CHILDCARE NETWORK #94

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 children are washing their hands after restroom and turning off the faucet knob with their bare hands. Ensure to educate children of proper hand washing procedures, and wash their hands correctly anytimes.

General Comment: 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 in infant room, bottle was sitting on the counter waiting to be offer to a child again within an hour according to teacher. EHS, teacher and director discussed and suggested proper feeding ways/procedures per the rule citation above. “ 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.”

Provide15A NCAC 18A .2812 (j) (j) A sanitizing solution shall be provided for cleaning purposes.- Observed infant room without sanitizer solution for cleaning purposes. Provide sanitizer solution. REPEAT 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 in toddler room sanitizer solution concentration measure at 1000 ppm. Ensure to provide correct sanitizer solution between 50-200 ppm at anytime.

REPEAT 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed slow draining and disrepair faucet handle at diaper sink in toddler need repair. 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed disrepair toilet covered with black plastic bag in 3’, and damaged toilet seat in Meck 3 needs repair/ replacement. Observed disrepair wall where toilet tissue handler is in 2’ need repair. Observed Meck 1 restroom floor need cleaning and keep clean.

REPEAT 15A NCAC 18A .2812 (i) An approved disinfectant shall be provided for cleaning purposes. When a chlorine solution is prepared by a child care center employee for use as an approved disinfectant, then the solution shall be prepared for use within 24 hours, and a testing method shall be used to ensure compliance with the prescribed chlorine concentration (500 -800 ppm).- Observed in infant room the disinfectant solution spray bottle measure at 200 ppm. Ensure to provide correct disinfectant solution concentration between 500- 800 ppm at all times.

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 looking water table in Meck 3, teacher stated that they play last yesterday. Teacher refill the water again this morning and children had not been playing with it yet. EHS, teacher and director discussed proper procedures about water play table at the time of inspection.

15A NCAC 18A .2832 (a) Child care center premises, including the outdoor learning environment, shall be kept clean, drained to minimize standing water, free of litter and hazards, and maintained in a manner which does not create conditions that attract or harbor pests.- Observed old standing puddle of water on a ground outdoor from kitchen leading to playground. Repair the ground, do something with it to prevent standing water that will create mosquitoes friendly environment.

REPEAT 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 throughout the facility measured in excess of 1000ppm. Chlorine sanitizer should be between 50ppm - 200ppm.

REPEAT 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed toilets with build up of soil and splash and in need of cleaning in room Toddler 2, Meck 3, and Meck 2. 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair Observed sinks in need of cleaning around basin and faucet in classrooms 2/3, Threes, and Meck 2. Observed slow draining at handwashing sinks in classroom 2/3’s. Need repair.

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 handwashing soap or paper towels at handwashing sinks in infant room, Toddler 2 and first room for Threes.

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 concentration throughout the facility measured in excess of 1000ppm. Ensure to maintain between 500ppm - 800ppm for chlorine disinfectant.

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 teacher conducting diaper change in the middle of step 7. Observed teacher missing steps 9, 10, and 11. Corrective actions were discussed and steps were completed.

GENERAL COMMENT 15A NCAC 18A .2820 (a). Adequate space shall be provided for the storage of equipment, furniture, toys, clothes, linens, backpacks, book bags, diaper bags, beds, cots, mats, and supplies, and shall be kept clean. Observed overlapping jackets in Fours and backpacks in Meck 1.

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 flying pests in infant room and Meck 1. 15A NCAC 18A .2832 (a) Child care center premises, including the outdoor learning environment, shall be kept clean, drained to minimize standing water, free of litter and hazards, and maintained in a manner which does not create conditions that attract or harbor pests. Observed standing water in buckets and in mop buckets with mosquitoes and mosquito larvae present. Ensure all standing water is drained or emptied to prevent mosquitoes.

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.- In older 2’, Observed children washed their hands after using toilets and turn off the faucet knob with bare hands. Observed teacher did not wash her hands after helping a child from using toilet. Proper hand washing procedures discussed in detail with teachers and director at the time of inspection. Ensure everyone is washing their hands properly after toileting before moving to a new task.

General Comment: 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. - Observed ensure in cans and fruit cups in a big container stored in kitchen refrigerator for one child, items came to the center on Monday each week. There is name of a child o the container, but no date that was received. Ensure to put both name and the date that was received on items/container.

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, rubber bibs placed inside a diaper hand washing sink in infant room. According to a teacher items get clean in that sink daily. EHS discussed proper cleaning procedures for multi-service articles with teachers and director. Observed water jugs in classrooms, according to teacher the jugs get clean and water refills every 2-3 days. 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/day.

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 concentration measured at 500ppm. Ensure to provide correct chlorine sanitizer between 50-200 ppm at all time.

REPEAT 15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed damage toilet seats in restrooms 3’, and 4’. Repair/replace needed. Observed soiled toilet in guest room at the front and Meck2. Detail cleaning throughout the surfaces needed and 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 change a child diaper and missing step 3-5, 8-11. Proper procedures discussed in detail with teachers at the time of inspection. Classroom had diaper procedures posted.

General Comment: 15A NCAC 18A .2820 (c) Bulk soaps shall be kept inaccessible to children by storing the product at least 5ft above the floor.- Observed big refill container of soap stored on the floor under front desk. Ensure to store items at 5ft or higher at all time.

REPEAT 15A NCAC 18A .2821 (c). Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens.- Observed children’s cots with mix and match number/name. Some has name and number that does not match, some has two different numbers on the same cot. Ensure to provide a list of number and name of the cot assignment, and clearly indicate name or number on each cot.

