KIDDIE ACADEMY OF CHARLOTTE-HIGHLANDS

General Comment: 15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required.- Observed teacher is coming in and out/ switching breaks without washing hands when staying and engaging with kids. Ensure to wash hands as required upon entering the classrooms.

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 several babies food and snack in infant refrigerators without date or name on items send from home. Ensure to label both name and date. 15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs.- Observed specialty milk in kitchen refrigerator one without date, the other dated 5/5 and 5/11. Ensure to receive the unopened container of specialty milks at the beginning of the week, put both name and date that was received at the center, send items home or discard at the end of the week either opened or unopened containers.

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. -Observed high chair tray need better cleaning at the back or side crevices. According to teacher the trays get clean at the sink in the classroom. All multi-service articles (high chair trays, spoons, plates/bowls, rubber bibs) shall be washed, rinsed and sanitized properly in the kitchen after each use.

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 spray bottle measured more than 250 ppm. Ensure to provide chlorine sanitizer solution concentration between 50- 200 ppm at anytime.

15A NCAC 18A .2817 (a) In child care centers, toilet tissue paper shall be provided in each toilet room and stored in a clean, dry place.- Observed no toilet tissue available at one of the toilet in room 5. Ensure to provide toilet tissue at every toilets. 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 the dispenser in room 7 and 8. Have all hand washing supplies available at all hand sinks at all time.

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 spray bottle stored on a diaper sink counter in infant B. Ensure to keep item at 5ft or higher at anytime.

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, rice in a bulk bag opened and taped back up with painting tape. Ensure to keep/store all leftover food items in resealable bags/containers after opening. 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 children’s snack sent from home with name, but without date received. Ensure to label both name and date that items receive at the center.

REPEAT 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed cots stored in the restroom 2 after cleaning. Ensure to only store any toilet related items in restrooms. Restroom is not a storage for classroom items.

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 center without testing strips for disinfectant solution. Also the disinfectant solution is measured less than 500 ppm. Ensure to provide correct concentration between 500-800 ppm and obtain the test strips for testing purposes.

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 and missing steps 5 and 10 in the process. There is diaper changing procedures on the wall to follow. EHS and teacher review through the correct procedures together at the time of inspection.

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 several classroom, name labeling fall off the cots. And some classroom has no labeled on the cots. Ensure to label individual cots with name or numbers clearly and visibly. If numbers are use, be sure to provide the cot chart as well. 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 several classroom with soiled sheets on the cots. Ensure to change the sheets and clean them when visibly soiled.

REPEAT 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 diaper pad in several classrooms start to frayed along edges/ on the surface itself, not in good repair. Provide good repair, cleanable, smooth surface of diaper pad if use.

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 baby bottles in refrigerator without date in infant rooms. Ensure to put both name and date that was received at the center on items. 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 in infant rooms that was sent from home without name and or date received. Ensure to put both name and date that was received at the center. 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 several sippy cups in infant C inside refrigerator. Cups look soiled from previous used earlier this morning. NO bottles or cups that was previously used can return back into the refrigerator to prevent any possible cross contamination. Different methods discussed with teacher and director at the time of inspection. 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, with name and date 1/20-1/26. EHS and director 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 .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 big bags of snack (cheese-it/cracker), closed with blue paining tape stored inside a cabinet and kitchen. All left over foods shall be stored properly in a resealable bags or containers.

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. - According to detail discussion with several teachers in the classrooms, high chair tray, cups get wash in the hand washing sink in the classroom. Proper way to clean (wash/rinse/sanitize) items discussed in detail with teacher and director at the time of inspection. 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.

REPEAT 15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed toy bins, toys, book shelves stored in the restroom in several classrooms. Only toileting related items can be stored in restrooms.

General Comment REPEAT 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 left out less than 5ft on diaper table in room 10. All diaper cream shall be stored at 5ft or higher at all times. Or keep them lock. NOTE: **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. Store key out of lock and put the key at 5ft or higher at all time**

General Comment REPEAT 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed key left in a lock on cabinet in restroom 10, inside a cabinet there is Clorox wipes container and air freshener spray bottle. Observed sunscreen in aerosol spray can in the red bag in room 9. All Hazardous items and how to store them discussed with owners/ director at the time of inspection. NOTE: Keep cabinets with hazardous items locked at all time. Remove keys from the lock and store 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 squeeze bottle on teacher keychain store on counter near diaper table in room 10. Observed vaseline bottle stored next to diaper table in infant A, less than 5ft. Observed disinfectant/sanitizer bottles in infant B on the sink counter. 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 bag/personal belongings stored on the floor at computer desk in room 2. Store all personal belongings that contain no hazardous items at 5ft or higher at all time.

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 very soiled (dirt, residue) under diaper pad in room 8. Observed diaper pad in infant C starts to frayed, not in good repair. Keep diaper pad in good repair, clean throughly from front to back and all surfaces. Keep clean.

REPEAT 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 in several classrooms where mouthing/dirty toys present. The dirty toys were collected and put in dirty bin and get clean at the end of the day or during nap time. Teacher spray soapy water, water and disinfectant solution on toys and let them air dry. When asked which sink in the classroom that use to clean toys, all said the diaper sink. 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. If choose to clean toys inside the classroom, they shall be cleaned in the clean sink after change of use procedures of the sink and toys shall not be cleaned in the sink that located inside the toilet room. NOTE: The center has the Ozone toy cleaning machine in the hall way. EHS suggested to set a schedule for each classroom, and utilize the toy cleaning machine to properly clean their toys every time.

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 baby bottles in refrigerator without date in infant A and B. Observed individual milk carton from home without name and date in infant C. Ensure to put name and date that was 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 container of yogurt from home without name and date in refrigerator infant C. Baby foods from home without date in infant A, and one baby food dated 7/29 in refrigerator infant B. Ensure to put name and date that was received at the center.

