CHILDCARE NETWORK #53

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 at 68-70F throughout majority of center. Ensure hot water accessible to children is between 80-110F.

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 solution is between 500-800ppm.

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 packet of Emergen-C stored on table in School Age room. Ensure medications are stored locked. 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 hand sanitizer stored below 5ft in Toddler room and Vaseline stored below 5ft in School Age room. Ensure these items are stored 5ft and up.

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 2 sets of 3 bottles with no date. Ensure bottles of milk are labeled with name of child and date brought into center.

General Comment: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed aerosol Lysol spray stored in unlocked drawer in 3s room and aerosol Lysol spray stored in unlocked cabinet in Meck Pre-K room.

15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions. Repeat- Observed debris build-up on bottle warmer interiors. Clean more frequently. 15A NCAC 18A .2812 b) Except for fixed equipment and utensils too large to be cleaned in sink compartments, equipment and utensils that are cleaned manually instead of in a dishwasher shall be washed, rinsed, and sanitized. Observed incorrect 3-comp sink set-up. Sanitizer was in the middle. CDI-sinks changed to W/R/S

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be kept clean and in good repair. Observed build-up in vats of 3-comp sink. Clean more frequently.

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. Repeat-Observed incorrect procedures. Missing steps 5 and saw diaper creams stored below administered before hand wipe and child’s hands not washed at the diaper changing hand sink.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed bottle of liquid correction fluid unlocked in 4’s class.

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 homemade diaper cream unlabeled with contents in container and stored unlocked.

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 unlabeled cots and no cot chart in 2’s class.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Repeat-Observed cubby bins with debris at bottom, sticky tape residue on furniture, room dividers. Frays on surfaces of vinyl couches.

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. Observed toys not being picked up after being mouthed, one toy mouthed then mouthed again by another child.

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 rust holes on outsides of the exterior doors. Lint on floor in laundry room.

15A NCAC 18A .2830 (c) Dumpsters and other containerized systems shall be kept clean and covered. Observed drain plug missing from dumpster.

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. Repeat-Observed hole in exterior wall in back of building. (Considerably better than before)

15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed child’s hands not washed at hand sink after diaper change, infants and 2’s. Child’s hands washed after correction from PIC.

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 washing hands turning off water with hand, touching bottom of the sink and lifting the lid of the garbage can. Supervise and coach children on proper hand washing.

15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions. Observed debris build-up on bottle warmer interiors. Clean more frequently.

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 weak sanitizer in sanitize basin of 3-comp sink. Check with test strip

15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washer was not able to reach a min of 120F

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 placed next to each other and only 1 set of soap/paper towels. Hand sinks must have soap and paper towels accessible without having to walk around other sink to reach it.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed storage below hand sink in one classroom.

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 incorrect diaper changing procedures in both infant and 2’s classroom. 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 diaper changing signs too far from table to read. Keep where can be read from changing table.

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 chap stick in a child’s cubby

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 units and play stations with debris or sticky tape residue. Cubby bins with debris at the bottoms. Torn books. Damaged vinyl couch.

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 unpainted block wall in kitchen. Window sills dusty. Flooring damage at exterior doors. Walls peeling paint in areas. Ceilings dusty in laundry and kitchen.

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 cracked window in 2’s classroom.

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 non-slip coating on play structures damaged. 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 holes in back of building, area water damaged and moldy. Broken soffit and water damage. Ground has severe erosion and parts of building are undercut. Ponding on playground. Drainage needs to be addressed