THE GROWING YEARS

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 baby food in infant 1 refrigerator some without date, the other with name and date received at the center. Ensure to label both name and date received on items send from home.

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 spray bottle measure more than 500 ppm. Ensure to provide correct concentration of chlorine sanitizer between 50-200 ppm at anytime.

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 solution spray bottle measure more than 1000 ppm. Ensure to provide correct concentration of chlorine disinfectant between 500- 800 ppm at anytime.

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 store on the counter less than 5ft in room 8. Keep all non hazardous items at 5ft or higher at all times.

REPEAT 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 personal bag/purse sit on top of the cot in Meck PreK classroom less than 5ft. Ensure to keep personal belongings at 5ft or higher at anytime.

REPEAT 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 disrepair wall where soap/toilet tissue dispenser misplaced in playroom/ hallway restroom. Observed stained ceiling tiles and restroom’s vent in room 8, need cleaning and repair or replace ceiling tiles.

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 milks in kitchen refrigerator some with name and without date. Some are without date that was received at the center. One dated 8/11. Ensure to receive the unopened container of specialty milks at the beginning of the week, put name and date that was received before storing in the refrigerator for the week. Ensure to send home or discard at the end of the end either opened or unopened containers. 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 no date on baby bottles in infant 1. Ensure to put name and date on bottles from home.

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 room 3, washed, rinsed rubber bibs, and let air dry around hand sink in the classroom. All multi-service articles (high chair trays, spoons, plates/bowls, rubber bibs) shall be wash, rinse and sanitize properly in the kitchen after each use.

General Comment: 15A NCAC 18A .2814 (b) Cleaned and sanitized utensils and equipment shall be stored above the floor in a clean, dry location and shall be kept clean while stored. The food-contact surfaces of fixed equipment shall be kept clean while stored or otherwise not in use. Equipment and utensils shall not be stored under exposed sewer lines. - Observed classroom materials, clean supplies stored underneath hand sinks in several classrooms. Ensure to remove items and not to store anything under exposed sewer lines at anytime.

GENERAL COMMENT, 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 temperature at hand sink in infant 2 measured at 115F at food prep sink. Ensure to provide tempered water between 80F to 110F where accessible to children. No points due to improvement.

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 towels available in a dispenser in the small therapy room. Ensure to provide all hand washing supplies at all hand sinks at all times.

REPEAT 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed bags of toy stored on a shelf in restroom 7. No other items shall be stored inside the restrooms unless toileting related items only at anytime. NOTE: Observed diaper changing mat in restroom 8 stored on the floor. Keep a mat and store above the floor to prevent contamination.

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 is changing diaper for a child and missed the very last step is washing her hands at the end after cleaning the diaper table. Ensure to wash hands at the end of the diaper procedure each time, before begin a new task.

REPEAT 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 bag/personal belongings in unlocked cabinet in room 8. Ensure to keep personal belongings/bags/purses that contain no hazardous items at 5ft or higher at anytime.

General Comment: 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 damaged wall, peeling paint at hand sink in room 6, holes on wall from misplaced soap dispenser in restroom 5. Repair needed.

15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required.- Observed a child was dropping off by a mother without hand washing before engaging in Room 4 activity. Ensure all employees and children who plan to stay and engage in activities wash their hands upon arrival at the classroom.

REPEAT 15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children.- Observed water temperature at hand sinks range from 61F- 76F (diaper sink and restroom sink infant 2, restroom and classroom sink room5, classroom sink room 6). Alway provide tempered water between 80F to 110F where accessible to children.

General Comment: 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed soiled toilet in restroom 4. Cleaning needed and keep clean. 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed gap between hand sink and wall in room 9 and 8. New caulking needed. Keep sealed, no space for pest harborage.

REPEAT 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed shelve/book cabinet stored inside the restroom 4. No other items shall be stored inside the restrooms unless toileting related items only at anytime.

General Comment: 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 diaper creams on the shelve less than 5ft in closet room 3, supposed to be locked, but not. The closet door was not push all the way to latch when close, leaving easy access to just pull open. Ensure to remind staff and self to check behind you when the doors/cabinets supposed to locked. They shall stay locked when you leave at all time.

