THE LEARNING EXPERIENCE

15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. Observed one specialty milk with no date in Toddler 2 room. Ensure specialty milks are labeled with name of child and date brought in to 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 disinfectant solution at 250ppm. Ensure disinfectant is at 500-800ppm.

General Comment: 15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key. Observed diaper creams stored in unlocked drawer below 5ft in Twaddler classroom. Ensure diaper creams are stored 5ft and up or behind lock and key.

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 reach 114F in Preschool C classroom. Ensure hot water is between 80F-110F. No points deducted.

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 Infant A, Infant B, and Preschool C rooms at 250ppm. Disinfectant needs to be between 500-800ppm.

15A NCAC 18A .2821 (e). When in use, cribs, cots, mats and play pens shall be placed at least 18 inches apart or separated by partitions that prevent physical contact between children. Observed mats in use in several classrooms less than 18 inches apart. Ensure mats are at least 18 inches apart or separated by partitions when in use.

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 bottle of milk in Infant B with date 1/2 on bottle. Ensure bottles are labeled with correct date. 15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. Observed speciality milks sent from home in Infant B, Toddler B, and the kitchen with dates from previous week, or no date. Ensure speciality milks are labeled with name/date when brought into facility, and sent home at the end of each week or discarded.

15A NCAC 18A .2812 (j) (j) A sanitizing solution shall be provided for cleaning purposes. Observed sanitizer solution in all classrooms reading 500ppm chlorine concentration. Sanitizer should read between 50-200ppm chlorine concentration.

15A NCAC 18A .2815 (e) Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. Observed kitchen unattended, and hot water greater than 120F accessible to children. Key could not be located but was eventually found, and kitchen door was locked to make water inaccessible. Hot water temperature in kitchen measured at 126F which is a burn hazard. Ensure hot water exceeding 120F is made inaccessible to children.

General Comment: 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed baby doll bed stored inside bathroom in Twaddler room. Ensure storage in bathrooms in limited to toileting and diapering supplies. *No points deducted. Points not deducted due to improvement in number of items stored in bathrooms from previous inspection. Points will be deducted if noted on next inspection.*

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 Twaddler room use sanitizer instead of disinfectant during diaper changing process. Ensure proper solution is used. REPEAT

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Observed employee in Infant A miss steps 4 and 5 and incorrectly perform step 10, and employee in Twaddler miss step 5, and incorrectly perform steps 10 and 11. Ensure proper procedure is followed and performed correctly. REPEAT

General Comment: 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 super glue labeled “Keep out of reach of children” and warnings stored in locked cabinet in Preschool 3 room and key for cabinet stored below 5ft. Ensure keys are stored at least 5ft above the floor. No points deducted.

15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key. Observed lotions stored below 5ft in unlocked staff bathroom. Observed soapy water and disinfectant stored below 5ft in Preschool 1C bathroom and Toddler C bathroom. 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 non-prescription diaper creams in Toddler C bathroom stored below 5ft. Ensure diaper creams are stored at least 5ft above the floor. REPEAT

General Comment: 15A NCAC 18A .2820 (f) A child's coats, hats, bags, and other items or accessories belonging to a child that are stored using cubicles, lockers, or coat hooks shall not come into contact with stored items belonging to other children. Observed children’s coats coming in contact with each other while stored on hooks in multiple classrooms. Coats were moved so that they do not come in contact with each other. No points deducted.

General Comment: 15A NCAC 18A .2821 (f) Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Observed two mats with linen not covering entire sleeping surface in Preschool 1C and mat in use with no covering on sleeping surface in Preschool 1B. Ensure linens are large enough to cover sleeping surface. No points deducted.

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. Mouth contact toys in all rooms with children who are not toilet trained are not being sanitized properly after discussion with director/teachers. Director stated toys are sprayed with sanitizer. Mouth contact toys need to be submerged in sanitizer for at least two minutes then air dried. No points deducted.

General Comment: 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. Staff stated high chair trays are cleaned and sanitized in classrooms. Needs to be washed, rinsed, and sanitized in the kitchen.

15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. Observed several classroom sinks between 112-117F. Needs to be 80-110F.

15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed hot water knob not working in Preschool 1A.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed blankets and lunch box stored in Toddler B bathroom and ball stored in Twaddler bathroom. Storage in toilet rooms shall be limited to toileting and diapering supplies.

15A NCAC 18A .2819 (d). (9), Diapering surfaces shall be cleaned, prior to disinfection, by spraying the entire diapering surface with detergent solution and wiping clean, using disposable paper towels. Observed employee in Infant A clean diapering surface by spraying soapy water and then spraying disinfectant without wiping clean the soapy water. Needs to follow appropriate process.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Observed employee in Infant A miss steps 4 and 5 and incorrectly perform step 10 in diaper change. Needs to perform correct procedure. 15A NCAC 18A .2819 (h) Signs that instruct child care center employees on proper methods of diaper changing and handwashing as set forth in the rules of this Section shall be posted in each diaper changing area. Observed facility diaper change procedure is incorrect and no correct procedure was posted in Toddler C. CDI- Director posted a copy of the correct procedure in Toddler C diaper change 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 sanitizer and disinfectant less than 5ft up in Preschool 1B. Observed lotions stored less than 5ft up in unlocked staff bathrooms. Needs to be stored 5ft up or locked. 15A NCAC 18A .2820 (c ) Sanitizing, disinfecting, and detergent solutions shall be labeled with the product name (ex. "Sanitizer"). Observed soapy water in Twaddlers and in infant A missing labels. Needs to be labeled.

