EARLY BEGINNINGS CHILD DEVELOPMENT CENTER

REPEAT 15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs.- Observed some specialty milk in kitchen refrigerator without date. Ensure to receive the unopened container of specialty milks at the beginning of the week, put name and date that was received, send home or discard at the end of the week either opened or unopened containers.

15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions.- Observed bottle warmers in infant rooms need cleaning and keep clean.

REPEAT 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed slow draining at hand sink in Safari need repair. Observed cleaning needed under hand sink in Fairy. Observed disrepair surface around diaper sink in infant 2 need repair. Keep all hand sinks clean and in good repair.

General Comment: 15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area.- Observed no paper towel available in the dispenser at hand sink in Ocean. Ensure to provide all hand washing supplies at all hand sinks at all times.

General Comment: 15A NCAC 18A .2820 (d).Medications, including prescription and non-prescription items, shall be stored in a locked cabinet or other locked container and shall not be stored above food.- Observed Benadryl stored in the ziplock bag along side with Abuterol in outside bag in Ocean. All Medications, including prescription and non-prescription items, shall be stored in a locked space. Except the emergency medication (e.g. Epi-pen or inhaler) that can be store at 5ft.

15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed hand lotion stored in a drawer in infant 1 less than 5ft. Ensure to keep/store all non hazardous items at 5ft or higher at anytime.

15A NCAC 18A.2803 (e). Handwashing procedures shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing the hands under tempered water for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands.-Observed teacher is washing her hands after diaper changed, and turn off faucet knob with bare hands. Proper hand washing reviews in detail with teacher at the time of inspection. NOTE: Ensure to use correct hand washing sink after diaper changed. Use diaper sink, NOT food prep sink.

General Comment: 15A NCAC 18A .2804 (k) Hot foods that a child brings from home to the child care center in double-walled, insulated thermos containers may be stored outside of refrigeration at the child care center with the written permission of the child's parent or guardian.- Observed infant food in regular glass container in infant 2 stored inside a cabinet, not in the refrigerator. Observed lunchable package in the lunch box with ice pack in Safari room sat on top of the cubby. Ensure that potential hazards food items are stored properly at anytime, either inside the refrigerator to maintain cold temperature at 45F or below OR in the double walled-insulated thermos container along with written parent/guardian permission form that was signed and dated. NOTE: 15A NCAC 18A .2806 (h) The temperature of potentially hazardous food provided by the child care center for consumption by children shall be 45 degrees Fahrenheit or below, or at 135 degrees Fahrenheit or above at all times, including field trips, catering events, and outdoor service, except during periods of preparation and service immediately prior to consumption.

15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs.- Observed several specialty milks in the kitchen refrigerator without date received at the center. Ensure to label clearly both name and date that was received at the center. 15A NCAC 18A .2804 (d) All human milk, formula, and other bottled beverages, including beverages in sippy cups, that are sent from home shall be fully prepared and labeled with the date received at the child care center and the name of the child to whom the milk, formula, or beverage belongs before being brought to the child care center.- Observed bottles in infant 2 labeled incorrect date (11/16, 11/18). Ensure to label clearly and correctly on each bottle for that day.

General Comment: 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed several hand sinks in classroom not including (club house, ocean) need repair, new caulking. Keep hand sinks in good repair.

General Comment: 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed toy/clean sheets/clean laundry stored in the restroom in some classes. Only restroom related items are permitted to be stored in the restroom.

15A NCAC 18A .2812 (i) An approved disinfectant shall be provided for cleaning purposes. When a chlorine solution is prepared by a child care center employee for use as an approved disinfectant, then the solution shall be prepared for use within 24 hours, and a testing method shall be used to ensure compliance with the prescribed chlorine concentration (500 -800 ppm).- Observed teacher is using sanitizer solution to clean diaper table instead of disinfectant solution that was provided in the classroom. CDI- Correct cleaning solution to use for specific cleaning purposes discussed in detail with teacher at the time of inspection.

REPEAT 15A NCAC 18A .2820 (f) A child's coats, hats, bags, and other items or accessories belonging to a child that are stored using cubicles, lockers, or coat hooks shall not come into contact with stored items belonging to other children.- Observed children jackets are hanging in infant 2 touching each other. Store individual items separate and not allow touching while storing at anytime. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock.- Observed teacher purse stored on top of drawer in unlocked closet in club house, less than 5ft. Put personal belongings that contain no hazardous items at 5ft or higher at all time.

General Comment: 15A NCAC 18A .2804 (a) In child care centers, food shall be kept free from spoilage, filth, or other contamination and shall be safe for human consumption.- Observed a box of raw ground beef patties in the freezer of infant 2, stored next to mouthing toys. CDI- The toy item removed and place above the raw item at the time of inspection. Ensure to keep raw food separate from clean ready items to avoid any possible cross contamination.

REPEAT 15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children.- Observed hot water measured at 111F-113F in club house, 114F in Train, 114F in restroom bears, 115F in Dino. Ensure to provide tempered water between 80F-110F where is accessible to children.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed damaged toilet seat in several classrooms. Replacement needed. REPEAT 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed slow draining at hand sink in club house and ocean. Repair needed.