General Comment: 15A NCAC 18A .2820 (b) (e). All hazardous items must be stored behind lock and key. A locked kitchen is not considered to be a locked storage room or cabinet for the purpose of this rule - Observed containers of Clorox and other cleaning products stored on shelves in the kitchen not being lock away in a lock storage room. Hazardous items and how to store them discussed with chef and director at the time of inspection. Clorox/cleaner containers shall be put away and store in a locked storage room inside the kitchen or where is applicable at all time. CDI- Items was removed to lock storage outside the kitchen at the time of inspection. 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, keep/store keys at least 5ft or higher at all time**

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 purses/belongings bag inside unlock closet in room 9. Teacher purse in unlocked cabinet (magnet does not latch correctly) in infant 1. Ensure to keep all closets/cabinets doors locked and latched correctly before leaving the area when intended to lock the items. 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 coats are hanging on hooks touching each other in room 8. Keep all individual items separate and not allow to touch while storing.

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 classroom where mouthing/dirty 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 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 in the bin for cleaning toys each day and ensure to store the sanitizer bin at 5ft or higher.

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 speciality milks in kitchen refrigerator some with name and without date. Some are without name and date that was received at the center. Ensure to receive the unopened container of specialty milks at the beginning of the week, put name and date that was received before storing in the refrigerator for the week. Ensure to send home or discard at the end of the end either opened or unopened containers.

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 temperature in women restroom hallway measure at 112F, Infant restroom 2 at 117F -120F, Food prep sink in infant 2 measured from 121F then down to 112F, staff lounge at 118F. Ensure to provide tempered water between 80F- 110F.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed toys and chair stored inside the restroom 4. Observed throughout the center sitting chair is storing inside the restrooms. Ensure to only store toiling related items in restrooms.

REPEAT 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 the chlorine concentration of disinfectant solution in spray bottles measure at 250 ppm. The solution fixed during the inspection. Ensure to provide correct concentration at all time. EHS and the cook fixed the solution together and ensure to give/edit correct formula at the time of inspection.

General Comment: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed throughout the center in outside bag, there is instant ice pack that has label “Keep out of reach of children” and extra caution and warning. Ensure to keep all hazardous items that has the kind of warning label in lock cabinet/storage 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 key at 5ft or higher**

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 stored on the counter less than 5ft in the unlock office. Ensure to put all non hazardous items at least 5ft or higher at all time.

REPEAT 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 missing cot chart in classroom 7. And some classroom need new current update list to match with actual name and number enroll. Ensure to put name/number, provide chart if use number.

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 gallon of milks, container specialty milks sitting on the classroom counter temperature measured at 53F. Position proper way to handle hazardous food items discussed with director assistant and cook at the time of inspection. Ensure to maintain cold food at 45F or below at all time.

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 baby bottles in refrigerator in room 2 without date. Ensure to put both name and date received. REPEAT 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 opened cracker bag folded with tape to close in room 4. All food shall be stored in resealable bag/container properly. 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 milks in the classrooms counter/ kitchen refrigerator some with name and without date. Some are without name and date that was received at the center. EHS, kitchen staff, director assistant discussed proper way to handle specialty milks at the time of inspection. 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 end either opened or unopened containers.

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 chlorine sanitizer solution bottles measured at 250ppm. The solution fixed during the inspection. Ensure to provide correct concentration between 50 -200 ppm.

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 temperature in restroom class #1 measured at 116F.

15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean.- Observed water fountains covered with dust, need cleaning regularly and keep clean.

REPEAT 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed stained/yellow ring around inside the toilet bowls need detailed cleaning and Keep all toilets clean throughout the center.

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 the chlorine concentration of disinfectant solution in spray bottles measure at 100 ppm. The solution fixed during the inspection. Ensure to provide correct concentration at all time.

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 is changing a child and missing steps 3, 5, 6. Proper procedures discussed 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 shaving cream, air freshener/aerosol spray cans in unlock cabinet in room #5, 7, 3. Observed paint buckets/cement bag in the gym where construction is happening and a child and therapist are working in there at the time of inspection. CDI- Director locked the gym and put the keep up 5ft, no therapy session in the gym until the construction work complete.

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 cream/sanitizer on the counter, in drawer less than 5ft (front desk, unlock door front office, room3). Observed sanitizer/disinfectant solution bottles on the counter less than 5ft in room 3. Ensure to store all non hazardous items at 5ft or higher at all time.

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 missing cot chart in several classrooms. Ensure to put name/number, provide chart if use number.

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. - Provide the bucket with sanitizer solution with correct concentration for toy cleaning process in the classroom. Keep the bucket at 5ft or higher. Ensure to clean all toys at the food prep sink only.

