LEAFSPRING SCHOOL AT MCALPINE

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 sets of bottles in Infant room with no dates. Ensure bottles are labeled with name and date.

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 117F in Red Buds 1. Plumber was onsite during inspection and corrected water temperature immediately.

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 at 250ppm throughout center. Ensure disinfectant is between 500-800ppm.

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 with EpiPen in outside bag in Red Buds 2 classroom. Ensure Benadryl is stored behind lock and key as it is not considered an emergency medication.

15A NCAC 18A .2820 (d) Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use 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 two containers of diaper creams stored in unlocked cabinet below 5ft in Red Buds 2 classroom. Ensure diaper creams are stored 5ft up or behind lock and key.

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 speciality bulk milk in kitchen fridge with no date. Ensure speciality milk sent from home is labeled with name and date brought into center.

General Comment: 15A NCAC 18A .2806 (j) (1) Each refrigerator shall be provided with a numerically scaled indicating thermometer that is accurate to ± 3 degrees Fahrenheit and located to measure the air temperature in the warmest part of the refrigerator. Recording thermometers that are accurate to ± 3 degrees Fahrenheit may be used in lieu of indicating thermometers. Observed no thermometer inside mini fridge in Sapling 1 room. Provide thermometer.

General Comment: 15A NCAC 18A .2819 (c) and 15A NCAC 18A .2819 (d) (10). Diapering surfaces shall be disinfected using an approved disinfectant by spraying the entire diapering surface with an approved disinfectant and allowing to remain on the surface for two minutes or as specified by the manufacturer, or air dry. Observed teacher in Red Buds 3 room use only soapy water after a diaper change and immediately placed another child on the diaper changing surface. EHS educated teacher on proper procedure.

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 teacher in Red Buds 3 room leave gloves on throughout entire diaper changing process and miss steps 5 and 10. Ensure proper procedure is followed.

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 couch with tears in Pre-K room. Repair/replace. REPEAT

15A NCAC 18A .2826 (b).Windows and window treatments shall be kept clean and in good repair. All ventilation equipment, including air supply diffusers, return grilles, and fans shall be kept clean and in good repair. Observed dust buildup in vents in multiple bathrooms throughout center. Ensure ventilation equipment is kept clean. REPEAT

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 bottle on counter in infant room, staff stated that the baby no longer wanted it and she was holding it for an hour in case she wanted it again. 15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Repeat-Observed large bag of sugar open, needs to be put into a lidded container and labeled. Drinking cups in sugar, use cups with handle or scoop. Keep handle out of food.

15A NCAC 18A .2812 (e) Multi-service articles, including highchair feeding trays, shall be washed, rinsed and sanitized in the child care center kitchen after each use. Observed build-up on under sides of high chair trays, send to kitchen even if used for art. 15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions. Discussion with staff in infant room said they wash and rinse bottle warmer but not sanitize. Follow preceding rule. 15A NCAC 18A .2812 (d) For fixed equipment and utensils and equipment that are too large to sanitize in a dishwashing machine or dishwashing sink, a spray-on or wipe-on sanitizer of sufficient chemical strength as indicated in Subparagraph (b)(5) of this Rule shall be used. Observed build-up on ice machine guard, put on a regular cleaning cycle. **dishwashing procedure in 3-comp needs to be reversed where sanitizer basin is over the Dishmachine. Dirty dish basin will be far right.

15A NCAC 18A .2814 (a) In child care centers, food-contact surfaces, equipment, utensils, and single service articles shall be protected from contamination. Observed single service ware and cups stored exposed in open cabinet or with lips exposed.

15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean. Observed build-up around nozzle bases. Needs more thorough cleaning. 15A NCAC 18A .2815 (f).. The water pressure of a drinking fountain shall be regulated so that an individual's mouth does not come in contact with the nozzle and so that water does not splash on the floor. Observed water pressure too high and splattering onto floor, needs regulating

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed a couple toilets with toilet paper barrier on seats. Teachers need to check toilets more frequently for cleanliness.

15A NCAC 18A .2818 (e) Handwash signs shall be posted at every handwash lavatory area. The signs shall instruct children and child care center employees to wash their hands in accordance with Rule .2803. Observed missing hand wash sign. CDI-gave hand wash signs, diaper changing signs and potty training signs.

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 in Village classroom ~100 ppm chlorine. Use test strips to get proper strength.