REPEAT 15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed hand lotion and sanitizer in drawer in cabinet stored less than 5ft in Dino. Observed hand sanitizer bottle at front desk less than 5ft. Ensure to store all non hazardous items at 5ft or higher at all time.

General Comment: 15A NCAC 18A .2820 (f) A child's coats, hats, bags, and other items or accessories belonging to a child that are stored using cubicles, lockers, or coat hooks shall not come into contact with stored items belonging to other children.- Observed children book bag that contains diapers stuff hanging on hooks in restroom touching each other in Jangle. Ensure to not allow individual items touching while storing.

General Comment: 15A NCAC 18A .2804 (k) Lunches, snacks, and other meals containing potentially hazardous foods shall be refrigerated at 45 degrees Fahrenheit or below and stored in the child care center kitchen or approved food preparation area.- Observed fried rice in student lunch box in the cubby in 4’s classroom measured 71F. Ensure to maintain required temperature at 45F (cold food) and/or 135F (hot food) at all time. NOTE: 15A NCAC 18A .2804 (k) Hot foods that a child brings from home to the child care center in double-walled, insulated thermos containers may be stored outside of refrigeration at the child care center with the written permission of the child's parent or guardian.- EHS and director assistant and director discussed detail in this rule if the center choose to not put in food items that require temperature in refrigerator when it comes from home for student’s lunch.

General Comment: 15A NCAC 18A .2812 (g) A testing method or equipment shall be used in accordance with the product manufacturer's instructions to test the strengths of sanitizing solutions to ensure the prescribed concentrations are met.- Observed sanitizer solution concentration was between 500-750 ppm. Director fixed the solution. NEnsure to provide chlorine concentration between 50-200 ppm for sanitizer solution at all time.

General Comment: 15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be kept clean and in good repair.- Observed rusted rack for bottle warmers in Infant 1. Provide good repair item to the classroom.

General Comment: 15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children.- Observed hot water at hand sinks in in Train restroom measured at 112F. Provides tempered water between 80-110F.

15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed some hand sink throughout the center need better cleaning all around the surfaces, covered with dust, and new caulking/backsplash maybe needed for easily cleanable.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area.- Observed no soap available at food prep sink Clubhouse. Ensure to provide all hand washing supplies at all hand sinks at all time.

REPEAT 15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands.- Observed teachers are changing diapers and missing step 3-6, and 11. When washing hands, ensure to follow proper hand washing procedures, turning the faucet knob off with paper towels. EHS discussed proper steps with teacher at the time of inspection.

General Comment: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed 2 aerosol cans of shaving cream in broken lock cabinet in Bear. All hazardous items shall be kept in lock cabinet at all time. NOTE: **Lock storage rooms and cabinets shall include those which are unlocked with a combination lock, electric or magnetic device, key pad, key, or equivalent locking device. Store/keep keys at least 5ft or higher at all times.**

REPEAT 15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed hand sanitizer bottle on the sink counter in Bear and Clubhouse. Observed little lotion, lip gross in little basket near the sink counter less 5ft in Bear. Observed disinfectant wipes in the lower cabinet under diaper sink in Clubhouse. Ensure to put all non hazardous items at least 5ft or higher at all time. 15A NCAC 18A .2820 (c) Bulk soaps shall be kept inaccessible to children by storing the product at least 5ft above the floor.- Observed bulk container of soap in lower cabinet under diaper sink in Clubhouse. Keep all bulk soap up at 5ft or higher at all times. 15A NCAC 18A .2820 (c ) Sanitizing, disinfecting, and detergent solutions shall be labeled with the product name (ex. "Sanitizer").- Observed spray bottle in women staff restroom and spray bottles in cabinet in Dino and Train. Ensure to labeling all the bottles if it is not in its original container even it’s just a water.

General Comment: 15A NCAC 18A .2804 (h) After the completion of each feeding, any leftover formula, human milk, or other bottled beverages used during the feeding shall be discarded or sent home with the child whose name is on the label for the formula, human milk, or bottled beverage at the end of each day. Feeding is complete when the child care center employee has stopped feeding the child and the child has been removed from the feeding area in the child care center and returned to other activities. Bottles previously used for feeding shall not be returned to communal mechanical refrigeration.- Observed teacher putting bottle on the counter and when asked, bottle will be fed to a child again in about an hour. Education provided about there is not an hour rule for feeding. Once the feeding is complete and everyone proceed to new task, the use of bottle is finished. Suggestion maybe to bring small portion as many as needed for a child throughout the day.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands.- Observed teachers are changing diapers and missing or mix/match the step 3-6 and wash a child’s hands at the food prep sink. Proper steps discussed with teacher at the time of inspection. Ensure to use the correct designated hand sink for diaper changing, and/or disinfect and practice change of use of a sink properly each time.

REPEAT: 15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed disinfectant wipe container in unlock cabinet bottom shelf less than 5ft in Club House. Ensure to store all approved non hazardous items at 5ft or above. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock.- Observed teacher purse hanging on the hook in unlock cabinet in Train less than 5ft. Ensure to put item at 5ft or higher at all time.