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 infant rooms. Better cleaning all around front and back crevices needed and keep clean.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed tables, chairs, toy bins, toys, rug, sand box stored in the restroom in several classrooms. Remove items and store where appropriate. Only toileting related items can be stored in restrooms.

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 spray solution in several classrooms measured about 200-250ppm. Ensure to provide correct concentration solution every 24 hours.

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 5, and incorrectly wash hand in step 11. Proper diaper changing and hand washing procedures discussed in detail with teacher at the time of inspection. Diaper changing and hand washing procedures posters provided at the time of inspection.

General Comment REPEAT 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 and sunscreen in a lock box less than 5ft on diaper table, left unlock (combination) in Two classrooms A and B. All items shall be stored at least 5ft or lock them up. Ensure to turn the lock combination so the box is locked when not in use and during storage. NOTE: **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 (d).Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. A product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor.- Observed emergency medication (EpiPen) in a combination lock box left unlock less than 5ft in Two classroom. Ensure to keep item at 5ft or higher or lock it up at all time.

General Comment REPEAT 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 container of cleaners in a left unlock cabinet in restroom Fours A/B, key was also on the lock. Observed air freshener in aerosol spray can on a desk in open office upon arrival. All Hazardous items and how to store them discussed with owners and director at the time of inspection. NOTE: Keep cabinets with hazardous items locked at all time. Remove keys from the lock and store 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 .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 and sand mixed in the water table covered left since last Friday according to teacher. On top of the table cover (lid), it starts to see mold growing. Proper water table procedures discussed in detail with teacher and director at the time of inspection. Ensure to empty and clean out the station right after the end of each play session.

General Comment REPEAT 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 assistant 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. NOTE: The center has the Ozone toy cleaning machine in the hall way. EHS suggested to set a schedule for each classroom, and utilize the toy cleaning machine to properly clean their toys every time.

General Comment: 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 drain flies in several classrooms around/near sinks. Keep the center free of flies.

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 A dated 3/20. Ensure to check after parents and ensure all name and correct date on items when arrived at the center. 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 teacher was rinsing a bottle after feeding and put back inside the refrigerator in infant room. Proper procedures discussed with teachers and director at the time of inspection. Ensure to not put any previously used items back in the refrigerator to prevent any possible contamination. NOTE: all multi use articles shall be washed/rinsed/sanitized in the kitchen. 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 without date that was received at the center. Some milks dated 3/15 and 2/27. EHS, kitchen staff, director 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 .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 big bags of cereal in kitchen shelving keep closed with tape. Store all leftover foods in resealable bags/containers. 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 yogurt snack container in kitchen refrigerator without date. Ensure to put both name and date on all items that was from home to the center.

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 in Infant C at both sinks at 113F -114F. Provide tempered water where accessible to children.

15A NCAC 18A .2815 (g). Outdoor drinking fountains shall be constructed to protect the spout from contamination and shall be kept clean.- Observed water fountains inside and outside need better cleaning and keep clean.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies.- Observed little coaches/ chairs stored in the toilet room 3.

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 in a lock box, left unlock in Two B. Observed sunscreen and diaper cream left on the desk at front desk. All items shall be stored at least 5ft or lock them up. **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 (d).Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. A product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor.- Observed emergency medication in the outside bag left on top of storage box less than 5ft. EHS suggest to install hooks to keep item at 5ft or teachers carry the bag on them.

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 container of bleach, big containers of dish detergent and sanitizer liquids under the 3 compartment sinks in the kitchen not being lock away in the storage room. Hazardous items and how to store them discussed with chef and director at the time of inspection. **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 cream in unlocked drawer less than 5ft in infant A. Observed sanitizer solution bottles stored less than 5ft on the counter near by hand sink in Infant A and Toddler B. Ensure to store all non hazardous items at 5ft or higher 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/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 assistant 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. NOTE: The center has the big toy cleaning machine in the hall way.

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.

15A NCAC 18A .2806 (h) Raw meats, poultry, fish, shellfish and eggs shall be stored in a refrigerator or freezer on shelving beneath and separate from other foods. Observed raw chicken, shell eggs and raw turkey sausage stored above RTE foods in refrigerator. 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 and foods sent from home nor clearly labeled with name and date.

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 no digital food thermometer. Provide digital

15A NCAC 18A .2812 (h) After sanitizing, all equipment and utensils shall be air dried. Observed wet nested dishes left in dishwasher. Provide more storage space for clean items to be air dried and stored. 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. Through discussion staff said high chair trays are not being taken to kitchen after each use for W/R/S.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed dirty spoons, cups and high chair tray in hand sink. Keep hand sinks free of any items. Handwashing only.

15A NCAC 18A .2812 (i) Provide a testing method for chlorine disinfectant to ensure compliance with prescribed chlorine concentration. Observed no disinfectant test strips available.

15A NCAC 18A .2819 (b) Nothing shall be placed on the diapering surface except for those items required for diapering and the child whose diaper will be changed. Observed dirty toy buckets, containers of cups, paperwork in diaper changing area. 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 improper diaper changing procedures at every monitored diaper change. 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 wrong diaper changing signs posted. Some signs provided. Remove current signs.

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 first aid kit in lobby unlocked. All medications must be locked.

15A NCAC 18A .2820 (f). Coat hooks not in individual cubbies or lockers must be 12 horizontal inches apart. Observed back row of hooks < 12 inches from front hooks. Remove back hooks.

15A NCAC 18A .2822 (b) and .2810 (f).Hard plastic toys may be washed, rinsed, and sanitized in a dishwasher, food preparation handwashing sink, or in the kitchen sink. Through discussion toys being washed at diaper changing hand sink.