LIGHTBRIDGE ACADEMY OF HUNTERSVILLE

General Comment: 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 left over crackers, cereals in bulk bag folded and taped with painting tape in kitchen cabinets, some are stored properly as notated in the rule. Ensure to keep or store any leftover dry goods in resealable bags or 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 measured at 112F- 115F in room 3/10/11. Ensure to provide tempered water between 80F- 110F at anytime.

General Comment: 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed disrepair hand sink in room 10 needs repair.

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 soap container stored inside a white cabinet less than 5ft in back hallway restroom. Ensure keep/store item at 5ft or higher at anytime.

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 baby bottle sat out on the counter after offered once to a child in infant room. When asking a teacher why it sat out here, teacher stated that it was waiting to offer to a child again in 45 minutes per parent request. There was total of 5 ounces, 1 oz was given, and 4 oz left to give. EHS review the sanitation rules with teachers and director at the time of inspection. And suggest that milk comes in a bottle in small portions and enough to feed in one setting at a time.

REPEAT 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 rubber bibs face down air drying on the counter in infant room. According to our conversation, the bibs gets clean at hand sink in 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. 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 younger infant room. Details cleaning needed and keep clean.

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 closet in multi purpose room where clean supplies (paper towels, tissues, utensils, etc..) stored on the floor. Ensure to store/keep all supplies above the floor at least 6 inches at anytime. Observed roll paper towels and classroom folders stored underneath hand sinks in room 3. Items removed at the time of inspection.

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 at diaper sink in infant rooms measured at 113F- 115F. 115F in room 11, 114F in room 10. Provide tempered water between 80F- 110F at anytime anywhere children have access to.

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 last water testing for lead from private company was 10/05/2022. Water testing shall be updated again once every three years.

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 at hand sink in restroom 12 and 5, room 7. Ensure to keep any hand sinks supplied with soap and paper towels at all time.

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 potential hazardous food item (soup) in a regular plastic food container siting in a cabinet in room 6. A student has a permission from parents to leave the food outside the refrigerator, however did not contain food in a double-walled insulated thermos container. The center will communicate with parents and ensure to be in compliance with this rule.

REPEAT 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 trays in infant need detail cleaning all around surfaces up/down. After clean and while sit as cleaned, shall be clean to sight and touch.

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 a chlorine disinfectant solution measured above 250 ppm and less than 500 ppm. Ensure to provide a solution with proper 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 changing diaper and missing step 4, 5, 10. Proper procedures going over with teacher after diaper change at the time of inspection. Ensure to follow proper diaper changing procedures 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 lotions in restroom cabinet (class 7) stored less than 5ft. Ensure to store 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 a bulk soap refill container store inside cabinet room 4 less than 5ft. Ensure to put all bulk refills at 5ft or higher at all time.

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 water damage and water stain on ceiling/tile in room 4 and in front of kitchen. Check for no active leaks, repair/replace the ceiling/tile.

REPEAT 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 several bottles in infant 2 refrigerator. Ensure to have name and date that items received at the center. 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 no date on some food/snack items in infant 2 refrigerator and infant 1 cabinet. Name and date received on items send from home.

REPEAT 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 trays in infant can be better cleaned. According to teacher in infant, high chair tray/rubber bibs get clean in the classroom at food prep hand washing sink. 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 .2815 (e) (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use.- Observed hot water in the kitchen sinks measured at 82F. Obtain hot water in kitchen sinks a minimum of 120F.

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 measured at 73F- food prep sink infant, 79F room 4, 11, 76F in man restroom, 69F in room 5, 77F- 79F in woman restroom/room 7/room 10. Provide tempered water.

General Comment: 15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean.- Observed soiled water fountains at the drain base. Detail cleaning needed all around surfaces (crevices, drain, spouts, etc..) Keep clean.

General Comment: 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 changing diaper and missing step 3, 4, 5. Proper procedures going over with teacher during inspection. Ensure to follow proper diaper changing procedures at all time.