REPEAT 15A NCAC 18A .2804 (k) Lunches, snacks, and other meals that a child brings from home to the child care center shall be labeled with the date on which the food is brought to the child care center and the name of the child to whom the food belongs at the child's home and shall be returned to the child's home or discarded at the end of each day.- Observed lunch/snacks/ baby foods brought from home in infant rooms without date received at the center. Ensure to put name and date when received. 15A NCAC 18A .2804 (d) All human milk, formula, and other bottled beverages, including beverages in sippy cups, that are sent from home shall be fully prepared and labeled with the date received at the child care center and the name of the child to whom the milk, formula, or beverage belongs before being brought to the child care center.- Observed bottles in infant refrigerator without date received, one bottle dated 6/7. Ensure to check and make sure name and date received are on items and send/discard all items at the end of each day.

15A NCAC 18A .2810 (f) A classroom food preparation area countertop shall be kept clean and in good repair. All equipment shall be kept clean.- Observed soiled looking/dusts covered/on/around the food preparation area/counters throughout the center. Soiled refrigerator, need details cleaning. Keep all areas and equipment clean.

PROVISIONAL ITEM: REPEAT 15A NCAC 18A .2815 (e) Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children.- Observed utility faucet outside near parking and way around to the playground. There is no lock/gate around the shed where the faucet located, made it accessible to children when walking by. Hot water measured at 130F at the time of inspection.

General Comment: 15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean.- Observed water fountains, left hallway need better cleaning all around surfaces, nozzles, spouts, crevices where hard to reach. Keep them clean.

General Comment: 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed leaking sink, underneath sink in Dino. Repair needed. Observed throughout the center, around hand sinks caulking maybe needed, keep area clean and easily cleanable.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed book/toy shelf, pillow, play items, mat/rug stored inside the share infant restroom.

General Comment: 15A NCAC 18A .2819 (b). Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair.- Observed disrepair diaper pad on changing table in club house. Need repair/replace.

PROVISIONAL ITEM: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed weed killer, bugs/yard chemicals spray in containers/aerosol cans in the unlock storage box/cabinet where outside near the parking where the utilities faucet/mop sink is. All hazardous items must be locked at all time. NOTE: **Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keep key at 5ft or higher at all time.**

REPEAT: 15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed hand lotion bottle stored on cabinet shelf less than 5ft in preK. Ensure to store all non hazardous items at 5ft or above. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock.- Observed teacher purse hanging on the hook in infant room and on cabinet shelf in preK stored less than 5ft. Ensure to put all non hazardous items at 5ft or higher at all time. 15A NCAC 18A .2820 (c) Bulk soaps shall be kept inaccessible to children by storing the product at least 5ft above the floor.- Observed big container of soap stored in cabinet less than 5ft in clubhouse.

REPEAT General Comment: 15A NCAC 18A .2822 (a). In rooms designated for children who are not toilet trained, toys and other mouth-contact surfaces that are used by children shall be cleaned and then sanitized after each use and when visibly dirty. Toys and other mouth-contact surfaces shall be cleaned and sanitized as follows: (1) the items shall be scrubbed in warm, soapy water, using a brush to reach into any crevices; (2) the items shall be rinsed in clean water; (3) the items shall be submerged in a sanitizing solution for at least two minutes or in accordance with the instructions on the label of the sanitizing solution; and (4) the items shall be air dried. --According to teacher in classrooms where mouthing toys present. The dirty toys were collected and put in dirty bin and get clean at the end of the day. Teacher spray sanitizer solution on toys and let them air dry. Proper toys cleaning discussed with teacher and director assistant at the time of inspection. All dirty toys shall be washed/rinsed/sanitized properly in the kitchen at the three compartment sinks. Or 3 step bins suggested, label (wash/rinse/sanitize). Some toys that cannot not be submerged in water after washed and rinsed, the sanitizer spray can be used. All toys that can be in the water shall be submerged in sanitizer solution for at least 2 minutes and let air dry after. Ensure to use/provide the correct strength of sanitizer solution when cleaning toys each day and store the sanitizer bin at 5ft or higher.

15A NCAC 18A .2804 (k) Lunches, snacks, and other meals that a child brings from home to the child care center shall be labeled with the date on which the food is brought to the child care center and the name of the child to whom the food belongs at the child's home and shall be returned to the child's home or discarded at the end of each day.- Observed pediasure milks that belong to a child in the the kitchen refrigerator without name and date that was received at the center. Ensure to put name and date when received. 15A NCAC 18A .2804 (g) After opening, jars of baby food shall be covered, labeled with the date on which they were opened, refrigerated and used within two days of opening, provided that the baby food is not served directly from the jar.- Observed infant room, baby food that was open sat out on the counter. When asked teacher how to store leftover food, stated that it went back in the cabinet and not refrigerator. EHS educated teacher to follow proper way to handle baby food that is not used in once going forward. 15A NCAC 18A .2804 (d) All human milk, formula, and other bottled beverages, including beverages in sippy cups, that are sent from home shall be fully prepared and labeled with the date received at the child care center and the name of the child to whom the milk, formula, or beverage belongs before being brought to the child care center.- Observed on bottle in infant refrigerator without date. Ensure to check and make sure name and date received are on items sent from home. 15A NCAC 18A .2810 (f) Water from hand wash lavatory shall not be used for bottle warming or to prepare formula, mix dry cereals, or other foods. Observed teacher in infant room used water from food prep handwashing sink to warm the bottles in the warmer. Water needs to come from the kitchen or bottle water, not from the hand sink.

