CHILDCARE NETWORK #55

General Comment: 15A NCAC 18A .2812 (j) (j) A sanitizing solution shall be provided for cleaning purposes. Observed sanitizer at 750ppm. Ensure sanitizing solution is between 50-200ppm.

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 above 110F in all classrooms and bathroom throughout center. Temps ranged from 112-120F. Ensure hot water accessible to children is between 80-110F.

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 76F at all hand sinks throughout center. Ensure hot water is between 80-110F.

General Comment: 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 above 1000ppm throughout center. Ensure disinfectant is between 500-800ppm. Director stated they are getting over HFMD so they purposely increased disinfectant concentration to help prevent spread.

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 in Toddler room miss steps 4 and 5. Ensure diapering method is followed.

General Comment: 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 no cot list in Toddler room and some cots labeled with names and some only numbers. Ensure cots are labeled and assigned to each child.

General Comment: 15A NCAC 18A .2831 (b). Sand toys, water tables, and other unfiltered items that can collect standing water in the outdoor learning environment shall be emptied and stored to prevent the collection of standing water. Observed two items in outdoor play area with standing water. Empty and store to prevent collection of water.

15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed opened bag of grits not in lidded container or baggie. 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 not dated, follow above rule.

15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washing machine not reach at least 120F. Was not able to check washing machine today, it was in the middle of a cycle.

15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed a couple of the sink basins have chipped areas, some are stained badly. Work on replacing out the worst ones.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Observed soap not at all hand sinks, 3-4’s class

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 ~100 ppm chlorine. Bottles returned to kitchen for correction.

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 below changing table. Store diaper creams locked or 5 feet above floor.

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 no cot chart or children’s names on cots, 2’s class

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 windows sills need wiping of dust and touch up painted where chipped. Several walls need repainting where a shelf was removed, cabinet removed etc.

15A NCAC 18A .2830 (d) Solid wastes shall be disposed of to prevent conditions that attract and harbor pests and other public health nuisances. Observed bag of dirty diapers on ground next to dumpster.

15A NCAC 18A .2831 (b). Sand toys, water tables, and other unfiltered items that can collect standing water in the outdoor learning environment shall be emptied and stored to prevent the collection of standing water. Observed containers full of rain water on playground, keep emptied.

15A NCAC 18A .2810 (f) Bottle warming equipment shall be cleaned and sanitized per rule .2812 and the manufacturer's instructions. Observed scale and build-up in bottle warmers, put on a daily cleaning schedule.

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be kept clean and in good repair. Observed dried food debris underneath and under pad on high chairs. Clean more frequently. Dried food in microwave in kitchen.

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 several hand sinks 111-112F, adjust mixing valve 15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washing machine not reach at least 120F

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed urine on toilet seat in gang bathroom at beginning and end of the inspection. Several toilet seats with damaged surfaces or stained 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed build up around sink fixtures in gang bathrooms. More frequent/thorough cleaning needed.

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 several toilets out of toilet paper, children went to bathroom as a group so all toilets being used at same time.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed storage under hand sink plumbing in classrooms where cabinets open.

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 changing table not cleaned/disinfected after diaper change. Staff washed hands picked up a child out of their crib and put her in a play area before cleaning table. Clean table first so it doesn’t get forgotten about

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 stored < 5 feet above floor.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed vomit coagulant unlocked in gang bathroom and a fizzing powder ball that looked like candy unlocked in unused classroom, packaging said it was not food and not to be eaten. Cold pack with warnings in outside bag

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 books in disrepair in one classroom. Vinyl couch in disrepair in 3’s. Debris in bins, clean bins more frequently. Damaged particleboard shelving.

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. Through discussion toys in infant room are cleaned then sprayed with sanitizer. Follow preceding cleaning procedure.

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 wet/stained ceiling tiles in several areas. Cracked window in one classroom. Missing floor tiles in laundry/storage room. Chipped paint on window sills in classroom (school age). Secure outlet covers, one is taped to wall in pre-k. Flooring dirty under/ behind storage in laundry room area.

15A NCAC 18A .2830 (d) Solid wastes shall be disposed of to prevent conditions that attract and harbor pests and other public health nuisances. Observed trash and old carpet on ground near dumpster. Keep trash picked up

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 drainage appears to be a problem, evaluate and repair as needed (raining at time of inspection).