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 opened cereal bags in kitchen was tape closed. All food shall be stored in resealable bag/container properly. 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 milks in the kitchen refrigerator, some with name and without date. Some are without name and date that was received at the center. EHS, kitchen staff, director and health and safety coordinator discussed proper way to handle specialty milks at the time of inspection. 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 end either opened or unopened containers. 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. According to teacher in infant room, teacher 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 .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 high chair tray need better cleaning at the back crevices. According to teacher high chair trays get clean and sanitized using spray bottle in the classroom. EHS discussed proper cleaning multi-service articles with teachers, director, and health and safety coordinator at the time of inspection. All multi-service articles (high chair trays, spoons, plates/bowls and rubber bibs) in the shall to be wash, rinse and sanitize properly in the kitchen after each use.

REPEAT 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed loose toilet seats in men’s restroom on hall, room 1. Observed toilets need detailed cleaning in room 1, 2, 3. Keep all toilets clean.

General Comment: 15A NCAC 18A .2820 (b). (C) All hazardous items must be stored behind lock and key. A locked kitchen is not considered to be a locked storage room or cabinet for the purpose of this rule - Observed containers of Clorox in the kitchen not being lock away in the lock storage room. Hazardous items and how to store them properly discussed with kitchen staff, director, and health and safety coordinator at the time of inspection. Observed unlock cabinet in the gym which has cleaning crew chemicals in it. Director re-latched the magnet lock at the time of inspection. The cabinet is locked. EHS, director, and health and safety coordinator discussed to remind staff to check behind themself and ensure all lock storage locks the way it supposed to before leaving the area.

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 in room 3 stored on the counter less than 5ft. 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 bags and belongings inside the lock cabinet that has magnetic key stored on the metal handle less than 5ft. Ensure to put the key at 5ft and above at all time.

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 classroom 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, director, and health and safety coordinator 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.

General Comment: 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.- Observed the facility without the vomiting and diarrhea written procedures in place. EHS emailed the director the written plan and poster at the time of inspection.

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 1 child’s bottle stored in dorm refrigeration unit in younger infant classroom with no date. Observed several specialty milks stored in domestic refrigeration in kitchen with no dates (milks brought into center by parents).

Provide a numerically scaled metal stem-type thermometer accurate to 2°F. 15A NCAC 18A .2807 (h). Observed no thermometer within childcare center.

Keep toilets and urinals clean and in good repair. 15A NCAC 18A .2817 (a). Observed 1 loose toilet seat in classroom 6. Observed loose toilet seats in classroom 7. Keep handwashing sinks clean and in good repair. 15A NCAC 18A .2818 (a). Observed water pressure low at 1 handsink located in restroom closet to rear exit door in classroom 6. Observed 1 handsink faucet loose in girls restroom located in classroom 7.

Hand washing signs shall be posted at all hand washing areas. 15A NCAC 18A .2818 (e). Observed several handwashing signs not posted in restrooms where children aren’t toilet trained. Although children are not using restrooms, handwashing signs should be posted at all handwashing sinks (classroom 2 and 5). Handwashing sinks must be free of storage. 15A NCAC 18A .2818 (a). Observed toys stored in handsink located in gym.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Observed aerosol cleaner and general cleaners stored on high shelving out of reach of children in gym stored in cabinets that were not locked. Teacher properly locked cabinets during time of inspection.

Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed several minor stained ceiling tiles throughout childcare center. EHS advises center to ensure no active leak is occurring and to have stained ceiling tiles replaced.

Solid waste must be covered, and dumpster area must be kept clean. 15A NCAC 18A .2830 (c ) and (d). Observed minor debris/litter behind dumpster. #49. Keep the premises clean and free of dilapidated structures and broken play equipment. 15A NCAC 18A .2832 (a). Observed palates and mirror behind dumpster area.

Disposable towels shall be provided at all hand washing sinks. 15A NCAC 18A .2818 (d). Observed most hand sink without paper towels. Keep paper towels available.

Prepare disinfectant between 500-800 ppm chlorine daily. 15A NCAC 18A .2819 (c ) and .2801 (7). Observed weak disinfectant. Went over bleach dilution chart with staff. Staff didn’t realize there were different columns depending on bleach strength. Do not use scented or splash-less bleach.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Critical violation-Observed aerosol air freshener unlocked in older infant bathroom and bulk disinfectant in cabinet with broken magnetic lock.

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 a purse stored in a child’s cubby. 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 diaper creams on counter in classroom.

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 toys, paint brush, paints and several bins of toys about to be washed in diaper changing hand sink. Use general hand washing sink or food prep hand sink with change of use before.