15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions.- Observed soiled bottle warmers in infant room. Need cleaning daily and keep clean.

15A NCAC 18A .2812 (g) A testing method or equipment shall be used in accordance with the product manufacturer's instructions to test the strengths of sanitizing solutions to ensure the prescribed concentrations are met.- Observed the kitchen without the QAC test strips for sanitizing solution at the 3 compartment sinks. Director is ordering item at the time of inspection.

General Comment: 15A NCAC 18A .2815 (e) Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children.- Observed utility faucet outside near parking and way around to the playground. Hot water measured at 127F. Director will install lock faucet so hot water cannot be turned on without keys or lock storage to prevent access from children.

General Comment: 15A NCAC 18A .2816 (b) (1) Child care operators, as defined under G.S. 110-86(7), shall test, once every three years, all water outlets used for drinking or food preparation. Samples shall also be collected and tested within 30 calendar days of completion of any renovations or repairs that may impact the facility's drinking water infrastructure, such as repair or replacement of all or part of drinking water service lines or faucets, at impacted outlets. The operator shall provide documentation of testing results for review by the Department during each unannounced routine sanitation inspection.- Observed the facility last water testing for lead was 10/9/2020. The director is already scheduled to attend a seminar with RTI on 12/12/23. The facility will follow the requirements and once test result comes in, Director will give an update at the next inspection.

15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key.- Observed following items stored less than 5ft: hand sanitizer bottle on the hand sink counter in ferry room, sanitizer and lotion bottle in infant room, swiped wipes in safari, hand lotion in Dino. Ensure to store all non hazardous items at 5ft or above. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock.- Observed key hung on the wall less than 5ft to unlock the cabinet that has teacher purse in there. Key put up above 5ft at the time of inspection.

General Comment: 15A NCAC 18A .2822 (a). In rooms designated for children who are not toilet trained, toys and other mouth-contact surfaces that are used by children shall be cleaned and then sanitized after each use and when visibly dirty. Toys and other mouth-contact surfaces shall be cleaned and sanitized as follows: (1) the items shall be scrubbed in warm, soapy water, using a brush to reach into any crevices; (2) the items shall be rinsed in clean water; (3) the items shall be submerged in a sanitizing solution for at least two minutes or in accordance with the instructions on the label of the sanitizing solution; and (4) the items shall be air dried. --According to teacher in classrooms where mouthing toys present. The dirty toys were collected and put in dirty bin and get clean at the end of the day. Teacher spray sanitizer solution on toys and let them air dry. Proper toys cleaning discussed with teacher and director assistant at the time of inspection. All dirty toys shall be washed/rinsed/sanitized properly in the kitchen at the three compartment sinks. Or 3 step bins suggested, label (wash/rinse/sanitize). Some toys that cannot not be submerged in water after washed and rinsed, the sanitizer spray can be used. All toys that can be in the water shall be submerged in sanitizer solution for at least 2 minutes and let air dry after. Ensure to use/provide the correct strength of sanitizer solution when cleaning toys each day.

Label all baby bottles, sippy-cups, and bottled beverages sent from home with the child's name and date it was brought into the facility. 15A NCAC 18A .2804 (d). Observed a couple speciality milks brought from children’s home labeled with name and no date. For the volume of speciality milks, the center is doing a great job labeling the milk’s with child’s name and date.

Keep toilets and urinals clean and in good repair. 15A NCAC 18A .2817 (a). Observed 1 loose toilet seat in “Ocean” classroom.

Hand washing signs shall be posted at all hand washing areas. 15A NCAC 18A .2818 (e). Observed handwashing sign missing at handsink in “Safari” classroom. EHS advises center to post handwashing signs at all sinks (to include sinks in classrooms that only teachers utilize).

Follow the correct diaper changing procedure as described in 15A NCAC 18A .2819 (d). Observed teacher not wipe her hands with a wipe before placing clean diaper on child. EHS advises center to ensure the correct diaper changing procedure is being followed.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Observed aerosol shaving cream stored on high shelving in “Ocean” classroom. Teachers properly locked aerosol shaving cream behind lock and key during time of inspection.

Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock. 15A NCAC 18A .2820 (f). Observed purse stored in unlocked cabinet below 5 feet in “Bears” classroom.

Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed child sized “cozy” chair in “Safari” classroom in need of repair around edges of chair.

In areas where children are not toilet trained, small mouth contact toys shall be washed, rinsed, sanitized (submerged for 2 minutes), and allowed to air dry, after use and more frequently when visibly dirty. 15A NCAC 18A .2822 (a). Observed teachers in infant classroom rinsing off pacifiers in handsink. EHS advises center to follow the notated steps to properly clean pacifiers. EHS recommends that center have parents provide 2 pacifiers so that when 1 is being properly cleaned the child has a back up that is already cleaned. The backup pacifier may be stored in a clean plastic container within the child’s designated cubby or within a cabinet in classroom.

Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed minor touch up paint needed to walling throughout classrooms within center. Observed carpet in need of repair near administration check in area and “Dino” classroom.

Keep all light fixtures clean and in good repair. 15A NCAC 18A .2826 (a). Observed 1 light bulb missing in storage closet in “Tran” classroom. *NOTE: Assistant Director, Charice Harper, was present during time of inspection. Report emailed to center at: Charper@earlybeginningscdc.com

Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b). Observed changing mat pitted / damaged in need of replacing inside (infant) classroom.

Approved non-hazardous products must be stored 5 ft above the floor or behind lock and key. 15A NCAC 18A .2820 (b), (c ) and (d). Observed hand creams and hand lotions stored below 5ft inside unlocked drawers inside (Train room / Safari room); CDI lotions and hand creams stored in cabinets above 5ft during inspection.

REPEAT Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed counter top back splash area water damaged in need of replacing inside (safari) classroom; (note) many of the back splash molding is being replaced. Observed numerous classrooms having ripped / damaged books in need of removal.

Observed several containers of specialty milk in the kitchen refrigerator with names, but no dates that they were brought into the facility. *REMINDER: If bulk milk from home is provided, ensure it is brought into the facility unopened labeled with the name and date, and sent home at the end of the week. All food shall be stored and handled in a manner that protects it from contamination. 15A NCAC 18A .2806 (d),(f), .2807 (b), and .2808 (e).

Observed some sanitizer bottles at disinfectant strength, some the correct strength, and others weak. Remake all to the proper strength. (The facility already has the sanitizer/disinfectant makeup handout from the Health Department). Prepare a wipe-on or spray-on sanitizer daily at 50 to 200 ppm chlorine. 15A NCAC 18A .2812 (d)

No Points Deducted: -Observed old food buildup on and under the high chair trays as well as on the chair portion (on the arms and under the cushions) in both infant classes. -Observed buildup in both of the oven drawers. Clean out all debris. Keep all non-food contact surfaces and equipment clean and in good repair. 15A NCAC 18A .2812 (f) and .2809 (1) and (3).

Observed the water at the handsinks at 114F then drop. The water continued to fluctuate up and down throughout while turned on. Provide a plumber to regulate water temp to 80F-110F. Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. 15A NCAC 18A .2815 (e).

No Points Deducted: -Observed a sand box stored in the restroom in the Train room. Remove to follow the rule below. -Observed a sweater hanging in the restroom in the Bears room. " " Limit storage in restrooms to toileting and diapering items only. 15A NCAC 18A .2817 (a).

-Observed some of the disinfectant bottles below 500ppm chlorine and a few the correct strength. Remake all to the correct strength. Prepare disinfectant between 500-800 ppm chlorine daily. 15A NCAC 18A .2819 (c ) and .2801 (7). -Observed no disinfectant test strips. Provide to test the bottles. Provide test strips for the chlorine disinfectant. 15A NCAC 18A .2819 (c )

-Observed some of the cot sheets stretched and moved allowing the children's bodies to be on the cots while they are sleeping. Provide new cot sheets that fit properly. *Linens shall be large enough to cover the entire sleeping surface of mats, cots, and crib mattresses. 15A NCAC 18A .2821 (f). -Observed holes/rips in multiple crib mattresses. *Keep all mats, cots, and cribs clean and in good repair. 15A NCAC 18A .2821 (a). -Observed some of the crib mattresses absorbent. It was asked if mattress covers were ok to use. Answer: If the mattress is fully enclosed, a mattress cover can be used. It is the choice of the facility. *All sleeping mats, used during nap time, shall be waterproof, washable, and at least 2 inches thick. 15A NCAC 18A .2821 (b).

-Repeat: Observed the backsplash damaged and separating from the walls in several classes. Repair all needed areas. -Observed sticky residue on book/toy shelves. Clean all areas. -Observed buildup on toys in several classes (dolls, large kitchen sets, etc.) -Observed contact paper peeling off of the toy shelves and the wood chipped in areas on other toy shelves. Repair areas of disrepair or replace.- Clubhouse room. Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b).

-Observed a hole at the bottom of the door in the Dino room. Per the PIC, all of the outside doors around he building are to be replaced. -Repeat: Observed walls in need of repainting/cleaning. Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

No Points Deducted: -Observed dust buildup on the ceiling vents in several rooms. Clean dusty areas. -Observed the ceiling vent hanging/detached from the ceiling in the Dino room. Be careful and have it reattached. Keep all ventilation related equipment clean and in good repair. 15A NCAC 18A .2826 (b).

REPEAT Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed back-splash at hand sinks throughout classrooms damaged by water or in need of general repair.

REPEAT Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed walls scuffed on corners near hand washing stations throughout classrooms in need of touch-up painting.

REPEAT Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed tape residue stuck to wooden toy cubbies in need of removal in some classrooms especially (Ocean Room).

REPEAT Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed wall damage inside kitchen in need of repair.

