This report discusses efforts to ensure and promote quality child care through enforcement of state standards and other activities. The Child Care and Development Block Grant Act of 1990 authorized the dispersing of funds to states for child care services through the United States Department of Health and Human Services (HHS). These funds are used for such regulatory activities as screening applicants for licensure as child care providers, on-site monitoring, and imposing sanctions. Other methods used by states to ensure safety in child care settings include educating parents, training providers, establishing complaint hotlines, and requiring liability insurance. The report details the insufficiency of authorized funds for improving quality in child care, and offers recommendations concerning ways HHS can improve safety in child care settings. Appendixes include a description of the scope and methodology of the study that produced this report, tables and graphs that present data on child care licensing and enforcement activities, comments from HHS, and a list of major contributors to the report. (PM)