Child Care Center OF First Presbyterian Church

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 2/12/2026 Number Present: 59 Completed Date: 2/12/2026 Age: From 0 To 5 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 2/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Child Care Center of First Presbyterian Church, Inc., is current/active as of 2/3/26. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 1/22/26. The last shelter-in-place drill was practiced on 11/24/25. The last playground inspection was documented on 2/4/26. The last fire inspection was approved on 1/6/26. The last sanitation inspection was conducted on 8/20/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. The program does not provide transportation. Upon arrival we were greeted by Ms. Bosse. In classroom spaces 3 and 6 children were engaged in a large group music activity. Children danced to music, played instruments and shook musical shakers. In classroom space 5, children were exploring the outdoor learning environment for infants and toddlers. Children rode scooters, and balanced on seesaws. Children from classroom spaces 2 and 1 were exploring the outdoor learning environment for preschool children. Children built large structures with connecting blocks, drew pictures with sidewalk chalk and rode tricycles. In classroom space 6, children were engaged in a large group teacher led letter drawing activity. Interactions were positive and nurturing. Supervision was adequate. Two (2) new staff files and two (2) existing staff files were monitored in full. Three (3) staff files were partially monitored for missing information. Seven (7) children’s files were monitored. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. An six and a half (6.5) inch opening was observed on the bottom of the structure around the air conditioning unit between playground spaces 1 and 2. .0605(g) 815 Electrical cords were accessible to infants and toddlers. String lights were observed within reach of one year old children in classroom space 6. 10A NCAC 09 .0604(f) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) diaper cream and one (1) permission to administer diaper cream expired in January 2026. .0803(12) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The date the parent signed the medication administration permission form was missing from two (2) permission forms in classroom space 6 and two (2) permission forms in classroom space 5. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical assistance was provided as follows: Item #714: To reach compliance with this item, the gap must be closed. We discussed the most cost efficient way to accomplish this is to attach lattice to the bottom. In your letter of compliance, please include a statement that indicates how this gap was closed. Alternatively, you can provide pictures of the closure. Item #815: To reach compliance with this item, plan to make the string lights inaccessible to children by placing furniture in front of the cords. Alternatively, you can remove the string lights. In your letter of compliance, please include a statement that indicates how you have made the string lights inaccessible to the children. Item #849: The diaper creams were removed from the classroom during the visit today. Plan to return the medications to the parents. In your letter of compliance, include a statement that indicates the medications were returned to the parents. Item #1882: To reach compliance with this item, parents must date the forms. Moving forward, plan to screen all medication administration permission forms to ensure they are completed accurately. In your letter of compliance, include a statement that indicates the four (4) forms have been dated by the parents. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 2/26/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email Kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Change of Administrator: We discussed Elizabeth Olwell’s last day as Administrator was 1/9/26. Ms. Bosse took over as Administrator on 1/12/26. The forms to document this change were sent to me on 2/4/26. The changes will be made in the Regulatory system following today’s visit. QRIS/Rated License Discussion: Today we discussed the Quality Rating and Improvement System: Pathways to the Stars. We review the requirements on the Division’s website at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization. Additionally, we reviewed resources on the website for the North Carolina Rated License Assessment Project (NCRLAP) at ncrlap.org. We discussed, at this time, you would like to pursue Pathway 2: Classroom and Instructional Quality. We discussed you would like to apply for a Rated License Reassessment by May 2026. We discussed one lead teacher will complete the AAS degree in May 2026 to satisfy the 50% requirement. We discussed that you are not held to this decision today and pursue another pathway if you decide. Criminal Background Check: As a reminder, all staff must be added to the roster in the ABCMS Provider Portal. Additionally, any new staff must be added to the roster within five days after employment. Any staff who are departing the facility must be separated from the facility. Staff files: A staff member with a hire date of 9/21/21 was initially hired as a substitute staff, but he/she transitioned to a teaching role in May 2025. Therefore, on-going training requirements for this staff member are due May 2026. A lead teacher with a hire date of 1/29/24 completed two (2) on-going training hours during 1/29/25 – 1/28/26. However, the Staff and Training Worksheet notes that the lead teacher was on leave between 9/26/24 to 5/15/25 due to the effects of Tropical Storm Helene. Please complete the required on-going training hours by the end of May 2026 for the training period of 1/29/25 – 1/28/26. The next training period for the staff member will be due by 1/28/27. There are two (2) hours of verified training hours for a lead teacher with a hire date of 3/27/17. Even though he/she did not meet the required training hours of five (5) during 3/27/24 – 3/26/25 period, part of the training period falls under period affected by Helene. During the period, on-going training was exempt. Both staff members were affected by Tropical Storm Helene and the reason for not completing on-going training requirements were likely direct results on the storm; therefore, no violations for item 1052 was cited. The medical statement for the behavioral specialist is dated 6/18/25, with a hire date of 2/5/25. The staff member’s medical file includes a physical examination completed on 11/19/24 with an electronic signature from a physician. While the documentation does not include a specific statement verifying that the staff member is physically and emotionally fit to care for children, there is no information in the record indicating otherwise. The staff completed additional medical exam using the form provided the Division on 6/18/25. Due to both medical statement on 11/19/24 and 6/18/25, no violation were cited. We discussed that medical form that is provided by the Division is strongly recommended but not required. Children’s files: We discussed the off-site premises form and “Permission for Walk” form that the program uses. The “Permission for Walk” form is the parent authorization form to allow staff members to take children in areas surrounding the child care center. It states that separate permission form is sent home for field trips that required children to leave the school for extended period. Blanket Off-premises form is typically used up to twelve (12) months for children to play/walk outside of the fenced area or access to auxiliary spaces, such as sanctuary, gym, director’s office where children may use occasionally (not regularly). Per interview with Ms. Bosse, “Permission for Walk” form is used in the same intention as Off-premises form. I advised the program to use off-premises form to broadly cover occasional activities or modify “Permission for Walk” form to off-premises permission form”. The rule regarding Safe Sleep Policy .0608 (b) states that the following information is required on the acknowledgement form for Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy shared with parents. (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0606 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 9/10/2025 Number Present: 55 Completed Date: 9/10/2025 Age: From 0 To 4 Total Minutes: 275 Time In: 09:15 AM Time Out: 01:50 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Program Coordinator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, CPR/First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, adequate/approved space, program records, license posted. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three percent (83%) as of 9/2/25. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 8/4/25. The last shelter-in-place drill was practiced on 8/20/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 8/28/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. Upon arrival I was greeted by Ms. Bosse. In classroom space 3, children explored their environment through crawling cruising, shook rattling toys and were soothed by caregivers. In classroom space 6, children explored the outdoor learning environment. Children built small structures with interlocking blocks and explored a small climber. In classroom space 1, children were engaged in a large group meeting, sharing stories. In classroom space 2, children were engaged in an off-premise spiritual enrichment activity. In classroom space 5, children were engaged in a large group meeting before transitioning to outdoor play. In classroom space 8, children transitioned in to the classroom from spiritual enrichment. Interactions were positive and nurturing, supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The medication administration permission form for one (1) diaper cream in classroom space 2 expired on 7/30/25. .0803(12) 871 Center staff did not comply with the safe sleep policy. Three (3) infants in classroom space 6 had blankets on them while they slept. 10A NCAC 09 .0606(a) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. The Administrator’s ITS-SIDS certificate expired on 7/19/25. .1102(f) Technical assistance was provided as follows: Item #1065 To reach compliance for this item, the Administrator must receive the ITS-SIDS training. A training on 9/25/25 was located during the visit today. In your letter of compliance, include a statement that indicates the training has been completed. If there is a delay in receiving the training certificate, plan to retain any documentation the trainer sends you that the course has been completed, such as an email with a post-training survey. Item #849 Plan to return the medication to the parent or have the parent update the permission form. In your letter of compliance, please include a statement that indicates the medication has been returned to the parents or the permission form has been updated. Item #871 The blankets were removed from the infants during rest time. We discussed the child care rules nor the facility's safe sleep policy allows for infants 12 months or younger to use blankets. We also clarified that the safe sleep rules apply to infants 12 months or younger. This means, safe sleep rules apply to children- including sleep checks- until they turn 13 months old. Plan to discuss these clarifications with your infant/toddler staff. In your letter of compliance, please include statement that indicates how you will ensure the safe sleep policy is followed. I recommend updating the safe sleep policy to include a statement that indicates cots are used for some infants. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 9/24/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed supervision during naptime. While there is no rule that indicates staff cannot use devices while children are sleeping, staff must still be able to see all children. I recommend conducting walk throughs of the caregiving spaces to ensure all supervising staff are able to see all children. Have staff reposition themselves to a better vantage point if they cannot see all children in the classroom. Alternatively, you can consider room arrangement to ensure a clear line of sight for all sleeping children. Staff must be able to identify and respond to emergencies during nap time. If children older than 12 months place a blanket over their head, you must remove the blanket from their face when they fall asleep. Staff may never place a blanket over a child's face. You can reach out to our Child Care Health Consultants for additional Technical Assistance or training regarding safe sleep: Chrissy Wolfe, Child Care Health Consultant Phone: (828) 424-0562 Email: Chrissy.wolfe@mahec.net Robin Worley, Child Care Health Consultant Phone: 828-772-0504 Email: robin.worley@mahec.net During your next visit, we will discuss the new Quality Rating and Improvement System (QRIS): Pathways to the Stars. In the meantime, plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the different pathways. Additionally, plan to ensure all staff have updated WORKS letters on file. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 9/10/2025 Number Present: 55 Completed Date: 9/10/2025 Age: From 0 To 4 Total Minutes: 275 Time In: 09:15 AM Time Out: 01:50 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by April Bosse, Program Coordinator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Bosse was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, CPR/First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, adequate/approved space, program records, license posted. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three percent (83%) as of 9/2/25. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only The last annual compliance visit was conducted on 3/6/25. The last fire drill was practiced on 8/4/25. The last shelter-in-place drill was practiced on 8/20/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 8/28/25 with fifteen (15) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 1/17/24 without hazards. Lead paint and asbestos testing was completed on 9/1/24. Upon arrival I was greeted by Ms. Bosse. In classroom space 3, children explored their environment through crawling cruising, shook rattling toys and were soothed by caregivers. In classroom space 6, children explored the outdoor learning environment. Children built small structures with interlocking blocks and explored a small climber. In classroom space 1, children were engaged in a large group meeting, sharing stories. In classroom space 2, children were engaged in an off-premise spiritual enrichment activity. In classroom space 5, children were engaged in a large group meeting before transitioning to outdoor play. In classroom space 8, children transitioned in to the classroom from spiritual enrichment. Interactions were positive and nurturing, supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The medication administration permission form for one (1) diaper cream in classroom space 2 expired on 7/30/25. .0803(12) 871 Center staff did not comply with the safe sleep policy. Three (3) infants in classroom space 6 had blankets on them while they slept. 10A NCAC 09 .0606(a) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. The Administrator’s ITS-SIDS certificate expired on 7/19/25. .1102(f) Technical assistance was provided as follows: Item #1065 To reach compliance for this item, the Administrator must receive the ITS-SIDS training. A training on 9/25/25 was located during the visit today. In your letter of compliance, include a statement that indicates the training has been completed. If there is a delay in receiving the training certificate, plan to retain any documentation the trainer sends you that the course has been completed, such as an email with a post-training survey. Item #849 Plan to return the medication to the parent or have the parent update the permission form. In your letter of compliance, please include a statement that indicates the medication has been returned to the parents or the permission form has been updated. Item #871 The blankets were removed from the infants during rest time. We discussed the child care rules nor the facility's safe sleep policy allows for infants 12 months or younger to use blankets. We also clarified that the safe sleep rules apply to infants 12 months or younger. This means, safe sleep rules apply to children- including sleep checks- until they turn 13 months old. Plan to discuss these clarifications with your infant/toddler staff. In your letter of compliance, please include statement that indicates how you will ensure the safe sleep policy is followed. I recommend updating the safe sleep policy to include a statement that indicates cots are used for some infants. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 9/24/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed supervision during naptime. While there is no rule that indicates staff cannot use devices while children are sleeping, staff must still be able to see all children. I recommend conducting walk throughs of the caregiving spaces to ensure all supervising staff are able to see all children. Have staff reposition themselves to a better vantage point if they cannot see all children in the classroom. Alternatively, you can consider room arrangement to ensure a clear line of sight for all sleeping children. Staff must be able to identify and respond to emergencies during nap time. If children older than 12 months place a blanket over their head, you must remove the blanket from their face when they fall asleep. Staff may never place a blanket over a child's face. You can reach out to our Child Care Health Consultants for additional Technical Assistance or training regarding safe sleep: Chrissy Wolfe, Child Care Health Consultant Phone: (828) 424-0562 Email: Chrissy.wolfe@mahec.net Robin Worley, Child Care Health Consultant Phone: 828-772-0504 Email: robin.worley@mahec.net During your next visit, we will discuss the new Quality Rating and Improvement System (QRIS): Pathways to the Stars. In the meantime, plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the different pathways. Additionally, plan to ensure all staff have updated WORKS letters on file. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/8/2025 Number Present: 57 Completed Date: 4/8/2025 Age: From 0 To 5 Total Minutes: 130 Time In: 09:20 AM Time Out: 11:30 AM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an Unannounced Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. A signed copy of the visit summary was emailed to you. During a complaint visit on 2/21/25, concerns regarding supervision and general safety were substantiated. The general safety concerns were corrected during the complaint visit on 2/21/25. During the Annual Compliance visit on 3/6/25, follow-up monitoring was conducted regarding item #303. Compliance was confirmed during the visit and the item was corrected by Consultant visit. Due to the substantiated supervision concern, an Administrative Action may be recommended. Per consultant procedures, I am required to make a follow-up visit every four (4) to six (6) weeks until a determination is made. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. Limited monitoring was conducted today including staff/child ratio, permit restrictions, adequate/approved space, supervision, and general safety. The facility operates on a five (5) star license issued 9/5/17. Restrictions include: 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. Staff child ratios and observations as follows: Group 1: Six (6) infants with two (2) caregivers present in classroom space 3. Children were exploring their environment through crawling and pulling up on furniture. Children were held by caregivers while feeding. Group 2: Ten (10) one year old children with three (3) caregivers present in classroom space 6. Children were playing musical instruments and exploring books. Group 3: Eight (8) children ages one to two years old with three (3) caregivers present in classroom space 5. Children read books with caregivers, built small structures with blocks of varying sizes and self-soothed in the calming corner. Group 4: Twelve (12) three year old children with three (3) caregivers present in classroom space 2. Children explored puppets, painted with watercolors, molded playdoh into various shapes with their hands and tools and pretended to cook and serve food. Group 5: Thirteen (13) children ages three to five years old with three (3) caregivers present in classroom space 1. Children played bowling, built large structures with wooden blocks and washed hands as they arrived to the classroom. Group 6: Eight (8) five year old children with one (1) caregiver present in classroom space 8. Children built large structures with connecting blocks and pretended to sell items from a store. Supervision was adequate in each caregiving space. General safety requirements were monitored in each space. In classroom space 5, there were cords accessible to children in the book area as well as the shelf next to the block area. Requirements were reviewed with caregivers regarding electric cord accessibility in classrooms for infants and toddlers. The cords were made inaccessible to children during the observation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 815 Electrical cords were accessible to infants and toddlers. Electrical cords were accessible to children in classroom space 5 in two locations. An electrical cord for a lamp was accessible in the book area and charging cords for an iPad and speaker were accessible on the shelf next to the block area. 10A NCAC 09 .0604(f) Technical Assistance provided as follows: Item #815: The electrical cords were made inaccessible to children during the visit by placing the cords behind heavy furniture that cannot be moved by children. This was corrected. We discussed challenges with outlet placement in the classrooms and that some rearranging may be needed to ensure cords are inaccessible while children are in care. We discussed “toddler” is defined as a child aged 13 months to 35 months old in rule 10A NCAC 09 .0102 (50). Therefore, this rule applies to classrooms 6 (G02), 5 (G04), and 3 (G08) with current enrollment. I recommend creating checklists of common general safety items to review prior to children’s arrival each morning, including electrical cord accessibility. Consultation is provided as follows: Ms. Bosse has been conducting observations of staff completing diaper changes once per week. Ms. Bosse provided documentation of the observations during the visit today. I recommend continuing these observations and document any feedback you provide to staff. General Safety can also be part of these observations. Plan to note any feedback that is discussed with staff. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/8/2025 Number Present: 57 Completed Date: 4/8/2025 Age: From 0 To 5 Total Minutes: 130 Time In: 09:20 AM Time Out: 11:30 AM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an Unannounced Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. A signed copy of the visit summary was emailed to you. During a complaint visit on 2/21/25, concerns regarding supervision and general safety were substantiated. The general safety concerns were corrected during the complaint visit on 2/21/25. During the Annual Compliance visit on 3/6/25, follow-up monitoring was conducted regarding item #303. Compliance was confirmed during the visit and the item was corrected by Consultant visit. Due to the substantiated supervision concern, an Administrative Action may be recommended. Per consultant procedures, I am required to make a follow-up visit every four (4) to six (6) weeks until a determination is made. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. Limited monitoring was conducted today including staff/child ratio, permit restrictions, adequate/approved space, supervision, and general safety. The facility operates on a five (5) star license issued 9/5/17. Restrictions include: 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. Staff child ratios and observations as follows: Group 1: Six (6) infants with two (2) caregivers present in classroom space 3. Children were exploring their environment through crawling and pulling up on furniture. Children were held by caregivers while feeding. Group 2: Ten (10) one year old children with three (3) caregivers present in classroom space 6. Children were playing musical instruments and exploring books. Group 3: Eight (8) children ages one to two years old with three (3) caregivers present in classroom space 5. Children read books with caregivers, built small structures with blocks of varying sizes and self-soothed in the calming corner. Group 4: Twelve (12) three year old children with three (3) caregivers present in classroom space 2. Children explored puppets, painted with watercolors, molded playdoh into various shapes with their hands and tools and pretended to cook and serve food. Group 5: Thirteen (13) children ages three to five years old with three (3) caregivers present in classroom space 1. Children played bowling, built large structures with wooden blocks and washed hands as they arrived to the classroom. Group 6: Eight (8) five year old children with one (1) caregiver present in classroom space 8. Children built large structures with connecting blocks and pretended to sell items from a store. Supervision was adequate in each caregiving space. General safety requirements were monitored in each space. In classroom space 5, there were cords accessible to children in the book area as well as the shelf next to the block area. Requirements were reviewed with caregivers regarding electric cord accessibility in classrooms for infants and toddlers. The cords were made inaccessible to children during the observation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 815 Electrical cords were accessible to infants and toddlers. Electrical cords were accessible to children in classroom space 5 in two locations. An electrical cord for a lamp was accessible in the book area and charging cords for an iPad and speaker were accessible on the shelf next to the block area. 10A NCAC 09 .0604(f) Technical Assistance provided as follows: Item #815: The electrical cords were made inaccessible to children during the visit by placing the cords behind heavy furniture that cannot be moved by children. This was corrected. We discussed challenges with outlet placement in the classrooms and that some rearranging may be needed to ensure cords are inaccessible while children are in care. We discussed “toddler” is defined as a child aged 13 months to 35 months old in rule 10A NCAC 09 .0102 (50). Therefore, this rule applies to classrooms 6 (G02), 5 (G04), and 3 (G08) with current enrollment. I recommend creating checklists of common general safety items to review prior to children’s arrival each morning, including electrical cord accessibility. Consultation is provided as follows: Ms. Bosse has been conducting observations of staff completing diaper changes once per week. Ms. Bosse provided documentation of the observations during the visit today. I recommend continuing these observations and document any feedback you provide to staff. General Safety can also be part of these observations. Plan to note any feedback that is discussed with staff. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at Kaitlyn.marshall@dhhs.nc.gov or 828-713-8192 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0608 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1804 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/6/2025 Number Present: 58 Completed Date: 3/6/2025 Age: From 0 To 5 Total Minutes: 378 Time In: 09:12 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with a rated license assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. Kaoru Eddins, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Olwell and April Bosse, Program Coordinator, were present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty percent (80%) as of 3/3/25. The North Carolina Secretary of State website was checked during the visit today and the Non-profit corporation Child Care Center of First Presbyterian Church, Inc. was current and active. Permit type – Five (5) star license issued 9/5/17. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets enhanced ratios, Children under 2.5 years old in rooms with direct exits only. The facility serves children with special needs. The last annual compliance visit was conducted on 3/13/24. The last fire drill was practiced on 2/27/25. The last shelter-in-place drill was practiced on 2/28/25. The last playground inspection was documented on 2/28/25. The last fire inspection was approved on 2/4/25. The last sanitation inspection was conducted on 9/4/24 with twenty-one (21) demerits for an Approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The program does not provide transportation. Upon arrival I was greeted by Ms. Olwell and Ms. Bosse. Children in classroom space 3 sang songs and explored rattling toys with caregivers. Children also participated in routine caregiving activities including handwashing and diapering. In classroom space 2, children built large structure with cardboard and plastic blocks, read books with caregivers and formed various patterns with Potato Head figurines. In classroom 5, children painted pictures with watercolor paint, built small structures with legos, and built large structures with magnetic frames. In classroom space 2, children built small structures with wooden blocks and train tracks, utilizing toy vehicles and animal figurines in their creations, pretended to care for babies in dramatic play and explored various x-ray images on a light table. In space #6, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. The children explored the environment and played with toys, such as soft blocks, books and toy instruments. Permission form for diaper creams and feeding plans were in compliance. Supervision and interactions were adequate. In space #8, a group of nine (9) children, all five (5) years of age, were present with two (2) staff members. The children used flashlight to read books. After lights were turned on, the children participated in group time. No medications are maintained in the classroom. Supervision and interactions were adequate. Lunch was observed in space #2. Children bring lunch from home. One child brought strawberries, grapes, pretzels, sun butter and Jelly sandwiches, apple sauce and water. Milk was offered to this child. Another child brought mac and cheese, corns, blueberry, pickles, Ritz crackers and milk. Supervision during the lunch was adequate. During the complaint visit on 2/21/25, a violation regarding supervision was cited. Per procedure, a follow-up visit must be conducted when violations regarding Supervision are cited. I observed diaper changing procedures for two (2) children in space #6. The staff member followed the diapering procedures appropriately including supervision during diaper changing, handwashing and cleaning. No electrical cord was accessible to the children. Supervision and interaction were adequate. Lunch was observed, and the children ate at the table. During the visit, item 303 cited during complaint visit conducted on 2/21/25 was marked corrected by the consultant visit. Per interview with Ms. Bosse, she has observed the classroom for diapering procedures and meal time practices. For this week, Ms. Bosse has observed the classroom every day. However, no documentation of the observations were created. Due to the supervision violation cited on 2/21/25, an Administrative Action may be recommended. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 620 All walls and ceilings including doors and windows were not kept clean, free of visible fungal growth, and in good repair. The bottoms of the doorframes for doors leading to the playground from classroom spaces 5 and 6 were damaged and splintering. 15A NCAC 18A .2825(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Three (3) children’s files did not contain annually updated emergency medical care information. .0802(c) Technical assistance was provided as follows: The following items were cited as violations today. Compliance is due on 3/20/25: Item # 705: We discussed the splintering doors pose possible choking hazards and sharp edges. We discussed the areas must be covered to prevent access to children. We discussed you have already contacted contractors and receive quotes for repairs to the doorframes. Please inform me of the anticipated date for the work to be completed. We discussed possible solutions for temporary compliance including covering the damaged areas with metal plates, plaster or heavy fabric that prevents children from accessing the areas as well as fallen splintered wood. Item #1311: Emergency Medical Care information for Children: We discussed rule .0802 (c) that states emergency medical information for children must be updated annually or as changes occur. Three (3) children’s files did not contain update information. We discussed parents can complete a new enrollment application to update this information. Alternatively, parents can update the existing form and sign/date the changes made. To reach compliance, the parents of the three (3) children must update the emergency medical care information. I recommend completing an audit of all files to ensure all children have update emergency medical care information. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, our area is under a state of emergency. Additional time and guidance is given to achieve compliance for certain items. Please note, violations may be cited during future visits if compliance is not reached: Item #1034: Medical Statement Medical Report is a statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. A copy of physical exam can be accepted as long as there is a statement that the staff member is physically and emotionally competent to take care of children. E. Reid must obtain additional medical statement that meets this requirement. Please refer to 10A NCAC 09 .0701. Item #1898: Health and Safety training L. Hoffart needs to complete Administration of Medication in Child Care training immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. Item #1889 WORKS Letters on file: One (1) staff hired 10/9/23 does not have a WORKS letter on file. According to rule .0703 (d), staff must submit to the Division documentation of completion of the coursework or credential to be considered for equivalency within six months of assuming the duties. In short, staff must submit all information to have their education evaluated within six (6) months of assuming lead teacher duties. To achieve compliance, plan to have the staff member submit transcripts to WORKS and apply for the desired positions. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/20/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall PO Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Rated License Assessment: Your facility was placed in cohort 1. Your Prep Year was 7/1/23-6/30/24. You submitted your application for re-assessment on 1/28/25. Your Rated License Assessment is based on the following: Education: Points are earned based on the lowest level of education for any one position. The Administrator has the North Carolina Early Childhood Administration Credential (NCECAC) Level 3, a Graduate Degree in Elementary Education, has forty-five (45) years of experience earning seven (7) points. The facility has six (6) lead teachers. Fifty percent (50%) or three (3) lead teachers meet the following: NCECC, 2 year degree in Early Childhood Education or Child Development, two (2) years of experience earning seven (7) points. The facility has five (5) teachers. Fifty percent (50%) or three (3) teachers meet the following: NCECC, six (6) additional semester hours, two (2) years of experience earning seven (7) points. The facility earns seven (7) education points. Program Standards – The program currently meets enhanced space and enhanced ratios. On 7/1/24, the ECERS-R assessment was conducted, resulting in a score of 5. On 7/2/24, The ITERS-R assessment was conducted, resulting in a score of 5.52. The overall score is 5.26 points. The facility earns six (6) program points. Quality Point: The facility’s personnel and operational policies were reviewed today. The facility meets the programmatic option of staff benefits package and infrastructure of parent involvement. The facility provides vacation time, sick leave, health insurance and paid leave for professional development to meet the staff benefits package requirement. The facility provides a parent advisory committee and periodic conferences to meet the infrastructure of parent involvement. The facility earns one (1) quality point. Total – 7+ 6 + 1 = 14 for a Five (5) Star License. We discussed that these calculations are preliminary and must be sent for approval by supervisory staff. If there are any discrepancies, errors, or additional information needed, you will be contacted. Consultation is provided as follows: Reminder: L. Hoffart’s CPR/First Aid training will expire on 4/5/25. L. Hoffart needs to complete three (3) additional hours of on-going training on or before 3/26/25. S. Noble needs to complete three (3) additional hours of on-going training on or before 10/8/25. Policy Signature Forms: We discussed updating your policy signature forms to capture more information. As a reminder, the Discipline policy and Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy rules requires additional information. Please see the rules below: 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) The center shall obtain the parent's signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child's file for review by the Division: (1) The child's name; (2) The date the child first attended the center; (3) The date the operator's policy was given and explained to the parent; (4) The parent's name; (5) The parent's signature; and (6) The date the parent signed the acknowledgment. 