General Comment: 15A NCAC 18A .2804 (a) In child care centers, food shall be kept free from spoilage, filth, or other contamination and shall be safe for human consumption.- Observed foods item in boxes store on the kitchen floor in pantry. Ensure to store all food related items off the floor at least 6 inches. Observed baby food boxes and single use articles stored under diaper changing table in infant room. Proper way to store food/clean items away and separate from dirty discussed in detail with teachers 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 baby bottles in refrigerator infant room without date. Baby pouches dated 9/20. Ensure all items send from home have name and correct date at the time receive at the center. 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 bag of cereal in the kitchen shelves closed with blue painting tape. Store all leftover food items in a resealable bag/storage container for proper protection.

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 a thin probe food thermometer in the kitchen is 10 and more degrees Fahrenheit difference at the time of calibration. Obtain a new thin probe food thermometer that will provide accurate temperature of the food when using it.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair.- Observed several toilets with pink/brown lining inside the bowl throughout the facility. Toilets need better cleaning and keep clean. 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed slow draining at hand sinks in younger 2, and older 2. Repair needed. Observed some hand sink throughout the facility need detail cleaning and keep it look clean. Some sink may need new caulking for easily cleanable.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area.- Observed in several classrooms with no paper towels available for hand drying at the hand sinks. Ensure to provide all hand washing supplies at all hand sinks at all time.

General Comment: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key.- Observed floor cleaner, Clorox wipes, and air freshener aerosol can spray in the unlock metal cabinet in Meck 2. Classroom is not currently in session today due to CMS closing. All hazardous items shall be stored in a lock cabinet/storage at all time. NOTE: **Lock storage rooms and cabinets shall include those which are unlocked with a combination lock, electric or magnetic device, key pad, key, or equivalent locking device. Keep/store key at 5ft or higher at all times.**

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 hanging on a student bag store in closet less than 5ft. Ensure to store all non hazardous items at 5ft or higher at all time.

15A NCAC 18A .2821 (c). Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens.- Observed some classrooms without number/name cot list. Ensure to provide a list of number and name of the cot assignment.

15A NCAC 18A .2810 (c) A separate food preparation sink with drainboards or countertop space of adequate size shall be required when a review of construction plans, modifications, or change in child care procedures indicates that separate facilities are needed based on volume and preparation frequency. Observed prep sink directly drained, sink must be indirectly drained.

15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washing machine < 120F.

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 staff not clean table or hands after diaper change. She said she will clean it after she assembles stuff for the next diaper change. Follow posted procedures.

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 < 5 feet in one classroom.

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 shelving in disrepair, vinyl couches/chairs in disrepair, vinyl pillows in disrepair. Tape residue on shelving. Buckets and toys with debris.

15A NCAC 18A .2824 (d) Floors in areas accessible to children, shall be kept free of peeling, flaking, chalking, or otherwise deteriorating paint. 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 missing baseboards. Damaged walls in classroom closets. Walls peeling paint throughout. Peeling paint in bathrooms with cement flooring and in kitchen. Water damaged walls in kitchen. Replace missing baseboards.

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. Repeat-Observed children improperly washing hands, turning off water with hand, 4’s classroom. Children need more supervision and coaching during handwashing.

15A NCAC 18A .2810 (c) A separate food preparation sink with drainboards or countertop space of adequate size shall be required when a review of construction plans, modifications, or change in child care procedures indicates that separate facilities are needed based on volume and preparation frequency. Observed prep sink directly drained, sink must be indirectly drained.

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 staff wash and rinse a cooking utensil, no sanitizer step. High chair tray in infants classroom with dry, caked on food.

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 no sanitizer test strips. Test strip color chart range started at 250 ppm chlorine. Need test strips that include 50-200 ppm chlorine in its range.

15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washing machine < 120F.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed toilet seat needs replacing in Pre-K 1.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Observed hand sinks without paper towels easily accessible when hand washing.

15A NCAC 18A .2819 (b). Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair. Observed diaper changing tables in disrepair in infants and RTL #1.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Repeat- Observed cleaners, bleach, pesticide in unlocked (lock broken) cabinet in laundry/break room. Recommend making the laundry room bifold doors lockable since the room had constant therapy sessions with children.

15A NCAC 18A .2821 (f). Linens shall be laundered between users, when soiled, and otherwise once per week in rooms with children 1 year old or greater. Observed soiled sheets on cots in 2 classrooms.

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 shelving in disrepair, vinyl couches/chairs in disrepair, vinyl pillows in disrepair. Tape residue on shelving. Buckets and toys with debris.

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. Repeat-Through discussion with teachers improper procedures for cleaning toys was found in majority of classrooms. Toys that have been mouthed need to be put into a dirty toy bucket when the child has finished playing with it.

15A NCAC 18A .2824 (d) Floors in areas accessible to children, shall be kept free of peeling, flaking, chalking, or otherwise deteriorating paint. 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 missing baseboards. Damaged walls in classroom closets. Walls peeling paint throughout. Peeling paint in bathrooms with cement flooring and in kitchen. Water damaged walls in kitchen. Broken window in RTL #1. Paint new wood trims on windows.

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

15A NCAC 18A .2832 (a).In the child care center premises and outdoor learning environment. Debris, glass, dilapidated structures, and broken play equipment shall be removed from areas accessible to children. Wells, grease traps, cisterns, and utility equipment shall be made inaccessible to children. Observed landscape timber barriers in poor repair some with screws exposed.