15A NCAC 18A .2821 (e). When in use, cribs, cots, mats and play pens shall be placed at least 18 inches apart or separated by partitions that prevent physical contact between children. Observed mats less than 18 inches apart and in use in several classrooms. Needs to be 18 inches apart or separated by partitions.

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 broken mat shelf in Toddler B and Preschool 1A. Observed book corner seats peeling in Twaddler classroom. Needs repair.

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 oat milk in Toddler 2 dated 12/11. Needs to be sent in each week unopened and sent home at the end of the week.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed toys stored in the handsink of Infant B classroom. Lavatories shall not be used for storage.

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 laminate peeling on cubbies in classrooms and bathrooms. Observed handle missing from cabinet under diaper area in Toddler 2. Observed lower shelving with dust build up in several classrooms. Needs repair/cleaning. 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 bottles in Infant B with old or missing dates. Needs to be dated on the date received at the child care center.

Provide15A NCAC 18A .2812 (j) (j) A sanitizing solution shall be provided for cleaning purposes. Observed sanitizer testing at 500 ppm and in Infant B at 10 ppm. Needs to be 50-200 ppm chlorine. 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 at Infant A handwashing sink reach 112F. All other sinks were in appropriate range. Adjust temperature.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed a ball stored in the bathroom in Toddler A, hula hoops and blow up balls in Toddler B, and blankets in bathroom in Preschool 1A. Storage in bathrooms shall be limited to toileting and diapering supplies. REPEAT.

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 spray diaper pad with disinfectant and immediately wipe off disinfectant. Needs to remain on the surface for two minutes or air dry in Twaddler class. 15A NCAC 18A .2819 (d). (9), Diapering surfaces shall be cleaned, prior to disinfection, by spraying the entire diapering surface with detergent solution and wiping clean, using disposable paper towels. Observed teacher spray disinfectant on diaper pad and not clean with a detergent solution. Needs to be sprayed with detergent solution and wiped clean prior to disinfection. PROVISIONAL ITEM.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Observed employee in Twaddlers room miss steps 4, 5, 9 and 10. Needs to follow approved diapering methods. REPEAT.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed liquid white out stored in unlocked drawer in Prepper A and on top of small shelf in small basket in Preschool 3. Needs to be stored in a locked storage room or cabinet. REPEAT. 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 disinfectant stored less than 5ft up in Preschool 3. Observed hand sanitizer and lotions stored less than 5ft up in Infant B. Needs to be stored locked or 5ft above the floor.

Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed tape residue, dust and debris in cubby’s and toy shelves. Classroom cabinets and drawers need wiping out of debris. Observed peeling laminate on some cubby’s and counters. Observed cracked toy bins in Prepper A. REPEAT.

15A NCAC 18A .2824 (c). Carpet shall be vacuumed daily and extraction cleaned at least once each 6 months. Cleaning materials including surfactants, solvents, and water used for extraction shall be removed from the carpet before the space is reoccupied. Observed carpets have not been extraction cleaned since 3/1/21. Needs to be extraction cleaned at least once each 6 months.

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 does not have vomit and diarrheal cleaning procedures. EHS emailed a copy with updated rule information.

15A NCAC 18A .2831 (b). (b) Pests shall be excluded from the child care center. Traps set for pests shall only be placed in areas that are inaccessible to children. Observed glue traps for pests in Infant A and B rooms placed on the floor accessible to children. Facility stated pest control visited last night because a rodent was observed in the room by a teacher and pest control set out the traps. Traps were removed EHS advised facility contacts pest control for other options for removing/trapping pests.

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

Prepare a wipe-on or spray-on sanitizer daily at 50 to 200 ppm chlorine. 15A NCAC 18A .2812 (d). Observed sanitizer >200 ppm chlorine. Test strips expired, replace test strips.

Keep all food service equipment clean and in good repair. 15A NCAC 18A .2812 (f). Observed 4 microwaves in classrooms rusted/flaking paint.

In child care centers, areas accessible to children shall be free of identified lead poisoning hazards as defined in G.S. 130A-131.7(7). Observed drinking water needs testing for lead by 10//21/23. Test 3 comp sink, prep sink and 4 water fountains.

Disposable towels shall be provided at all hand washing sinks. 15A NCAC 18A .2818 (d). Observed a couple bathrooms without paper towels. If out of the paper towels that fit in the dispenser, paper towels can be put in a basket.

Limit storage in restrooms to toileting and diapering items only. 15A NCAC 18A .2817 (a). Observed blankets stored on a bathroom shelf

Follow the correct diaper changing procedure as described in 15A NCAC 18A .2819 (d). Observed staff kept gloves on throughout the diaper change. Staff hands not washed at end. Follow posted procedure.

All hazardous items must be stored behind lock and key. 15A NCAC 18A .2820 (b). Observed white out unlocked in 1 classroom. Label all spray bottles with contents. Repair hasp in kitchen so chemicals can be double locked after staff leaves.

Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. 15A NCAC 18A .2822 (a), (b). Observed tape residue, dust and debris in cubby’s and toy bins. Classroom cabinets and drawers need wiping out of debris.

Keep all floors, walls, and ceilings, clean and in good repair. 15A NCAC 18A .2824 and .2825. Observed several ceiling tiles stained. Repair leaks.

Keep the premises clean and free of dilapidated structures and broken play equipment. 15A NCAC 18A .2832 (a). Keep the property free of standing water. 15A NCAC 18A .2831 (b). Observed standing water on playground and in tires. Drill holes in tires so water can drain.