15A NCAC 18A .2821 (f).Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Observed blankets being stored under sheets while stacked, yellow willows. Blankets need to be stored separately from cot 15A NCAC 18A .2821 (c). Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens. Observed cribs were not individually labeled. Labeling was on wall, label cribs

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 bins and large toys with debris. More frequent cleaning needed

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 3’s class. Walls, light switch plates, door jambs with smudges throughout. Observed storage on floor in several areas, keep items off floor for ease of cleaning.

15A NCAC 18A .2826 (b).Windows and window treatments shall be kept clean and in good repair. All ventilation equipment, including air supply diffusers, return grilles, and fans shall be kept clean and in good repair. Observed dusty ceiling vents in several areas.

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 toy bin and tires with standing water. Mosquito larvae observed in tires.

15A NCAC 18A .2804 (d) Formula and other beverages that require refrigeration, baby food that has been opened, and human milk shall be labeled with the name of the child to whom the beverage, baby food, or milk belongs and shall be refrigerated at 45 degrees Fahrenheit or below. Observed milk in dining room fridge at 50F. Milk was voluntarily discarded. Temperature of fridge was adjusted.

15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed food used for projects stored in non resealable containers in the Village. Observed cereal taped closed in the kitchen. Needs to be in resealable bags or containers. 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 two specialty bulk milks in fridge dated 5/20. Needs to be sent in unopened each week and sent home at the end of the week. REPEAT. 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 pitchers and large carton of milk stored in mini fridges in saplings classrooms. Needs to be stored in a full sized refrigerator.

15A NCAC 18A .2806 (j) (1) Each refrigerator shall be provided with a numerically scaled indicating thermometer that is accurate to ± 3 degrees Fahrenheit and located to measure the air temperature in the warmest part of the refrigerator. Recording thermometers that are accurate to ± 3 degrees Fahrenheit may be used in lieu of indicating thermometers. Observed thermometers reading around 50F in saplings 1 fridge. EHS thermometer read 45F. Needs accurate thermometer.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed toilet clogged in boys bathroom in the village. Needs repair.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed plastic bin for spoons stored in food prep sink in Saplings 2. Lavatories shall not be used for storage.

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 soapy water bottle on floor in the Village. Needs to be stored 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 debris on table in the Village. Observed debris under diaper pad in Orange blossoms. Needs cleaning. REPEAT. 15A NCAC 18A .2822 (d).Water play centers shall be filled with potable water immediately before children begin a water play session. Water shall be emptied after each play session and at a minimum each morning and afternoon, or more often if no longer clean. Observed water in water play table in Orange blossoms classroom. Teacher stated it was filled yesterday. Water play tables shall be filled immediately before use. REPEAT.

REPEAT. 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 in pre-k 1 classroom, students line up for hand washing and did not complete the proper hand washing process. Students wet their hands and dried them with a paper towel but did not use soap. Teacher corrected the action and need to teach proper hand washing to students.

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 two cartons from home of specialty milk in kitchen this morning half empty dated 9/25. Director stated facility accepts milk from home that is opened. Ensure all specialty milks come into the center unopened with name and date and get send home at the end of the week with a child. 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 ziplock bag of gold fish and cereal in Red bud1 cabinet. Items need to be individually packaged since classroom is not equipped with food prep area. 15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed cereal bag opened and taped closed in kitchen. Food shall be stored in resealable container or bag after opening. REPEAT.

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 papertowels and soap in the dispensers in empty classroom next to after school and in the nursing room. Observed no paper towels in restroom hallway.

REPEAT 15A NCAC 18A .2820 (c ) Sanitizing, disinfecting, and detergent solutions shall be labeled with the product name (ex. "Sanitizer"). Observed a blue bottle next to the disinfectant bottle without label in Orange blossom. Observed a purple solution in the kitchen without label. Observed toy cleaning solution buckets in PreK1 need label. All bottle/bucket need to be labeled with proper solutions.

REPEAT 15A NCAC 18A .2822 (d).Water play centers shall be filled with potable water immediately before children begin a water play session. Water shall be emptied after each play session and at a minimum each morning and afternoon, or more often if no longer clean. Observed water play table in Red bud 1 was not empty from last play session. Need to be cleaned and emptied after each use. 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 residues and debris underneath diaper pad at the changing table need to be cleaned throughly after each use in Red bud1. **General Comment: Classroom (TK, Prek1, yellow willow, green pines) still have two buckets of toy cleaning system while the facility is using 3 buckets system for wash, rinse, sanitize. The third bucket is on the order and will be distributed when arrive. In the mean time, toys will be clean in the kitchen properly.

