tell you that I do have a personal moral belief system that dictates honesty and integrity.  I follow Jesus Christ and I will obey the laws of the State, because, it honors my God to do so.  That is the only reason I self-reported after witnessing the consequences of that honesty.
Many people when they are looking into the records of centers in their area, do not understand that the "Center" doesn't actually commit the non-compliance (this is the terminology for "breaking the rules").  It was not the building, and not (typically) the Director or Assistant Director that chooses to make a decision that leads to a non-compliance.  It is typically a staff member - acting on their own that chooses not to obey the standard.  However, it is reflected on the center and the Director - and not on that staff member.
For example (based in real life):  A staff member goes to 8 trainings in 6 months.  In those trainings, she (along with everyone else) is repeatedly told not to ever leave a child unsupervised.  Two of the trainings are very specific and informative about EXACTLY what supervision means.  This staff member is trained to always count her children (by name and face) and has a clipboard with a list of her children in her class with her at ALL times.   However, one day this staff member gets ill (stomach virus - hits during class) and calls for another staff member to take her class.  She has just come into the classroom from the playground and hands her clipboard to the incoming staff member and runs to the bathroom to be sick.  She (because she was going to be sick) did NOT do a name to face count of her children before she handed her class over to the incoming teacher.  The incoming teacher immeditely takes the clipboard and does a name to face count and realizes she has one less child than her roster says.  The outgoing staff member had left a child on the playground.  She immediately calls for another "floater" (this is a teacher who is on staff simply to help when children need to go to the bathroom or have accidents) and that teacher runs out to the playground and retrieves the child (who has been left alone for less than 3 minutes) and is still "hiding" in the playhouse.  Here are the options available to the Director:
1.  Report it to State licensing and call the parent and tell them what happened.
2.  Hide it and hope that the staff members don't report it - after all the child was only 2 and he won't be talking about it.
I submit to you that because of the "system" - most centers will never report the incident.  That is not how we ever handled business, but it was certainly difficult when faced with the reality of what self-reporting meant to our center.
What that means to the parents:  The online number of "deficiencies" is meaningless.  You can see which centers have self reports.  But, you have no idea just because your center doesn't have any reports - if they are actually being honest in their dealings.  Some centers have incredibly high numbers of deficiencies, but it is because 1. they self-report and 2. they are inspected more frequently.  You have to check out all the numbers to have any sort of accurate picture. For example if a center is inspected 3 times in 2 years and has 15 deficiencies - that means they have approximately 5 deficiencies per inspection.  If a center has 20 inspections and has 40 deficiencies - it looks worse (because 40 is obviously higher than 15), but in reality, they had only 2 deficiencies per inspection.  They just had a higher volume of inspections.
Some centers are only inspected once a year.  My staff and I went and observed at one such center.  We were appalled by what we saw.  This "top-notch", (and State funded) center was full of non-compliances - and I was so proud of my staff for knowing them and "citing" them in their heads.  That means they KNEW their minimum standards and can realize when people aren't meeting them.  We saw staff members not wash their hands after changing dirty diapers.  We saw that they did not use safety straps (which at the time was required by state law).  We saw them allow children to walk around with their cups(against state law).  We saw them wash those cups out in the "dirty" sink (which is the sink they were supposed to wash their hands in after changing diapers).  We saw the playground had "unitary surfacing" that was 6 inches below state requirements.  We saw a child run out a door headed towards the parking lot and he made it all the way to the parking lot before the teacher caught up with him.  We checked to see if that was reported by the staff or Director (though the Director did see it happen).  It was not.  We saw children eat their lunches without washing their hands.  We saw a LOT of non-compliances.  But, their record is virtually blemish free - and they are only inspected once a year.  They have on average 6 non-compliances during that visit.  But, still - they are scheduled only one visit per year, and they are hailed to be amazing by the State.