General Comment: 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.- Ensure to keep/store all emergency medications at 5ft or higher at all times. 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 diapers creams stored in unlock cabinet in infant 2, room 5, room 7. All diaper creams stored shall be stored at 5ft or higher or 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, keep/store keys at least 5ft or higher at all time**

REPEAT: PROVISIONAL ITEM- 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed aerosol spray can in unlock cabinet in infant room, saline eye solution bottle in unlock cabinet in 5, Clorox wipe in unlock cabinet room 12, essential oil bottle in unlock cabinet room 11. All hazardous items must be in lock cabinet or storage at all time. Keys put at 5ft or higher. 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**

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 lotions in unlock cabinet (class and restroom) stored less than 5ft in room 12. Ensure to store all non hazardous items at 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 purse in infant stored in unlock cabinet less than 5ft. Ensure to store all personal bags/belongings that contain non hazardous items at 5ft or higher at all time.

General Comment: 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 washed hand and turned off a faucet knob with bare hand before prepping lunch. EHS discussed proper hand washing with teacher and proper hands washing again before handing foods. Hand washing procedures poster provided at the time of inspection.

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 chicken nuggets in a plastic lunch containers in the lunch box holding temperature at 68F in brown bear. Items are not refrigerated per parent request. Proper procedures to handle potential hazardous food items discussed with teacher and director at the time of inspection.

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 with incorrect label dated 8/12. Ensure to put correct date on items. 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 bulk cereal/ cracker closed with painting tap in kitchen and classroom cabinet. Leftover food item shall be stored in resealable container/bag. 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 baby foods/snacks come from home in the refrigerator or cabinet without date receive at the center. Ensure to put both name and date that was received on items. 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 Kangaroo dated 9/12-9/16 and another one has no date that was received. Ensure to put correct month/date on each item of a child.

REPEAT 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 trays in infant can be better cleaned. According to teacher in infant, high chair tray get clean in the classroom food prep hand washing sink, and serving spoons and utensils in Kangaroo get clean in the classroom food prep hand washing sink as well. All multi-service articles shall be washed, rinsed, sanitized properly in the kitchen after each use.

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 water temperature measured at 112F (restroom multi purpose room, blue horse, green frog). Provide tempered water.

General Comment REPEAT: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed aerosol spray can of glass cleaner in unlock cabinet in Kangaroo restroom, baby oil in gold fish unlock cabinet. All hazardous items must be in lock cabinet or storage at all time. Keys put 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 on office counter, and in the outside bag in infant room less than 5ft. 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 soap in unlock cabinet stored less than 5ft in green frog and giraffe. 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 in infant stored in unlock cabinet less than 5ft. **Keep all non hazardous items at 5ft or higher or lock them up at all time**

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 on play table in blue horse, according to teacher water was played yesterday. Proper water play station discussed in detail with teacher and director at the time of inspection.

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 some bottles in infant refrigerators without date, and some dated 3/12, 3/21. Ensure to check with parent, all name and date on before putting items in the fridge. 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 bottles/sippy cups of milk or other beverages put back into the refrigerator in several classrooms after being served once this morning. Ensure keep out any previously used items listed in this rule from the refrigerator to prevent any possible contamination. 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 foods, snacks, and lunch box come from home without date that was received at the center and a wrong date marked on lunch box. Ensure to put name and correct date on all items come 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 high chair trays need better cleaning at the back and crevices.

General Comment: 15A NCAC 18A .2812 (i) Provide a testing method for chlorine disinfectant to ensure compliance with prescribed chlorine concentration.- Observed the center without test strip for the chlorine disinfectant solution. Obtain the test strips.

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 medications basket in unlock cabinet in the kitchen. Keep all medications in the luck cabinet at all time. **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.**

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 shaving cream in aerosol can stored in the unlock cabinet in gold fish and green frog. Observed Windex glass cleaner stored in the broken/unlock cabinet in gold fish. Observed Lysol cleaner spray on the sink in the kitchen. Keep all hazardous items in the lock cabinet/storage at all time. 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 magnetic key stored less than 5ft in the kitchen on top of microwave. Keep all unlocking devices at 5ft or higher at all time. **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.**

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, hand locations in unlock cabinet in yellow duck less than 5ft. 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 soap in unlock/broken cabinet in gold fish and brown bear 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 purse in young infant stored in unlock cabinet less than 5ft. **Keep all non hazardous items at 5ft or higher or lock them up 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 several classrooms hanging coats on the hooks, items are touching each other.