15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed two children enter Red bud 1 classroom without hand washing before joining a group. EHS notify the teacher, children washed hands properly at the time of inspection.

15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed cereal, sugar, and corn bread mix without proper sealed in a bag. Need to be store in resealable bag or container. 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 milk in the kitchen dated 8/16 and 9/11. Ensure to send all specialty milk home with a child at the end of the week.

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 50 ppm concentration of QAC sanitizer bottles through out the building.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed broken toilets/ not properly function in green pines and TK room. (Maintenance is aware of recent damage to toilets and is working on making repairs.)

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed wagon and chair stored in restroom red bud 1. Observed cot stored in nurse restroom. Ensure to stored only toileting items in restroom.

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 teacher missing/incorrect step 3,5,6 during diaper changing. Proper procedure explain and diaper changing poster provided.

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 medications in refrigerator in nurse room stored unlock. 15A NCAC 18A .2820 (d) Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use 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 diapering creams in drawer cabinets in nurse room below 5ft.

REPEAT 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 keys to lock cabinet stored in drawer where is accessible to children in TK classroom. Inside the lock cabinet there is a pink all purpose cleaner spray bottle. Teacher put the keys away above 5 ft at the time of inspection. Observed essential oil bubble bath bottle in Orange blossom and Sapling 1, fabuloso and glass wipes under the sink and bulk glue in Sapling 1-2, glass cleaner in Red bugs 1. All items keep unlock in classroom, they had warning labeled and extra caution labeled on them.

15A NCAC 18A .2820 (c ) Sanitizing, disinfecting, and detergent solutions shall be labeled with the product name (ex. "Sanitizer"). Observed buckets of soapy water and sanitizer in pre-K, TK, blue spruces, green pines, need a label. 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 in nurse office on desk, and drawers stored less than 5ft.

15A NCAC 18A .2822 (d).Water play centers shall be filled with potable water immediately before children begin a water play session. Water shall be emptied after each play session and at a minimum each morning and afternoon, or more often if no longer clean. Observed soiled water in water table in Orange blossom. Need to be clean and emptied after each use. 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 build up under diaper pad in Orange blossom. Observed 3 cushion floor seats in Village classroom with many tears in fabric. Needs repair. **General comment: Facility uses 3 bucket system for wash/rinse/sanitizing toys in classroom. Some classrooms are missing one bucket for process. EHS discussed methods with teachers in classrooms and received various answers that mentioned incorrect toy cleaning practices. Some teachers stated they are rinsing in handsink after sanitizing and others are not following a rinse step. EHS did not directly observe any toy cleaning. EHS and director discussed toy cleaning procedures. Director and toddler and infant classrooms were aware of appropriate toy cleaning procedures.

15A NCAC 18A .2827 (d). The child care center shall have written procedures that employees shall follow when responding to vomiting or diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the center. The procedures shall address the specific actions employees must take to minimize the spread of contamination and the exposure of employees, children, food, and surfaces to vomitus or fecal matter. General Comment: Observed facility did not have vomit and diarrhea cleaning procedures. New rules, diarrhea and vomiting poster provided at the time of inspection.

All potentially hazardous food products shall be maintained at 45°F, or below, or 140°F or above. 15A NCAC 18A .2806 (f). Observed refrigerator seal in infant room not sealing properly. Door slightly ajar. Have gasket/door looked at so seals properly.

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 bottle warmers in splash zone of hand sink. Cord accessible to infants. Bottle warmers need to be situated away from the hand sink and cords inaccessible. Use bottled water or water from kitchen to fill bottle warmers. Observed bottle being cooled down in hand sink. Hand sinks should not be used for this purpose.

Prepare disinfectant between 500-800 ppm chlorine daily. 15A NCAC 18A .2819 (c ) and .2801 (7). Observed disinfectant is quat based with 10 minute contact time. Not approved for diaper changing tables. Use the bleach/water solution 500-800 ppm.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Observed peroxide cleaner unlocked in an unopened classroom. Cleaner must be locked, not stored up 5 feet.

Keep dumpster lids and doors closed to prevent insect and vermin nuisances. 15A NCAC 18A .2830 (d). Observed door open on dumpster. Keep dumpsters and garbage containers free of holes and in good repair to prevent insect and vermin nuisances. 15A NCAC 18A .2830 (d). Observed small hole in dumpster, replace dumpster.