THE LEARNING EXPERIENCE AT MT HOLLY

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 A, several baby’s bottles are sitting on the counter. When asked the teacher mentioned that they have an hour to complete their bottles. EHS discussed in detail the proper way how feeding session starts and ends. Observed water bottle/sippy cup in infant B refrigerator got return back after offered to a child according to teacher. Ensure to keep bottles/cups previously used for feeding out and shall not be returned to communal mechanical refrigeration. NOTE: “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.” 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 snack/baby food send from home without date received in infant A and toddler. Ensure to label both name and date on items sent from. 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 leftover bulk bag of goldfish and crackers in infant B cabinet. Store leftover dry goods in ziplock bag/resealable containers to prevent pests.

General Comment: 15A NCAC 18A .2810 (f). Water from a handwash lavatory shall not be used for bottle warming or to prepare formula, mix dry cereals, or other foods.- Observed water in bottles warmers in infant room. When asked teacher where the water comes from, teacher stated that water comes from the food prep hand washing sink. EHS and teacher discussed in detail that water shall come from bottle water or the kitchen in the pitcher ready to use or drink.

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 measured at 111F -116F in infant A and B, Toddler A and B, PS2. Ensure to provide tempered water at all hand sinks where accessible to children between 80F -110F at anytime.

REPEAT 15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean.- Observed soiled/buildup on water fountains in the hallway need cleaning and keep clean. Observed water fountains in the playground also need cleaning and keep clean.

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 classroom with no toilet paper in the dispensers in the restrooms. Ensure to keep the dispenser refilled and make the toilet tissue available for children to use at anytime. 15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area.- Observed misplaced soap dispenser in restroom toddler C need repair.

REPEAT 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 purse stored on the counter less than 5ft in Prepper and unlock cabinet in infant A. Ensure to keep all purses/personal belongings that contain no hazardous items at 5ft or higher at anytime.

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 frayed on the climbing furniture in toddler room need repair or replace. 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 standing water on play table during lunch, the session was played and finished this morning before outside time. Teacher needs to ensure that water gets empty at the end of each session, and clean the station to keep clean.

General Comment: 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 playground where grass are growing and need to be cut and keep short.

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 teacher is washing her hands before serving lunch, turning a faucet knob with bare hands. Ensure to follow proper hand washing procedures as posted at the sink at anytime.

General Comment: 15A NCAC 18A .2804 (k) Lunches, snacks, and other meals containing potentially hazardous foods shall be refrigerated at 45 degrees Fahrenheit or below and stored in the child care center kitchen or approved food preparation area.- Observed a child lunch container with potential hazardous food stored in a cabinet classroom. Teacher stated that they forget to take it to the kitchen. Usually it stores in the kitchen until lunch time. Proper food safety and how to store them discussed in detail with manager/director at the time of inspection. NOTE: 15A NCAC 18A .2804 (k) Hot foods that a child brings from home to the child care center in double-walled, insulated thermos containers may be stored outside of refrigeration at the child care center with the written permission of the child's parent or guardian.

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 dated 8/7 in infant B. Ensure to label all bottles with correct date that they come in to 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 baby food jar dated 8/7 that came in today in infant A. Observed no date and name on snacks that come in for class in infant B. Observed lunch dated 8/7 and no date on snacks bag in Toddler A. Ensure to label both name and correct dated on items came from home for the day. REPEAT 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 Toddler refrigerator without date received. And one specialty milk in kitchen refrigerator dated 8/25. 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.

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.- According to teacher in infant room, the trays get clean in the kitchen at the end of the day. Observed high chair tray need better cleaning at the back crevices. Proper cleaning for all multi-service articles (high chair trays, spoons, plates/bowls, rubber bibs) discussed in detail with teacher/manager/director at the time of inspection. They shall be wash, rinse and sanitize properly in the kitchen after each use.

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 measured at 111F -119F in following class but not limited to (restroom Preper, Toddler C, PS2, Toddler A/B, Infant A). Hot water measured at 75F in restroom PS1. Ensure to provide tempered water at all hand sinks where accessible to children between 80F -110F at all time.

15A NCAC 18A .2815 (f).Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean.- Observed water fountains in the hallway need better cleaning and keep clean. Observed water fountains in the playground with painting tape and plastic covered, wrapped around a spout. The manager stated that to prevent kids from using it. If not intended to be used, cut off the water supply and keep clean even not in used.

General Comment: 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair- Observed slow draining at sink in Make Believe room. Observed very low water pressure on the hot side in restroom sink PS1. Repair needed. Observed many hand sinks need better cleaning and keep clean throughout the center.

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 disinfectant solution in spray bottles measured at 250 ppm throughout the center. Ensure to provide correct concentration between 500-800 ppm at all time.