General Comment: 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 residue at the back of diaper changing pad need to get better cleaning as the pad gets clean after changing each time.

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 little to empty cups/sippy cups of milk (had been once used this morning during breakfast) stored inside the refrigerator in red bird, purple cat, and kangaroo classroom. EHS suggested for a child to have several clean empty bottles/cups send from home for each time use, or staff will have to properly wash/rinse/sanitizer the bottle/cups in the kitchen after each use. 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 bags of cereal and crackers taped closed in the cabinet in the kitchen. And unsealed and left open bag of graham crackers in the cabinet in Blue horse. Ensure to store food in resealable bags or containers to prevent any possible contamination.

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 facility without vomiting and diarrhea written procedures. EHS emailed both plan and poster to director at the time of inspection.

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 children lunch (chicken nuggets, cut melon) inside the refrigerator in infant room holding temperature above 45F. Ensure to keep all hazardous food in children lunch boxes at 45F or below. EHS discussed options how to keep hazardous food that comes from home cool as it arrives at the center. Cooling methods (cracked the lids open, air out the containers inside the refrigerator to quickly cool) discussed with director at the time of inspection.

General Comment: 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 refrigerator in kangaroo room with name and without date. According to the director assistant in Goldfish room the specialty milk dated 10/24. The date gets changed every day. EHS discussed with director assistant and teachers about receiving specialty milk. Name of a child and date that was received at the center. And they all go home at the end of the week or discard.

General Comment: 15A NCAC 18A .2807 (h) Metal stem-type, thin probe, numerically scaled indicating product thermometers, accurate to ± 3 degrees Fahrenheit shall be used to ensure the maintenance of the internal cooking temperatures of all potentially hazardous foods required under this Rule.- Observed the center without thin probe thermometer. Obtain a thin probe thermometer to measure food or water temperatures.

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 soiled high chair trays in the infant room, need better cleaning.

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. - Observe teacher changed diaper (kangaroo and red bird) incorrectly/missing step #3, 4, 5, 6, 10. Proper diaper changing procedures discussed with teachers at the time of inspection and diaper changing procedures 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 medication basket in the cabinet in unlock staff break room. Observed medication in teacher personnel bag in the unlock cabinet in red bird classroom. All medications shall be stored in a locked cabinet. PROVISIONAL ITEM.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. 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. - Observed aerosol cans (air fresheners in the unlock restroom throughout the building, sunscreen in the unlock cabinet in several classrooms throughout the building). PROVISIONAL ITEM.

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 infant room stored below 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 purse store in cabinet below 5ft in infant room.

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 teachers dirty toys were collected and get clean at the food prep sink inside the classroom. Toys get sanitizer/disinfectant spray on them after washed and rinsed. Proper toys cleaning discussed with teacher and director and methods suggest with 3 step bins (Wash, Rinse, Sanitizer- the sanitizer solution concentration needs to be between 50-200 ppm of chlorine) during the inspection.

Prepare disinfectant between 500-800 ppm chlorine daily. 15A NCAC 18A .2819 (c ) and .2801 (7). Observed weak disinfectant throughout.

Follow the correct diaper changing procedure as described in 15A NCAC 18A .2819 (d). Observed 3 of 3 diaper changes done incorrectly. Provide training to staff.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Observed basket of air fresheners, lotions, etc in one hall bathroom and a glade plug-in in the other. These items must be locked.

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 unlocked and < 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). Observed diaper creams and spray bottles stored < 5 feet in classrooms.

Coat hooks must be 12 inches apart. 15A NCAC 18A .2820 (e). Observed children’s coats stored < 12 inches apart.

All cribs, beds, cots and mats must be labeled with each individual child's name. 15A NCAC 18A .2821 (c ). Observed no cot chart in filled out in 1 classroom.