Keep all ventilation related equipment clean and in good repair. 15A NCAC 18A .2826 (b). Observed ventilation grates and intake vents in need of general cleaning.

Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b). Observed pitted / worn center of changing pad inside Infant room in need of replacing (general commented prior inspection).

Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed tape residue stuck to wooden toy cubbies inside classrooms (Dino, upper age rooms). Observed back splashes behind hand washing sinks inside classrooms water damaged in need of repair. Observed cardboard boxes damaged in need of replacing inside (Dino) classroom.

Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed wall scuffed in need of touch-up painting inside classrooms.

Observed hot water 116F in restroom of Clubhouse class and 112F in Train class. Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. 15A NCAC 18A .2815 (e).

Repair counter around diaper sink in Bunnies class. Keep handwashing sinks clean and in good repair. 15A NCAC 18A .2818 (a).

Observed items other than diapering items stored in restroom between Bunnies and Frogs classes. Limit storage in restrooms to toileting and diapering items only. 15A NCAC 18A .2817 (a).

Observed hand sanitizer stored on food prep sink, less than 5ft. (Clubhouse) Approved non-hazardous products must be stored 5 ft above the floor or behind lock and key. 15A NCAC 18A .2820 (b), (c ) and (d).

Observed stain in hand sink and toilet in unused restroom between infants classes. Keep toilets and urinals clean and in good repair. 15A NCAC 18A .2817 (a). Keep handwashing sinks clean and in good repair. 15A NCAC 18A .2818 (a).

Observed debris under diaper pad in Train room. Observed handwashing completed before cleaning/disinfecting diaper table in Train room. Must wash hands at the end of diaper procedures (including clean/disinfecting). Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b). Follow the correct diaper changing procedure as described in 15A NCAC 18A .2819 (d).

Observed baseboard separating from wall behind toilet in Jungle 2 and Ocean(far restroom). Observed stains on wall to wall carpet and Abc animals carpet in Dinos room. Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Observed hand washing sink soiled in young 2 room and older 3 room. THOROUGHLY CLEAN AND DISINFECT SINK AT LEAST DAILY AND BETWEEN CHANGE OF USE! Replace damaged back splash behind hand washing sink in pre k 2 room. Do not attempt to repair backs plash; replace. Keep hand washing sinks clean and in good repair. 15A NCAC 18A .2818 (a).

Replace damaged diaper changing pad in toddler 1 and toddler 2 class. Replace damaged diaper changing table in toddler 3 room and clean lower cubby area of diaper changing table. Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).

Repaint /touch-up paint throughout in all classrooms, door framing and exit door leading out to playground area. Repair or replace damaged carpet in older 3's room. Clean spots on rugs in older 3's room or replace stained carpet. Replace damaged transitional floor molding at entrance to 3's room. Patch holes in wall and repaint in bathrooms where mop and broom holder were located. Replace damaged light switch cover in older 2's and young 3's bathroom. Secure loose rubber cove base molding behind toilet in young 3's. Repair and repaint corner of walls in classrooms where trash are stored. Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Remove thorny vegetative growth from fence line in playground area! Replace missing pedals on tricycles. Replace damaged cover for sand box. Replace damaged roll out gutter diverter located within playground area. Remove bin containing water from storage shed area within the playground area. Keep the property free of standing water. 15A NCAC 18A .2831 (b). Keep the property free of high vegetation. 15A NCAC 18A .2831 (i). Sand boxes must be covered when not in use and kept clean. 15A NCAC 18A .2832 (c ) (2). All play ground equipment must be kept clean and in good repair. 15A NCAC 18A .2832 (c ).

Repair counter top and back splash around hand washing and diaper changing hand washing sink in infant room. Thoroughly clean and disinfect food prep hand washing sink in infant 1 room. Observed sink soiled in infant 1 room. Replace damaged toilet seat in bathroom between infant 1 and infant 2 class. Tighten loose toilet seat in bathrooms(pre k 2 and young 3). Repair and replace damaged back splash on hand washing sink counter in pre k 3. Sinks shall be cleaned and disinfected at least daily, when visibly soiled, and when the designated use of the hand washing sink has been changed. 15A NCAC 18A .2818 (c). Keep hand washing sinks clean and in good repair. 15A NCAC 18A .2818 (a). Keep toilets and urinals clean and in good repair. 15A NCAC 18A .2817 (a).

Replace diaper changing pad in infant 1 room with exposed threads from diaper changing pad being attempted to be repaired. Replace stained diaper changing pads throughout classrooms at diaper changing tables. Observed diaper changing pads on tables stained! Replace damaged diaper changing table with damaged base and borders throughout in rooms. Observed wood paneling base and side wood/particle borders on table damaged from soapy water and disinfectant solution being used to clean and disinfect tables. Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).

Observed several cribs not labeled in infant 2 room. Cribs labeled at time of inspection. Observed old tape adhesive on corner of sleeping cots throughout in several classroom. Thoroughly clean old tape adhesive from corners of sleeping cots. Monitor and replace crib mattresses in infant 1 and infant 2 room. Observed corner of crib mattresses being pinch by tight fitting sheets causing corners of mattresses to crack. Keep all mats, cots, and cribs clean and in good repair. 15A NCAC 18A .2821 (a).