General Comment: 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 an outside bag with Epi-Pen inside hanging down a hook less than 5ft in couple classrooms. Ensure to put the bag up and the bottom of the bag and the strings sit right at 5ft or higher at anytime.

General Comment: 15A NCAC 18A .2820 (b) (c). 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 Clorox, floor cleaner, cleaner spray bottle stored in unlocked cabinet in the kitchen. Proper storage for chemicals inside the kitchen discussed in detail with chef, manager and director at the time of inspection.

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/soapy/sanitizer solution bottles stored in unlocked cabinet less than 5ft in Toddler C. Ensure to keep all approved cleaning solution 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/purse that contain non-hazardous items (hand lotion) stored in an unlocked cabinet in couple classrooms. Ensure to stored all personal belongings/bags/purses that contain no 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 several classrooms have mats/cots with numbers and no name assignments. Same number in two different mats. Number and name are not matching. Ensure to use either name or number. Be very clear which number assigned to what name. Have the cots list available if numbers are use. 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 holes on sheets for infant mattresses. Provide sheets that are in good repair. 15A NCAC 18A .2821 (a). In child care centers, beds, cribs, cots, mats, and play pens shall be kept clean and in good repair, stored to prevent contamination, and cleaned and sanitized between users.- Observed couple damaged mattresses in infant room. Replacement needed.

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, then rinse them, then let them air dry. 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.

15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed staff member not wash hands after return to classroom.

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 one child’s bottles not dated in infant room. 15A NCAC 18A .2807 (c) Food shall be prepared on food-contact surfaces that have been cleaned, rinsed, and sanitized prior to use. Food-contact surfaces and utensils that are exposed to bacterial, viral, fungal, or hazard contaminants during use shall be made clean, free from hazards, and sanitized before continued use. Observed soap and paper towels at prep sink in kitchen. Remove dispensers from prep sink, hands are not to be washed at prep sink.

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 disinfectant put into sanitizer spray bottles. Make sure correct solution goes into correct bottle.

15A NCAC 18A .2816 (b) (1) Child care operators, as defined under G.S. 110-86(7), shall test, once every three years, all water outlets used for drinking or food preparation. Samples shall also be collected and tested within 30 calendar days of completion of any renovations or repairs that may impact the facility's drinking water infrastructure, such as repair or replacement of all or part of drinking water service lines or faucets, at impacted outlets. The operator shall provide documentation of testing results for review by the Department during each unannounced routine sanitation inspection. Observed prep sink (next to microwaves) and 3-comp sink still need to be tested for lead. Water sampler from lab sampled wrong sinks. Need these 2 samples ASAP.

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 disinfect was less than 500 ppm. Sanitizer had been put into disinfectant bottles this morning.

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 torn/frayed diaper changing mat in 2’s class.

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 spaced < 18 inches apart during nap time.

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 tape residue on furniture, shelving, etc.

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 peeling paint on exterior doors.

15A NCAC 18A .2814 (a) In child care centers, food-contact surfaces, equipment, utensils, and single service articles shall be protected from contamination. Observed single service cups, plates, plastic ware stored below spray bottles. Protect from contamination.

15A NCAC 18A .2815 (e) (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Observed hot water in kitchen 117F. Must be >120F

15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. Observed several hand sinks 112-113F in classrooms. Adjust mixing valve to 80-110F

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 hot water at hall bathroom 122F. CDI-adjusted mixing valve.

15A NCAC 18A .2815 (f).. The water pressure of a drinking fountain shall be regulated so that an individual's mouth does not come in contact with the nozzle and so that water does not splash on the floor. Observed water fountains with pressure too high. Need to be regulated

15A NCAC 18A .2816 (b) (1) Child care operators, as defined under G.S. 110-86(7), shall test, once every three years, all water outlets used for drinking or food preparation. Samples shall also be collected and tested within 30 calendar days of completion of any renovations or repairs that may impact the facility's drinking water infrastructure, such as repair or replacement of all or part of drinking water service lines or faucets, at impacted outlets. The operator shall provide documentation of testing results for review by the Department during each unannounced routine sanitation inspection. Observed no current water samples. Must be within 3 years

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

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 eczema/rash cream unlocked in 3 classrooms. Diaper creams can be stored 5 feet up without being locked, creams that are not intended for diaper rash must be locked (eczema, hydrocortisone, etc)

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 items stored touching each other.

15A NCAC 18A .2821 (a). In child care centers, beds, cribs, cots, mats, and play pens shall be kept clean and in good repair, stored to prevent contamination, and cleaned and sanitized between users. Observed trifold mats stored touching each other. Trifold mats need barrier to protect sleeping side from another child’s mat. 15A NCAC 18A .2821 (d). Mats shall be of a waterproof, washable material at least two inches thick. Observed mats 1” thick in several 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 tape residue on furniture, shelving, etc.