In the case of the vomiting staff member...  how would you as a parent like your center to deal with it?  What does justice look like?  I will tell you how I, as the Director, handled the situation.  That staff member was fired that day.  We spend many hours in training.  We are responsible for people's children.  That requires an above averge need for common sense and quick thinking.  She did not make sure her entire class was inside before she left them.  Even if she had grabbed a trash-can, done her business, and then made sure her entire class was in, I would have "gone to bat" for her.  But, she did not do that.  And a child was left unattended on the playground.  She was dismissed immediately, and I hired and trained a new staff member to take her place - while instituting a substitute teacher for the class in the meantime.  Here's what it meant for me, as the Director.  Even though she was dismissed immediately.  Even though I had proof of her attendance at the meetings where we discussed all of these things regularly.  Even though she had years of experience when I hired her.  It cost me big time.  We did self report.   We called the parent immediately.  They were completely not upset, because their child has a propensity for hiding and trying to be "sneaky".  They thanked me for calling and that was that.  But, we did "take care of business".  We reported it to the State.  And that, was the beginning of many bad things.  The staff member responsible went on to work at another center.  It cost her nothing.  I was cited as the Director for not doing my job.  The "center" was cited for many deficiencies because the child was left outside unattended.  That stays with my center, but the teacher responsible has no accountability.  She can do the same thing at the next center she goes to.  It reflects on our record for 2 years, no matter how it is dealt with.  I am cited for not doing my job, no matter how much training I had given her personally, and no matter that it was not my decision to leave the child unattended.
So what does that mean for the parents?  How can you KNOW if your center is good or not?
I recommend really knowing the director and your child's teachers. Be involved!
Spend time asking questions.  Check the reports online, but remain open to hear how the center handles those situations.  Read the policies and procedures for the center.  Be friendly.
Find out what happens to the employees who make bad decisions.  
Go into the center different times during the day during the first few weeks of care.  Are you welcome there anytime - or do they ask you to schedule a time to come?
When something happens (a diaper is leaking out the sides)- do they make excuses, or do they "own" the problem? Do they apologize and is the problem fixed?  Are there repeated problems with the same teacher that don't get handled?  Does the Director take time to talk with you, or does she act like you are wasting her time?  Does your child like their teacher?
Other advice:  Don't get worked up over a scratch from the playground (unless it happens repeatedly - or is because of some faulty equipment).  Remember that your child gets cuts and scrapes at home too.
Be realistic.  If your child is just learning how to walk - expect that there will be knots on the head from lack of balance.  It just happens.
If your child has a dirty diaper one day (and you pick them up on the playground) give a little grace.  Did they offer to change it for you when you brought it to their attention?  Does it happen every day, or just every now and then? 
Always talk to the teacher and then the Director when you have a problem.  Don't leave angry and never address it when something happens.  The Director can not improve the program (or rid the program of problem staff) if it is not brought to her attention.  But, the teacher deserves to hear your complaint before she is pulled aside and talked to by the Director.
And finally, don't believe what you read on yahoo and other outlets.  The parents that love their centers usually don't post (unless the parent is a staff member) - those sites are typically outlets for people who are angry because their child got kicked out for being undisciplined, or they were asked to leave for lack of payment.  They will make up all manner of things to "get back" at the center.  Disgruntled staff also like to post things, but usually the reason they are "former" employees is that they did not do their job well, so they were fired.  You can not trust what they have to say  - you have to KNOW the staff yourself.  You have to know if your center operates honestly.
Unfortunately (in Texas) I have found the scales are not balanced.  Some centers have favor with the state and others do not.  There is no way for a center (without spending thousands of dollars) can balance those scales either.  It is just a flawed system.  Very few lawyers will take cases against licensing.  It requires too many hours of work - and it is very difficult to combat the brokenness of the system.
It is your responsibility as the parent to know what happens at the center your child attends.  Be informed.  Know the Director.  Know the staff - and if you love the center your child goes to - post that places (like yahoo) and be an avid supporter - not a quiet supporter!  Parents want to know where the good places are!