Repaint door framing and window framing in classrooms. Touch-up paint throughout in classrooms and bathroom. Replace damaged transitional molding at entrance to 3's room. Clean wall around/near door framing in bathrooms within classrooms. Replace water stained ceiling tiles in 3's bathroom. Repair or replace damaged frayed carpet in 3's room. Thoroughly clean floor around toilet in pre k 1 room. Clean and repaint front entrance door and door at end of hallway leading out to the playground area. BE CAREFUL ON WHAT TYPE OF TAPE TEACHERS ARE USING TO ATTACH THING ON THE WALL. TAPE BEING REMOVED FROM WALL IS PULLING PAINT FROM WALLS! Replace damaged rug in older 2 classroom. Replace damaged light switch cover in young 3's and older 2's bathroom. Repair wall in bathroom and storage room in young 3's class Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Observed water temperature at hand washing sink in 4's room reach 114F-115F. Observed water temperature(hot) fluctuate 107F-113F in other room. Water temperature in other rooms spiked to 113F-112F then water temperature would fall back between 80F-110F. Adjust water temperature on water heater or mixing valve. Hot water shall be maintained between 80°F and 110°F at hand washing sinks accessible to children. 15A NCAC 18A .2815 (e).

Observed storage in bathroom in older 2's room. Remove shelving containing toys, cots, etc. from bathrooms. Observed bin containing water play toys stored in pre k 2 bathroom. Limit storage in restrooms to toileting and diapering items only. 15A NCAC 18A .2817 (a).

Observed children sleeping on cots not properly spaced throughout in several classrooms. Monitor and repair end of cribs where children are teething on cribs. Clean old tape adhesive from end of cribs(outside). Children must be spaced at least 18 inches apart or separated by a partition while napping. 15A NCAC 18A .2821 (e). Keep all mats, cots, and cribs clean and in good repair. 15A NCAC 18A .2821 (a).

Secure and repair laminate on back splash and side splash near hand washing sinks throughout in room. Some side and back splash you might want to replace due to the swelling of wood under laminate. Clean dolls or replace stained dolls in toddler 1 room. Replace or remove damaged bean bag from 3's room. Clean area around lid on washer machine in laundry room. Observed children napping and water was still present in water play table from morning session. Empty, clean and sanitize water play table and toys shortly after being used. Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b).

Continue to repair and repaint corner of walls near diaper changing area, hand washing and diaper hand washing sinks in rooms. Repair or replace damaged carpet in 3's rooms. Replace damaged transitional floor moulding at entrance to 3's room. Touch-up paint door and window framing entering into classrooms. Replace water stained ceiling tiles in 3's room. Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Observed teacher not properly wash her hands in young toddler class. Follow proper hand washing procedure on hand washing sign posted at hand washing sink! Hand washing procedure shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing well for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands. 15A NCAC 18A .2803 (c).

Quaternary ammonia sanitizer test strips could not be found. Provide chlorine and quaternary ammonia sanitizer test strips at all times. Establishment is using both chlorine and quaternary ammonia as sanitizer. Quaternary ammonia is being used in the kitchen as sanitizer. Provide sanitizer test kit. 15A NCAC 18A .2812 (g)

Observed cleaning products stored above single service articles in storage room/closet. Store cleaning products/material below single service articles. Work deliveries up as soon as possible. Single-service articles must be kept clean and protected from contamination. 15A NCAC 18A .2809 (8), .2814 (a) and (b).

Observed stained and worn linen to cover sleeping mats/cots. Replace stained and worn linen to cover sleeping cots/mats. Individual linen must be kept clean and in good repair. 15A NCAC 18A .2821 (f).

Tightly secure and seal back/side splash near hand washing sink in infant 1 room. Clean covering on rocking chair and discard stained and damaged boppie in infant 1 room. Label dirty toy bin in infant 2 room. Observed varnish/sealant wearing and worn from furniture in 3's/4's room. Refurbish( apply coat of varnish/sealant) on furniture/fixture in 3's/4's room and any where else needed. Clean dolls in pre k 3 room. Tighten loose toys/funiture fixture in rooms( tables, chairs, mirrors). Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b).

Patch holes in walls where needed. Touch-up paint near trash can storage area and diaper changing areas within rooms. Clean doors and door framing near exit doors leading out to the playground area and repaint. Remove floor mats from within bathrooms located within rooms. Repair torn/damaged carpet in room or replace damaged carpet. Observed water stains on ceiling in 3's/4's room and young toddler room. Repair any roof leaks or heating and cooling unit leaks; then repair and repaint ceiling. Repair lower section of wall in young threes and repaint. Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Floors and floor coverings of all food preparation, food storage, utensil-washing areas, toilet rooms, and laundry areas shall be constructed of non-absorbent, easily cleanable material. 15A NCAC 18A .2824 (a).

Observed caregiver in infant 2 classroom with short duration for scrubbing and rinsing hands.Handwashing procedure shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing well for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands. 15A NCAC 18A .2803 (c).

