HOWARD LEVINE CHILD DEVELOPMENT CENTER

Observed gallon of milk outside of classroom above 45F. Recommended milk be poured into smaller containers and then discarded if it comes out of temperature requirement. GENERAL COMMENT **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.

Observed toys stored in diaper changing sink. Educated on how to properly sanitize toys in areas outside of the diaper changing sink. **15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage.

Observed water stained ceiling tiles in infant 1 and toddler 1. Continue to touch up paint throughout facility. **15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint.

Observed sink out of order in Toddler 1. Needs to be repaired. GENERAL COMMENT **15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair

Observed touch up paint needed Toddler 1, Preschool 2 and Preschool 3. Observed water stained ceiling tile in Toddler 1. **15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint.

General Comment: 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 dated with the child’s birthday instead of the date received in room 124. Observed cup of milk sent from home in room 123 with no name or date. Needs name and date received.

15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. Observed water at 112F at sink in 137, and 135 handsinks, and 113-115F in 143, 147,108, 110, 149, and 145. Needs to be 80-110F.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed several toilets with pink rings. Needs cleaning. Observed toilets possibly leaking in 143 and 145. Monitor for leaks and repair if necessary.

General Comment: 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 handsanitizer stored less than 5ft up in therapy room. Needs to be 5ft up.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Observed torn small couches and chairs in several rooms. Observed teacher chair peeling in 110. Needs removal/repair.

General Comment: 15A NCAC 18A .2824 (a). Floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. Observed cleaning needed on floors around toilets in several bathrooms. Needs cleaning.

General Comment: 15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed child enter classroom and not wash hands. Children shall wash hands upon arrival to classrooms.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed steps stored in handsink in room 141. Lavatories shall not be used for storage.

General Comment: 15A NCAC 18A .2806 (b) Food that is stored in child care center classrooms or other rooms intended for child care use, shall be limited to foods that are individually packaged unless the classroom is equipped with a food preparation area. Observed crackers and graham crackers stored in room 145 with no food preparation area. Needs to be individually packaged. 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 one bulk milk in kitchen missing date received. Needs date received.

General Comment: 15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions. Observed build up in infant 2 bottle warmer. Needs cleaning.

General Comment: 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed build up in toilets in 133 bathroom. Needs cleaning.

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 soap in 108 classroom sink. Observed paper towels out at infant 1 classroom sink and 110 classroom sink.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed toys stored in bathroom in 133. Storage in toilet rooms shall be limited to toileting and diapering supplies.

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 torn diaper pad in infant 1 (order had been placed for new one) and in 133. Observed diaper surface needing cleaning in 143. 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 employee miss steps 4 and 5 during diaper change in 141.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed white out stored unlocked in room 141. Observed aerosol room spray stored unlocked in room 140. Observed aerosol suscreen and toilet spray stored unlocked in room 145. Observed fish water spray stored unlocked in infant 2. 15A NCAC 18A .2820 (b).Keys used to access hazardous item storage must be out of reach of children (5 ft above the floor) and stored separately from lock. Observed key to closet stored in lock to closet in room 108 with cleaner spray in closet. Key needs to be stored separate from the lock and 5ft up. PROVISIONAL ITEMS.

General Comment: 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 lotions stored in cabinet less than 5ft up in infant 2 room. Needs to be 5ft up or locked.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Observed couches and chairs torn in several classrooms. Needs repair/removal.

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 between 111-114 in 135, 137, 140, 141, 143, 147, 145, 149, 108, 110, and mens and womens bathrooms. Needs to be 80-110F.

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 disinfectant between 250-500 ppm. Needs to be 500-800 ppm.

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 Zantac stored in cabinet in classroom 110 unlocked with key in lock. Needs to be stored locked with key located separately and 5ft up.

15A NCAC 18A .2832 (a). Child care center premises, including the outdoor learning environment, shall be kept clean, drained to minimize standing water, free of litter and hazards, and maintained in a manner which does not create conditions that attract or harbor pests. Observed standing water in water play tables and in overhead sunscreens. Empty standing water. (The past two or three days it has been raining.)

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 two bottles in 126 not labeled with the date. 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 specialty bulk milk in kitchen sent from home with dates from April. Observed specialty bulk milks sent from home in 132 missing name and date labels. Specialty bulk milks sent from home need to be sent unopened each week and labeled with the name of the child and date received and sent home at the end of the week. 15A NCAC 18A .2806 (d) Bulk food stored in a refrigerator shall be stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Observed bulk milk stored in mini fridge in room 132. Bulk food shall be stored in a full-size refrigerator.

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 facility does not have test strips for QAC sanitizer.

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 hot water in classrooms reaching 120F needs to be 80-110F. PROVISIONAL ITEM.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed build up in toilets in unused classrooms. Needs cleaning. 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed classroom automatic sink not operating in room 133. Observed sink leaking in room 110. Needs repair.

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 employee skip step 5 in room 132. Needs to follow all procedures.

No points deducted. 15A NCAC 18A .2820 (d).Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. A product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Observed epipen stored on shelf less than 5ft up in room 126. Epipen was moved to a higher shelf.

15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Observed stained ceiling tiles in room 132 and 108. Needs to be checked for leaks and repaired.

15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed students in infant 2 preparing to eat breakfast. Infant teacher stated she wiped their hands with a wipe but did not wash their hands before the meal. EHS informed teacher children mush have hands washed before meals. Observed student enter Twos 2 classroom and go to group seating area with teacher without washing hands. EHS asked teacher to have student wash hands and discussed handwashing with children.

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 113F at prep sink in Toddler 1, at 117F at prep sink and 118F at diaper sink in Toddler 2. Observed hot water at 119F in Twos diaper sink. Observed hot water at 117F in Twos 2. Needs to be 80 -110F.

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 diaper changing pad in infant 1 worn and need of replacement. Director stated another one had been ordered.

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 itch cream and nystatin cream for student stored in unlocked cabinet. Needs to be stored in locked cabinet. CDI - Director removed creams to be stored with student medications in front office.

Observed chips not stored properly in PreK3 and the second 2’s room. Spoke with staff about proper storage. **Store all foods in approved re-sealable bags or containers once opened. 15A NCAC 18A .2806 (a)

Observed hand washing sink not operating in the restroom in the first 2’s room. Needs to be repaired. **Keep handwashing sinks clean and in good repair. 15A NCAC 18A .2818 (a).

Observed toys stored in the handwashing sink in the second 2’s room. **Handwashing sinks must be free of storage. 15A NCAC 18A .2818 (a).

Observed bottles not labeled, missing dates in rooms 124 and 126. Ensure that bottles are properly labeled. **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 paper towels missing at several hand washing sinks during the inspection. **Disposable towels shall be provided at all hand washing sinks. 15A NCAC 18A .2818 (d).

Observed high grass on the playground. Have grass trimmed. **Keep the property free of high vegetation. 15A NCAC 18A .2831 (i).