Observed sanitizer below 50 ppm in kitchen.Prepare a wipe-on or spray-on sanitizer daily at 50 to 200 ppm chlorine. 15A NCAC 18A .2812 (d)

Observed sandbox not covered on playground.Sandboxes must be covered when not in use and kept clean. 15A NCAC 18A .2832 (c ) (2).

Observed one plastic container damaged in kitchen. Observed one knife with damaged handle and tip in kitchen. Observed sippy cups wet stored in zipper lock bag in infant 2's.Multi-service utensils must be washed, rinsed, and sanitized after each use. 15A NCAC 18A .2812 (e)Completely air-dry all equipment and utensils before stacking or storing the items. 15A NCAC 18A .2812 (h)

Repeat non-compliance: Observed diaper table damaged in Fairies and club house classrooms.Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).

Repeat non-compliance: Observed emergency medication stored below 5 feet in Jungle 2'sDesignated emergency medications shall be stored out of reach of children (5 ft above the floor). 15A NCAC 18A .2820 (d).

Repeat non-compliance: Observed plug-in oil air fresheners in Jungle 3's and in infant 2's classrooms. Observed instant cold packs in Jungle 3's and Dino's.All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b).

Repeat non-compliance: Observed baseboard throughout facility collecting residue. Observed wall repairs not completed in kitchen around HVAC unit.Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.Walls in rooms in which food is stored, handled or prepared, utensil-washing rooms, and toilet rooms shall be non-absorbent. 15A NCAC 18A .2825 (b).

Repeat non-compliance: Observed dusty vents in several classrooms.Keep all ventilation related equipment clean and in good repair. 15A NCAC 18A .2826 (b).

Observed caregiver turn off water with bare hands in infant 1. Observed caregiver turn off water with paper towel then wipe child's hand with paper towel.Handwashing procedure shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing well for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands. 15A NCAC 18A .2803 (c).

Observed residue collecting on lids for plastic containers.Multi-service utensils must be washed, rinsed, and sanitized after each use. 15A NCAC 18A .2812 (e)

Repeat non-compliance: Observed diaper changing table damaged in infant 1 classroom.Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).

Observed aerosol sunscreen stored over 5 feet in jungle 2's bathroom. Observed disinfecting wipes in infant restroom over 5 feet.All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b).

Repeat non-compliance: Observed dust collecting around HVAC vents on ceilings. Observed baseboards collecting residue in classrooms throughout. Observed wall damaged in infant 1 and on hallway door jams throughout.Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Observed dusty vents in classrooms throughout facility.Keep all ventilation related equipment clean and in good repair. 15A NCAC 18A .2826 (b).

Observed staff food stored over facility food in infant room 2. Observed milk stored in cups in refrigerator not covered in kitchen. Observed bulk food stored in classroom with no food preperation hand wash sink. Observed food stored in classroom with scoop in conatiner with no handle.All food shall be stored and handled in a manner that protects it from contamination. 15A NCAC 18A .2806 (d),(f), .2807 (b), and .2808 (e).Food storage in classrooms shall be limited to foods that are individually packaged unless the room is equipped with a food preparation area. 15A NCAC 18A .2806 (b)

Observed diaper table not easly cleanable in Clowns room. Observed damaged diaper changing pad in clowns room.Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).

Observed baseboards dirty in classrooms throghout faclility.Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825.

Observed sanbox uncovered on playground.Sandboxes must be covered when not in use and kept clean. 15A NCAC 18A .2832 (c ) (2).

Observed scoop handle touching food in infant 1 classroom.Store and handle food in a manner that prevents contamination.Observed gallons of milk going to classroom not on ice, caregiver stated that milk is discarded after use.Serving containers may be used to dispense milk for food service provided the unused milk is discarded. 15A NCAC 18A .2808 (a)

Observed diaper changing table damaged in Clowns room. Observed caregiver in clubhouse room wipe hands after placing clean diaper on child.Diaper changing surface must be easily cleanable, non-absorbent, smooth, and intact. 15A NCAC 18A .2819 (b).Follow the correct diaper changing procedure as described in 15A NCAC 18A .2819 (d).

Observed hand lotion in infant room 1 in drawer under 5 feet. Observed hand sanitizer bears room in outside bag under 5 feet.Approved non-hazardous products must be stored 5 ft above the floor or behind lock and key. 15A NCAC 18A .2820 (b), (c ) and (d).

Repeat non-compliance: Observed damaged back splash in several care rooms behind hand sinks. **Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. See rule .2822 (a), (b).

Observed dust collecting on vents throughout facility.Keep all ventilation related equipment clean and in good repair. 15A NCAC 18A .2826 (b).

Observed single service cups stored in backpacks throughout facility with mouth contact areas exposed.**Single-service articles must be kept clean and protected from contamination. See Rules .2809 (8), .2814 (a) and (b).

Observed damaged back splash in several care rooms behind hand sinks. Observed wood top of bin drawers with hole oceans room.**Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. See rule .2822 (a), (b).

Observed vents and lights collecting dust throughout facility.**Keep all light fixtures clean and in good repair. See rule .2826 (a). **Keep all ventilation related equipment clean and in good repair. See rule .2826 (b).

Observed sand box uncovered on playground.**Sand boxes must be covered when not in use and kept clean. See rule .2832 (c ) (2).