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (b) The child care center shall obtain from each parent, legal guardian, or full-time custodian a statement that attests that a copy of the center's written discipline policies was given to and discussed with him or her. That statement shall include the following: (1) the child's name; (2) the date of enrollment; and (3) if different, from the enrollment date the date the parent, legal guardian, or full-time custodian signed the statement. QRIS Modernization: The QRIS (or Star Rated License) system is changing. The public comment period is open until 4/4/25. Plan to visit https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization to learn more about the proposed changes. Comments should be directed to: Child Care Commission 2201 Mail Service Center Raleigh, NC 27699-2201 Attn: Julie Peck Julie.peck@dhhs.nc.gov Additionally, there is an in-person public comment opportunity on 3/26/25 in Raleigh. Please see below: Public Hearing: Date: March 26, 2025 Time: 1:15 p.m. Location: 333 Six Forks Road, Room 165, Raleigh, NC 27609 and By WebEx Criminal Background Check Provider Portal: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Approved Space: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment Training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Health and Safety Training: It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2201 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0225-108L Visit Date: 2/21/2025 Number Present: 57 Completed Date: 2/21/2025 Age: From 0 To 5 Total Minutes: 205 Time In: 09:15 AM Time Out: 12:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced e purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site to you. Ms. Olwell assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-three (83) percent as of today prior to this visit. The facility operates with a five-star license issued on 9/5/17. The Special Services/Restrictions includes daytime care, meets enhanced ratios and space, children under 2 ½ years old in rooms with direct exits only. The complaint was received by the Division of Child Development and Early Education on 2/11/25 and sent to Kaitlyn Marshall, Child Care Consultant on the same day. The complaint report was forwarded to me on 2/20/25. There are concerns regarding a safe environment and staff/child ratio. Additionally, a concern regarding supervision was added during the visit due to the nature of complaint. The allegations include concerns that a one-year-old child was left unattended on a changing table with a bottle for approximately three (3) minutes. The allegations include concerns that there are electrical cords accessible to children aged infants to one year old. The allegations include concerns that ratios are not met in the outdoor learning environment, with one (1) teacher to approximately seven (7) to eight (8) one year old children present on the playground. Due to concerns for the staff/child ratios, all classrooms were observed. In space #2, a group of eleven (11) children, all one (1) year of age, were present with three (3) staff members. In space #4, ten (10) children, all two (2) years of age, were present with three (3) staff members. In space #5, a group of eleven (11) children, three-to-four years of age, were present with two (2) staff members. In space #7, a group of twelve (12) children, two-to-three years of age, were present with three (3) staff members. In space #8, a group of six (6) children, all infants, were present with two (2) staff members. In space #9, a group of eight (8) children, four-to-five years of age, were present with two (2) staff members. Staff members were interviewed. According to Ms. Olwell and April Bosse, Program Coordinator, the enhanced staff-to-child ratio standards are always met. Administrative staff ensure that at least two staff members are present at all times. In classrooms with three staff members, they take turns taking one-hour breaks, ensuring that two staff members remain with the children at all times. Video footage was not available. The lead teacher, two assistant teachers, and a floater were interviewed regarding the incident involving a child allegedly left unattended on the changing table with a bottle. All four staff members denied ever feeding children on the changing table. None of them witnessed any staff member leaving a child unattended on the changing table. Additionally, they stated that no staff member had ever expressed concerns about children being left unattended on changing tables. Per staff members, two (2) teachers were absent on January 22, 2025. During the interview, the lead teacher stated that he/she momentarily removed his/her hands from a child on the changing table during a diaper change to address a conflict between two children eating at the table. The lead teacher reported "looking away for 1-2 seconds." According to interviews with Ms. Olwell and Ms. Bosse, a staff member expressed concerns about children being left unattended on the changing table in Space #2. Ms. Bosse addressed these concerns with all teachers in that space. During an interview, the lead teacher admitted to briefly taking his/her hands off a child on the changing table to bend down and retrieve clothes from the storage compartment underneath. Ms. Olwell and Ms. Bosse reviewed proper changing procedures and emphasized the importance of adequate supervision with all staff members in Space #2. Neither Ms. Olwell nor Ms. Bosse have witnessed any instances of children being left unattended or fed on the changing table. During the visit, lamps with cords were inaccessible to the children. In space #2, the cord was hidden behind a bookshelf and a pillow. The lamp is located next to the changing table. The electric cords of the lamps were not accessible to the children during today’s visit. However, due to the documentation provided by the reporter, the allegation of a safe environment is substantiated. Based on the observation and interview conducted today, the allegation of staff/child ratio was unsubstantiated. There are some discrepancies among staff members’ statements. Based on the interview and documentation provided by the reporter, the allegation regarding supervision is substantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per supplemental documentation received, a child, who was eleven (11) months old at the time of the incident was left unattended for approximately three (3) minutes on the changing table while the child was drinking from a bottle. The incident occurred on January 22, 2025. .1801(a)(1-5) 532 All children were not held or placed in feeding chairs or other appropriate apparatus to be fed. On January 22, 2025, a child was fed a bottle on the changing table while and after the child was changed. The child was on the changing table drinking from the bottle for at least three (3) minutes. 10A NCAC 09 .0902(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). There were four (4) children in space #2, who were fifteen (15) months of age or younger. Only one (1) child's feeding plan was posted. 10A NCAC 09 .0902(a) 815 Electrical cords were accessible to infants and toddlers. Per supplemental documentation received, the electrical cord for the lamp located by the changing table in space #2 was accessible to a group of children who were infants and one-year-old at the time of the incident. 10A NCAC 09 .0604(f) Technical assistance was provided as follows: 303: Supervision Children must be adequately supervised at all times. Infants and toddlers can roll over and fall from the changing table very quickly. A hand should be placed on the child on the changing table at all times during changing procedure. As long as a hand is placed on the child, the teacher can look away for a second or two at a time to supervise other children in the classroom. Communication among teachers is also critical in adequate supervision. Teachers should communicate their actions and needs with co-teachers in the classroom to support one another to provide adequate supervision of all children in the classroom. 532: Feeding practices All children shall be held or placed in feeding chairs or other appropriate apparatus to be fed. Refer to 10A NCAC 09 .0902(b). Children should be fed in a designated space, such as at the table/chair or feeding chairs. Due to sanitation issues, feeding children while getting diaper change should not occur for any reason. If a child is eating or drinking and a diaper change is necessary, make a decision to see if you could allow the child to finish eating/drinking in a timely manner or stop the child from eating/drinking, change the child and allow the child to go back to eating/drinking. 540: feeding plans An individual written feeding plan shall be provided by child's parent or health care provider or was not followed and posted. Any child who are fifteen (15) months old or younger shall have a feeding plan. Please make a copy of the feeding plan and post them in space #2 for four (4) children who are younger than fifteen (15) months of age. 815: Electrical cords Electrical cords shall not be accessible to infants and toddlers. Refer to 10A NCAC 09 .0604(f). Electrical cords shall be hidden behind furniture or tightly covered and attached to the wall or floor. This item was marked corrected during the visit. Achieving Compliance Based on today’s findings, this child care facility received a substantiated complaint regarding supervision. This may warrant an administrative action as identified by Child Care Rule 10A NCAC 09 .2201. Additional monitoring visits may be required. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: How to pick up children: Picking up children by arms can result in serious injuries. Many teachers unintentionally injure children by picking them up by hand or arm. All children should be picked up by torsos to prevent injuries. This may require reminders as well as training. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/6/2024 Number Present: 59 Completed Date: 8/6/2024 Age: From 0 To 6 Total Minutes: 180 Time In: 09:30 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: ERS Announced/Unannounced: Announced The purpose of today’s announced visit was to review the results of your Environment Rating Scale (ERS) conducted on 7/1/24 and 7/2/24. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Nicole Morris, Program Coordinator, during the visit. A signed copy of the visit summary was emailed to you. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted below: ECERS-R assessment – 7/1/24 Total score – 5 Item 11 Indicator: 5.3 (see pages: 28-29 in the ECERS-R) Score: 2 pts Assessor Comments: Diaper change routines occurred 10 times during the observation. Preparations: Preparations for all routines occurred prior to placing the child on the diapering surface. Disposal: The soiled diapers were disposed of properly. Wipes: The teacher's and children's hands were not wiped with a wipe prior to handling the clean diaper. Clean/Disinfect: Following each routine, the diaper changing surface was cleaned and disinfected properly. For more information on procedures required during diapering routines, please refer to the diapering procedure poster from the North Carolina Child Care Health and Safety Resource Center. This is a potential violation of the following rule: 15A NCAC 18A .2819 DIAPERING AND DIAPER CHANGING FACILITIES (d) Child care center employees shall change a child's diaper as follows: (1) gathering supplies before placing child on diapering surface; (2) donning disposable gloves (if needed); (3) using disposable towelette or moistened paper towel to clean child, wiping front to back; (4) disposing of gloves if used, soiled towelettes and diaper in a plastic-lined, covered receptacle; (5) wiping the child care center employee's hands and the child's hands each with a separate disposable towelette or moistened paper towel; (6) sliding a clean diaper under the child, applying diapering products if needed, using facial or toilet tissue, and discarding the tissue in a plastic-lined, covered receptacle; (7) fastening the diaper and placing clothing on child; (8) washing child's hands in accordance with Rule .2803 of this Section, or, if child is unable to support the child's head, cleaning the child's hands with a disposable towelette or moistened paper towel, then drying the child's hands and returning the child to a supervised area; (9) spraying entire diapering surface with detergent solution and wipe clean, using disposable paper towels; (10) spraying entire diapering surface with an approved disinfectant and allowing to remain on the surface for two minutes or as specified by the manufacturer, or air dry; and (11) washing hands in accordance with Rule .2803 of this Section even if disposable gloves are used by the child care center employee. Observations today: Diaper changes were observed in the classrooms for infants and two year old children. All steps were followed and handwashing occurred as required in rule. We discussed pulling out more wipes during the preparation of the diaper change, so that staff do not have to handle the wipes pouch with soiled hands. Item 13 Indicator: 3.1 (see pages: 30-31 in the ECERS-R) Score: 2 pts Assessor Comments: This indicator addresses handwashing related to entering and returning to the classroom, before and after water play, as well as after messy play in addition to handwashing that occurs after contact with bodily fluids and touching contaminated surfaces. Teachers, staff members, and children should wash their hands at least 75% of the time when needed. The teachers and staff member washed their hands 33% of the time. The teachers and staff did not wash their hands upon entering the classroom. During outdoor play, the teachers did not use hand sanitizer after playing in the water table. The children washed their hands 38% of the time. Some of the children did not wash their hands upon entering the classroom, and following outdoor play. Some of the children did not use hand sanitizer after they used the water table outdoors. *Please note the use of hand sanitizing products while outdoors is an acceptable substitute; indoors, soap and running water should be used for proper handwashing. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Handwashing was observed after toiletings and diaper changing today. All handwashing steps were followed according to rule. You stated that the handwashing rule regarding entering the classroom, returning indoors from outdoor play and the use of hand sanitizer in lieu of handwashing after waterplay outdoors was reviewed with staff. To clarify, the rule regarding hand sanitizer is specific to children. However, if staff are participating in water play, plan to follow the hand sanitizer requirement as stated in Sanitation Rule .2803 (d). Item 25 Indicator: 3.3 (see pages: 50-51 in the ECERS-R) Score: 2 pts Assessor Comments: The teacher stated during the interview that the children are not allowed to bring in natural objects, which does not meet the requirements for this indicator. This item is related to best practice. There are no potential violations associated with this indicator. Observations today: You clarified that children are permitted to bring in natural materials for exploration. ITERS-R assessment- 7/2/24 Total Score: 5.52 Item 6 Indicator: 3.3 (see pages: 18-19 in the ITERS-R) Score: 2 pts. Assessor Comments: During the observation, two children arrived to the classroom. The parents passed the children over the half door to a teacher. These parents did not enter the classroom. This item is related to best practice. There is no violation associated with this indicator. Observations today: You clarified today that most parents do come into the classroom at drop off and that the staff encourages them to do so. Caregivers stated that some parents prefer designated times to spend time in the classroom instead of at drop off. Item 8 Indicator: 3.2 (see pages: 22-23 in the ITERS-R) Score: 2 pts. Assessor Comments: An infant was placed on his side to sleep in his crib. In addition, two cribs were spaced 30 inches apart rather than at least 36 inches. This is potential violation of the following rule: 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; Observations today: The caregiver stated that children are always placed on their backs. One (1) sleeping infant was observed on their side while sleeping. The caregiver stated that the child can roll over. This was also stated in writing on the child’s crib. Sleep checks were monitored today and positions were documented showing that the child was placed on their back and then rolled over to various positions. We discussed the thirty-six (36) inch spacing requirement is best practice. Sanitation rules require that cribs are spaced at apart by eighteen (18) inches at a minimum. Please see the rule below for details: 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (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. Item 9 Indicator: 3.3 (see pages: 24-25 in the ITERS-R) Score: 2 pts. Assessor Comments: The children's hands were washed consistently after diapering; however, the teachers washed their hands 33% of the times needed, which was less than the 75% required. Of the 15 times that diaper changes occurred, the teachers washed their hands 5 times after spraying the diapering surface with disinfectant. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Diaper changes were observed in the classroom for infants and two year old children. Handwashing occurred after each diaper change according to rule. You stated that this rule was reviewed with staff as a reminder. A walk through of caregiving spaces was conducted. Beth Olwell, Administrator, was present on the walk through and available to ask and answer questions throughout the visit today. Children in group 1 were observed exploring their environment through crawling, scooting and pulling up on furniture, sleeping and participating in routine caregiving activities such as diapering. There were seven (7) children aged infant to one year old with three (3) caregivers. Children in group 2 were observed pretending to cook, singing with caregivers and participating in routine caregiving activities such as diapering and handwashing. There were ten (10) two year old children present with three (3) caregivers. Children in group 3 were observed playing outdoors, riding tricycles, and interacting with caregivers. There were seven (7) children present aged one to two years old with three (3) caregivers. Children in group 4 were observed completing puzzles with caregivers, trying on various articles of clothing, building small structures with magnatiles, and creating collages with stickers and markers. There were sixteen (16) children present ages two to four years old with three (3) caregivers. Children in group 5 were observed playing on the large playground. Children were observed riding tricycles, building structures with large connector blocks, and were practicing calming strategies with caregivers. There were eleven (11) children present ages four to five years old with three (3) caregivers. Children in group 6 were observed playing outside on the large playground, climbing the structure, riding tricycles and building structures with large connector blocks. There were eight (8) children present with one (1) caregiver. Interactions were positive and nurturing. Children were actively supervised at all times. The following violation was cited during the visit today: Violation Number Comment Rule 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Small plastic animals that failed the choke tube test were present in the classroom for two year old children. .0604(q) Technical Assistance provided as follows: Item #858 The small animals were removed from the classroom during the visit. This was corrected. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Consultation provided as follows: We discussed the changes to the requirements for the Rated License Reassessment process do the recent legislation that was passed. Hold Harmless has been extended, therefore any additional Rated License activities will only occur if you choose to participate. You stated that you would like to move forward with completing the Rated License Reassessment process. The Rated License Reassessment packet and the Staff Information Sheet is included in the email containing this visit summary. Please complete the attached forms and return to me when you are ready to move forward with your Rated License Reassessment. The facility current operates on a five (5) star license issued 9/5/17. Restrictions include: 1st shift (daytime care), meets enhanced ratios, meets enhanced space ,children under 2.5 years old in rooms with direct exits only. Program Standards: We discussed that you will elect to use the scored received from the ECERS assessment on 7/1/24 and the ITERS assessment on 7/2/24 toward your Rated License Reassessment. Your facility currently meets enhanced ratios and enhanced space requirements. Education Points: We discussed that your current licensed is calculated with seven (7) points in education standards. Ensure all staff have their education evaluated by WORKS and their most up-to-date WORKS letter is on file. Quality Point: We discussed you are currently meeting your quality point with the programmatic option through staff benefits package and infrastructure of parent involvement. Plan to review the current quality point options in section .2829 of the Chapter 9 Child Care Rules to determine what would be best for your facility. A Rated License Assessment visit will need to be conducted prior to the Rated License being processed. This visit can be announced if it occurs within six (6) months of your Annual Compliance date. If the Rated License visit occurs past six (6) months of your Annual Compliance date, an unannounced Annual Compliance with Rated License visit will need to be conducted. Once the Rated License Reassessment application is received and reviewed, we can discuss possible dates for this visit to occur. We discussed the rule regarding moving children up an age level for transition purposes without affecting the ratio or group size. Please see the rule below for details: 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; Written permission from a parent is needed to move a child up one age group without affecting the staff/child ratio for that group. Additionally, please see the rule below as a reminder when children are visiting classrooms for the purpose of transitioning: (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0606 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/6/2024 Number Present: 59 Completed Date: 8/6/2024 Age: From 0 To 6 Total Minutes: 180 Time In: 09:30 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: ERS Announced/Unannounced: Announced The purpose of today’s announced visit was to review the results of your Environment Rating Scale (ERS) conducted on 7/1/24 and 7/2/24. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Nicole Morris, Program Coordinator, during the visit. A signed copy of the visit summary was emailed to you. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted below: ECERS-R assessment – 7/1/24 Total score – 5 Item 11 Indicator: 5.3 (see pages: 28-29 in the ECERS-R) Score: 2 pts Assessor Comments: Diaper change routines occurred 10 times during the observation. Preparations: Preparations for all routines occurred prior to placing the child on the diapering surface. Disposal: The soiled diapers were disposed of properly. Wipes: The teacher's and children's hands were not wiped with a wipe prior to handling the clean diaper. Clean/Disinfect: Following each routine, the diaper changing surface was cleaned and disinfected properly. For more information on procedures required during diapering routines, please refer to the diapering procedure poster from the North Carolina Child Care Health and Safety Resource Center. This is a potential violation of the following rule: 15A NCAC 18A .2819 DIAPERING AND DIAPER CHANGING FACILITIES (d) Child care center employees shall change a child's diaper as follows: (1) gathering supplies before placing child on diapering surface; (2) donning disposable gloves (if needed); (3) using disposable towelette or moistened paper towel to clean child, wiping front to back; (4) disposing of gloves if used, soiled towelettes and diaper in a plastic-lined, covered receptacle; (5) wiping the child care center employee's hands and the child's hands each with a separate disposable towelette or moistened paper towel; (6) sliding a clean diaper under the child, applying diapering products if needed, using facial or toilet tissue, and discarding the tissue in a plastic-lined, covered receptacle; (7) fastening the diaper and placing clothing on child; (8) washing child's hands in accordance with Rule .2803 of this Section, or, if child is unable to support the child's head, cleaning the child's hands with a disposable towelette or moistened paper towel, then drying the child's hands and returning the child to a supervised area; (9) spraying entire diapering surface with detergent solution and wipe clean, using disposable paper towels; (10) spraying entire diapering surface with an approved disinfectant and allowing to remain on the surface for two minutes or as specified by the manufacturer, or air dry; and (11) washing hands in accordance with Rule .2803 of this Section even if disposable gloves are used by the child care center employee. Observations today: Diaper changes were observed in the classrooms for infants and two year old children. All steps were followed and handwashing occurred as required in rule. We discussed pulling out more wipes during the preparation of the diaper change, so that staff do not have to handle the wipes pouch with soiled hands. Item 13 Indicator: 3.1 (see pages: 30-31 in the ECERS-R) Score: 2 pts Assessor Comments: This indicator addresses handwashing related to entering and returning to the classroom, before and after water play, as well as after messy play in addition to handwashing that occurs after contact with bodily fluids and touching contaminated surfaces. Teachers, staff members, and children should wash their hands at least 75% of the time when needed. The teachers and staff member washed their hands 33% of the time. The teachers and staff did not wash their hands upon entering the classroom. During outdoor play, the teachers did not use hand sanitizer after playing in the water table. The children washed their hands 38% of the time. Some of the children did not wash their hands upon entering the classroom, and following outdoor play. Some of the children did not use hand sanitizer after they used the water table outdoors. *Please note the use of hand sanitizing products while outdoors is an acceptable substitute; indoors, soap and running water should be used for proper handwashing. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Handwashing was observed after toiletings and diaper changing today. All handwashing steps were followed according to rule. You stated that the handwashing rule regarding entering the classroom, returning indoors from outdoor play and the use of hand sanitizer in lieu of handwashing after waterplay outdoors was reviewed with staff. To clarify, the rule regarding hand sanitizer is specific to children. However, if staff are participating in water play, plan to follow the hand sanitizer requirement as stated in Sanitation Rule .2803 (d). Item 25 Indicator: 3.3 (see pages: 50-51 in the ECERS-R) Score: 2 pts Assessor Comments: The teacher stated during the interview that the children are not allowed to bring in natural objects, which does not meet the requirements for this indicator. This item is related to best practice. There are no potential violations associated with this indicator. Observations today: You clarified that children are permitted to bring in natural materials for exploration. ITERS-R assessment- 7/2/24 Total Score: 5.52 Item 6 Indicator: 3.3 (see pages: 18-19 in the ITERS-R) Score: 2 pts. Assessor Comments: During the observation, two children arrived to the classroom. The parents passed the children over the half door to a teacher. These parents did not enter the classroom. This item is related to best practice. There is no violation associated with this indicator. Observations today: You clarified today that most parents do come into the classroom at drop off and that the staff encourages them to do so. Caregivers stated that some parents prefer designated times to spend time in the classroom instead of at drop off. Item 8 Indicator: 3.2 (see pages: 22-23 in the ITERS-R) Score: 2 pts. Assessor Comments: An infant was placed on his side to sleep in his crib. In addition, two cribs were spaced 30 inches apart rather than at least 36 inches. This is potential violation of the following rule: 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; Observations today: The caregiver stated that children are always placed on their backs. One (1) sleeping infant was observed on their side while sleeping. The caregiver stated that the child can roll over. This was also stated in writing on the child’s crib. Sleep checks were monitored today and positions were documented showing that the child was placed on their back and then rolled over to various positions. We discussed the thirty-six (36) inch spacing requirement is best practice. Sanitation rules require that cribs are spaced at apart by eighteen (18) inches at a minimum. Please see the rule below for details: 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (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. Item 9 Indicator: 3.3 (see pages: 24-25 in the ITERS-R) Score: 2 pts. Assessor Comments: The children's hands were washed consistently after diapering; however, the teachers washed their hands 33% of the times needed, which was less than the 75% required. Of the 15 times that diaper changes occurred, the teachers washed their hands 5 times after spraying the diapering surface with disinfectant. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Diaper changes were observed in the classroom for infants and two year old children. Handwashing occurred after each diaper change according to rule. You stated that this rule was reviewed with staff as a reminder. A walk through of caregiving spaces was conducted. Beth Olwell, Administrator, was present on the walk through and available to ask and answer questions throughout the visit today. Children in group 1 were observed exploring their environment through crawling, scooting and pulling up on furniture, sleeping and participating in routine caregiving activities such as diapering. There were seven (7) children aged infant to one year old with three (3) caregivers. Children in group 2 were observed pretending to cook, singing with caregivers and participating in routine caregiving activities such as diapering and handwashing. There were ten (10) two year old children present with three (3) caregivers. Children in group 3 were observed playing outdoors, riding tricycles, and interacting with caregivers. There were seven (7) children present aged one to two years old with three (3) caregivers. Children in group 4 were observed completing puzzles with caregivers, trying on various articles of clothing, building small structures with magnatiles, and creating collages with stickers and markers. There were sixteen (16) children present ages two to four years old with three (3) caregivers. Children in group 5 were observed playing on the large playground. Children were observed riding tricycles, building structures with large connector blocks, and were practicing calming strategies with caregivers. There were eleven (11) children present ages four to five years old with three (3) caregivers. Children in group 6 were observed playing outside on the large playground, climbing the structure, riding tricycles and building structures with large connector blocks. There were eight (8) children present with one (1) caregiver. Interactions were positive and nurturing. Children were actively supervised at all times. The following violation was cited during the visit today: Violation Number Comment Rule 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Small plastic animals that failed the choke tube test were present in the classroom for two year old children. .0604(q) Technical Assistance provided as follows: Item #858 The small animals were removed from the classroom during the visit. This was corrected. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Consultation provided as follows: We discussed the changes to the requirements for the Rated License Reassessment process do the recent legislation that was passed. Hold Harmless has been extended, therefore any additional Rated License activities will only occur if you choose to participate. You stated that you would like to move forward with completing the Rated License Reassessment process. The Rated License Reassessment packet and the Staff Information Sheet is included in the email containing this visit summary. Please complete the attached forms and return to me when you are ready to move forward with your Rated License Reassessment. The facility current operates on a five (5) star license issued 9/5/17. Restrictions include: 1st shift (daytime care), meets enhanced ratios, meets enhanced space ,children under 2.5 years old in rooms with direct exits only. Program Standards: We discussed that you will elect to use the scored received from the ECERS assessment on 7/1/24 and the ITERS assessment on 7/2/24 toward your Rated License Reassessment. Your facility currently meets enhanced ratios and enhanced space requirements. Education Points: We discussed that your current licensed is calculated with seven (7) points in education standards. Ensure all staff have their education evaluated by WORKS and their most up-to-date WORKS letter is on file. Quality Point: We discussed you are currently meeting your quality point with the programmatic option through staff benefits package and infrastructure of parent involvement. Plan to review the current quality point options in section .2829 of the Chapter 9 Child Care Rules to determine what would be best for your facility. A Rated License Assessment visit will need to be conducted prior to the Rated License being processed. This visit can be announced if it occurs within six (6) months of your Annual Compliance date. If the Rated License visit occurs past six (6) months of your Annual Compliance date, an unannounced Annual Compliance with Rated License visit will need to be conducted. Once the Rated License Reassessment application is received and reviewed, we can discuss possible dates for this visit to occur. We discussed the rule regarding moving children up an age level for transition purposes without affecting the ratio or group size. Please see the rule below for details: 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; Written permission from a parent is needed to move a child up one age group without affecting the staff/child ratio for that group. Additionally, please see the rule below as a reminder when children are visiting classrooms for the purpose of transitioning: (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0713 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/6/2024 Number Present: 59 Completed Date: 8/6/2024 Age: From 0 To 6 Total Minutes: 180 Time In: 09:30 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: ERS Announced/Unannounced: Announced The purpose of today’s announced visit was to review the results of your Environment Rating Scale (ERS) conducted on 7/1/24 and 7/2/24. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaitlyn Marshall, Child Care Consultant and also signed by Nicole Morris, Program Coordinator, during the visit. A signed copy of the visit summary was emailed to you. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted below: ECERS-R assessment – 7/1/24 Total score – 5 Item 11 Indicator: 5.3 (see pages: 28-29 in the ECERS-R) Score: 2 pts Assessor Comments: Diaper change routines occurred 10 times during the observation. Preparations: Preparations for all routines occurred prior to placing the child on the diapering surface. Disposal: The soiled diapers were disposed of properly. Wipes: The teacher's and children's hands were not wiped with a wipe prior to handling the clean diaper. Clean/Disinfect: Following each routine, the diaper changing surface was cleaned and disinfected properly. For more information on procedures required during diapering routines, please refer to the diapering procedure poster from the North Carolina Child Care Health and Safety Resource Center. This is a potential violation of the following rule: 15A NCAC 18A .2819 DIAPERING AND DIAPER CHANGING FACILITIES (d) Child care center employees shall change a child's diaper as follows: (1) gathering supplies before placing child on diapering surface; (2) donning disposable gloves (if needed); (3) using disposable towelette or moistened paper towel to clean child, wiping front to back; (4) disposing of gloves if used, soiled towelettes and diaper in a plastic-lined, covered receptacle; (5) wiping the child care center employee's hands and the child's hands each with a separate disposable towelette or moistened paper towel; (6) sliding a clean diaper under the child, applying diapering products if needed, using facial or toilet tissue, and discarding the tissue in a plastic-lined, covered receptacle; (7) fastening the diaper and placing clothing on child; (8) washing child's hands in accordance with Rule .2803 of this Section, or, if child is unable to support the child's head, cleaning the child's hands with a disposable towelette or moistened paper towel, then drying the child's hands and returning the child to a supervised area; (9) spraying entire diapering surface with detergent solution and wipe clean, using disposable paper towels; (10) spraying entire diapering surface with an approved disinfectant and allowing to remain on the surface for two minutes or as specified by the manufacturer, or air dry; and (11) washing hands in accordance with Rule .2803 of this Section even if disposable gloves are used by the child care center employee. Observations today: Diaper changes were observed in the classrooms for infants and two year old children. All steps were followed and handwashing occurred as required in rule. We discussed pulling out more wipes during the preparation of the diaper change, so that staff do not have to handle the wipes pouch with soiled hands. Item 13 Indicator: 3.1 (see pages: 30-31 in the ECERS-R) Score: 2 pts Assessor Comments: This indicator addresses handwashing related to entering and returning to the classroom, before and after water play, as well as after messy play in addition to handwashing that occurs after contact with bodily fluids and touching contaminated surfaces. Teachers, staff members, and children should wash their hands at least 75% of the time when needed. The teachers and staff member washed their hands 33% of the time. The teachers and staff did not wash their hands upon entering the classroom. During outdoor play, the teachers did not use hand sanitizer after playing in the water table. The children washed their hands 38% of the time. Some of the children did not wash their hands upon entering the classroom, and following outdoor play. Some of the children did not use hand sanitizer after they used the water table outdoors. *Please note the use of hand sanitizing products while outdoors is an acceptable substitute; indoors, soap and running water should be used for proper handwashing. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Handwashing was observed after toiletings and diaper changing today. All handwashing steps were followed according to rule. You stated that the handwashing rule regarding entering the classroom, returning indoors from outdoor play and the use of hand sanitizer in lieu of handwashing after waterplay outdoors was reviewed with staff. To clarify, the rule regarding hand sanitizer is specific to children. However, if staff are participating in water play, plan to follow the hand sanitizer requirement as stated in Sanitation Rule .2803 (d). Item 25 Indicator: 3.3 (see pages: 50-51 in the ECERS-R) Score: 2 pts Assessor Comments: The teacher stated during the interview that the children are not allowed to bring in natural objects, which does not meet the requirements for this indicator. This item is related to best practice. There are no potential violations associated with this indicator. Observations today: You clarified that children are permitted to bring in natural materials for exploration. ITERS-R assessment- 7/2/24 Total Score: 5.52 Item 6 Indicator: 3.3 (see pages: 18-19 in the ITERS-R) Score: 2 pts. Assessor Comments: During the observation, two children arrived to the classroom. The parents passed the children over the half door to a teacher. These parents did not enter the classroom. This item is related to best practice. There is no violation associated with this indicator. Observations today: You clarified today that most parents do come into the classroom at drop off and that the staff encourages them to do so. Caregivers stated that some parents prefer designated times to spend time in the classroom instead of at drop off. Item 8 Indicator: 3.2 (see pages: 22-23 in the ITERS-R) Score: 2 pts. Assessor Comments: An infant was placed on his side to sleep in his crib. In addition, two cribs were spaced 30 inches apart rather than at least 36 inches. This is potential violation of the following rule: 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; Observations today: The caregiver stated that children are always placed on their backs. One (1) sleeping infant was observed on their side while sleeping. The caregiver stated that the child can roll over. This was also stated in writing on the child’s crib. Sleep checks were monitored today and positions were documented showing that the child was placed on their back and then rolled over to various positions. We discussed the thirty-six (36) inch spacing requirement is best practice. Sanitation rules require that cribs are spaced at apart by eighteen (18) inches at a minimum. Please see the rule below for details: 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (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. Item 9 Indicator: 3.3 (see pages: 24-25 in the ITERS-R) Score: 2 pts. Assessor Comments: The children's hands were washed consistently after diapering; however, the teachers washed their hands 33% of the times needed, which was less than the 75% required. Of the 15 times that diaper changes occurred, the teachers washed their hands 5 times after spraying the diapering surface with disinfectant. This is a potential violation of the following rule: 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. Observations today: Diaper changes were observed in the classroom for infants and two year old children. Handwashing occurred after each diaper change according to rule. You stated that this rule was reviewed with staff as a reminder. A walk through of caregiving spaces was conducted. Beth Olwell, Administrator, was present on the walk through and available to ask and answer questions throughout the visit today. Children in group 1 were observed exploring their environment through crawling, scooting and pulling up on furniture, sleeping and participating in routine caregiving activities such as diapering. There were seven (7) children aged infant to one year old with three (3) caregivers. Children in group 2 were observed pretending to cook, singing with caregivers and participating in routine caregiving activities such as diapering and handwashing. There were ten (10) two year old children present with three (3) caregivers. Children in group 3 were observed playing outdoors, riding tricycles, and interacting with caregivers. There were seven (7) children present aged one to two years old with three (3) caregivers. Children in group 4 were observed completing puzzles with caregivers, trying on various articles of clothing, building small structures with magnatiles, and creating collages with stickers and markers. There were sixteen (16) children present ages two to four years old with three (3) caregivers. Children in group 5 were observed playing on the large playground. Children were observed riding tricycles, building structures with large connector blocks, and were practicing calming strategies with caregivers. There were eleven (11) children present ages four to five years old with three (3) caregivers. Children in group 6 were observed playing outside on the large playground, climbing the structure, riding tricycles and building structures with large connector blocks. There were eight (8) children present with one (1) caregiver. Interactions were positive and nurturing. Children were actively supervised at all times. The following violation was cited during the visit today: Violation Number Comment Rule 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Small plastic animals that failed the choke tube test were present in the classroom for two year old children. .0604(q) Technical Assistance provided as follows: Item #858 The small animals were removed from the classroom during the visit. This was corrected. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Consultation provided as follows: We discussed the changes to the requirements for the Rated License Reassessment process do the recent legislation that was passed. Hold Harmless has been extended, therefore any additional Rated License activities will only occur if you choose to participate. You stated that you would like to move forward with completing the Rated License Reassessment process. The Rated License Reassessment packet and the Staff Information Sheet is included in the email containing this visit summary. Please complete the attached forms and return to me when you are ready to move forward with your Rated License Reassessment. The facility current operates on a five (5) star license issued 9/5/17. Restrictions include: 1st shift (daytime care), meets enhanced ratios, meets enhanced space ,children under 2.5 years old in rooms with direct exits only. Program Standards: We discussed that you will elect to use the scored received from the ECERS assessment on 7/1/24 and the ITERS assessment on 7/2/24 toward your Rated License Reassessment. Your facility currently meets enhanced ratios and enhanced space requirements. Education Points: We discussed that your current licensed is calculated with seven (7) points in education standards. Ensure all staff have their education evaluated by WORKS and their most up-to-date WORKS letter is on file. Quality Point: We discussed you are currently meeting your quality point with the programmatic option through staff benefits package and infrastructure of parent involvement. Plan to review the current quality point options in section .2829 of the Chapter 9 Child Care Rules to determine what would be best for your facility. A Rated License Assessment visit will need to be conducted prior to the Rated License being processed. This visit can be announced if it occurs within six (6) months of your Annual Compliance date. If the Rated License visit occurs past six (6) months of your Annual Compliance date, an unannounced Annual Compliance with Rated License visit will need to be conducted. Once the Rated License Reassessment application is received and reviewed, we can discuss possible dates for this visit to occur. We discussed the rule regarding moving children up an age level for transition purposes without affecting the ratio or group size. Please see the rule below for details: 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; Written permission from a parent is needed to move a child up one age group without affecting the staff/child ratio for that group. Additionally, please see the rule below as a reminder when children are visiting classrooms for the purpose of transitioning: (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0508 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0514 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/13/2024 Number Present: 60 Completed Date: 3/13/2024 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to time constraints, the visit was not able to be completed today. A return visit will be made to complete monitoring of all areas. Upon completion of the return visit, an annual compliance monitoring checklist will be emailed to you. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety percent (90%) as of 3/13/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the none-profit corporation, Child Care Center of First Presbyterian Church, Inc. is current/active as of 3/13/24.. Permit type – Five (5) star license issued 9/5/17 Special Services/Restrictions – 1st shift (daytime care), meets enhanced ratios, meets enhanced space, children under 2.5 years old in rooms with direct exits only. The program serves children with special needs. The last annual compliance visit was conducted on 3/30/23. The last fire drill was practiced on 2/29/24 The last shelter-in-place drill was practiced on 11/1/23. The last playground inspection was documented on 2/20/24. The last fire inspection was approved on 10/25/23. The last sanitation inspection was conducted on 9/8/23 with sixteen (16) demerits for an approved classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. The Emergency Preparedness and Response plan was updated on 2/16/24. The program does not provide transportation. There are eighteen (18) staff. Due to time constraints, the monitoring of staff files was unable to be completed during the visit today. Another visit will be conducted to complete the monitoring of staff files. There are sixty-seven (67) children enrolled. Seven (7) children’s files were monitored today. Upon arrival I was greeted by Ms. Olwell and Nicole Morris, Program Coordinator. Ms. Olwell and Ms. Norris accompanied me on the walk through. In classroom space 3, children were observe cruising, crawling and walking to explore their environment, pushing toys, and being fed and soothed by caregivers. Children from classrooms 6 and 5 were observed playing on the playground for infants and toddlers. Children pushed toys, rode tricycles, and threw rubber balls. In classroom space 2, children were playing on the playground for preschool aged children. Children were observed using balancing toys, digging in the sandbox with a variety of scoops and tools, climbing, running races, and sliding down the slide. In classroom space 1, children played Jenga in a small group led by the teacher. The teacher offered conflict resolutions strategies with disagreements arose. Children were also observed building with magnatiles, and reading books with caregivers. In classroom space 8, children were observed in a large group meeting, getting ready to transition to a gross motor activity in the hallway before lunch. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. One (1) five year old child was observed filling a water bottle directly outside of classroom space 8. Caregivers were not positioned to adequately see the child in the hallway. .1801(a)(1-5) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in classroom space 2. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. One (1) tube of clotrimazole and one (1) plastic container of Nyastatin was not kept in locked storage in classroom space 6. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In classroom space 5, there were two (2) diaper creams and seven (7) sunscreens without written authorization from the parent on file. 10A NCAC 09 .0803(1)(a & b) 843 A drug or medicine was administered after its expiration date. In classroom space 5, one (1) diaper cream expired 12/2023 and one (1) sunscreen expired 1/2021. In classroom space 6, one (1) diaper cream expired 2/2024. 10A NCAC 09 .0803(1)(d) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In classroom space 6, Nyastatin cream was in a plastic container with a handwritten label. .0803(2)(a) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. One (1) electronic sanitizer and the cords were accessible to an infant’s crib in classroom space 3. Two (2) bottle warmers were accessible to children in classroom space 3. .0604(e) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Seven (7) existing staff files contained Annual Staff Evaluations and Staff Development Plans dated 4/18/22. One (1) existing staff file contained an Annual Staff Evaluation and Staff Development Plan dated 2/21/22. One (1) existing staff file (hire date 3/13/23) did not contain an Annual Staff Evaluation and Staff Development Plan. 10A NCAC 09 .0514(f) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff, hire date 11/6/23, completed Recognizing and Responding to Suspicions of Child Maltreatment training on 3/14/24. .1102(g) Technical assistance was provided as follows: Item #303 We discussed the requirement that staff must be able to see and hear children for adequate supervision. A return visit may be made to follow up on this violation. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #428 Plan to post the current week’s activity plan in an area visible to parents. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #841 Plan to lock all over the counter or prescription medication on a locked box or cabinet. The only exception to this is non prescription diaper cream and non-aerosol sunscreen. Please see the guidance in the rule below. 15A NCAC 18A .2820 STORAGE (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. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. 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. Item #842 All medications must have written parent permission on file before administering. We discuss reminding staff about the policy to have all medication go through the office. We also discussed making a copy of the medication authorization forms before handing them off to the teacher. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; Item #843 Plan to send home or discard all expired medications. We discussed the possibility of using a log to document the expiration dates of medications and their authorizations. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (d) after its expiration date; Item #844 All over the counter and prescription medication must be kept in its original container. Plan to return the medication to the parent and request the original container of medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Item #898 Equipment with heating elements and their cords must be kept out of reach of children to prevent burns. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 3/27/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed adequate supervision for the use of the upstairs bathroom by classroom space 8. Following previous guidance, you were told the one (1) caregiver assigned to the classroom could stand by the door while a child used the bathroom in the hallway. We discussed how children's needs would be met in the event of an emergency and how you can ensure there are no church staff using the hallway bathroom. Revisit the supervision plan with your staff for this classroom. We discussed the possibility of increasing large group bathroom trips or calling for assistance if just one child needs to use the bathroom. We discussed the Nyastatin in classroom space 3 will will need a Medication Permission Form as it is considered prescription medication. We discussed that the prescription will expire in 6/6/24. The caregiver stated that the medication is no longer needed. Plan to return the medication to the parent or have them complete the Medication Permission Form. We discussed new Lead Teachers must submit their education to WORKS and include documentation of their education qualifications in their staff file within six (6) months of employment. This documentation can include diploma, degree, transcripts, WORKS letter, or proof of registration in courses. We discussed staff ER must sign the policy acknowledgment and job description page. The staff member completed the form but did not sign. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Your facility has been placed in cohort 1. Your Prep Year will end 6/30/24. We discussed that you would like to have your Prep Year Assessment completed in May 2024. In order to ensure you are able to participate in the Prep Year Assessment, plan to complete the Assessment Request Review form and return to me by mid April. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0302 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1101 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 10/19/2023 Number Present: 54 Completed Date: 10/19/2023 Age: From 0 To 5 Total Minutes: 240 Time In: 10:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Olwell was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 10/18/23. The last fire drill was practiced on 9/6/23. The last emergency drill, lockdown drill, was practiced on 6/30/23. The last fire inspection was approved on 8/29/22. The program’s most recent sanitation inspection was completed on 9/8/23, with sixteen (16) demerits for an approved rating. The Emergency Medical Care Plan was posted and current. The program does not provide transportation. In classroom space 3, children were cruising and pulling up on furniture, sleeping and being soothed by caregivers. In classroom space 6, children were playing with people figurines, stacking foam blocks, and pushing cars on various surfaces. Children were gently redirected as needed. In classroom space 5, children were observed playing outside, holding hands with friends and teachers while singing and walking on a path. In classroom space 2, children were observed playing outside, building with large connector pieces, pushing bulldozers and running. In classroom space 1, children were observed rolling balls with playdoh, scooping kinetic sand, building large structures with wooden blocks and were engaging in conflict resolution strategies independently. In classroom space 8, children were transitioning from center play to lunch, and sang the ABC's as they washed their hands. Children were actively supervised at all times. Interactions were positive and nurturing. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 8/29/22. 10A NCAC 09 .0304(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill documented on the log was dated 8/29/23. .0604(t); .0302(d)(5) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, rehired 8/28/23, did not complete sixteen (16) hours of orientation within the first six weeks of employment. .1101(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown and shelter-in-place drill was conducted on 6/30/23. .0604(u);.0302(d)(8) Technical assistance was provided as follows: Item #106 Plan to scheduled and obtain an approved fire inspection immediately. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #805 The fire drill that was conducted on 9/6/23 was not documented on the fire drill log. This was corrected during the visit today. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Item #1045 Plan to conduct the orientation training topics for the first six (6) weeks of employment with the one (1) staff. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. Item #1811 Plan to conduct a lockdown or shelter-in-place drill. Plan to document this drill on the log. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/2/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the North Carolina Early Childhood Equivalency Exam. This option is available on the DCDEE Moodle. Plan to ensure all staff/child ratio sheets are posted and complete in each classroom. Plan to store children's water bottles in their individual cubbies in the classroom. Water bottles can be carried outdoors collectively, but must be returned to their cubbies upon return to the classroom. We discussed the Rated License Reassessment. Your facility has been placed in cohort 1. You are currently in your Prep Year which ends on 6/30/24. Your reassessment year will be 7/1/24-6/30/25. We discussed the importance of ensuring all staff have their education evaluated by WORKS. We discussed the Prep Year Assessment option from the North Carolina Rated License Assessment Project (NCRLAP). Prep Year information was shared with you via email today. Plan to submit the Rated License Assessment Request Review form when your facility is ready for the Prep Year assessment. Please note, the Prep Year assessment option is only available to 6/30/24 for your facility. Please visit ncrlap.org for more information regarding Rated License Reassessment. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: CHILD CARE CENTER OF FIRST PRESBYTERIAN CHURCH Facility ID: 1152144 Consultant: KAORU EDDINS Operation Type: Center Case Number: 0823-100L Visit Date: 8/8/2023 Number Present: 53 Completed Date: 8/8/2023 Age: From 0 To 5 Total Minutes: 195 Time In: 09:15 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Complaint visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Beth Olwell, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site. Today, Beth Olwell, Administrator, and Nicole Morris, Program Coordinator, were available during the visit. The self-report was submitted to the Division on 8/4/23 and sent to Kaoru Eddins, Child Care Consultant, on 8/7/23. The concern is regarding discipline. Per the report, a parent reported to Ms. Olwell that the child’s teacher intentionally hit the child in the month with the elbow on 8/2/23, at approximately 10:40 am. The facility also submitted additional signed statements from the lead teacher, the teacher for the classroom where the incident occurred, Ms. Olwell, and the person who took the report from the parent. Limited monitoring was conducted during today’s visit including discipline, interaction, supervision, and permit restrictions. Permit type – Five-star Center License issued on 9/5/17. Special Services/Restrictions – Daytime care, meets enhanced ratios and space. Children under 2 ½ years old in rooms with direct exits only. The last annual compliance visit was conducted on 3/30/23. Upon arrival, I announced my presence and the purpose of the visit. I observed the classroom where the alleged violation occurred. Fifteen (15) children are enrolled in the classroom. Upon arrival, there were eleven (11) children, and two (2) additional children arrived during the visit. A group of three-to-five-year-old children engaged in free play. Upon arrival, the five-year-old child on the report was in a quiet area. Per the lead teacher, the child voluntarily laid down in the quiet area due to not feeling well. The quiet area is set up using the bottom of a shelf. In the quiet area, there is a poster asking how do you feel? There are pillows, blankets, weighted blanket, and stuffed animals in the area as well. The child started kicking the wall (of the shelf). The lead teacher calmly talked to the child. The lead teacher took the child to another room to get some climbers. The teacher and the child set up climbers in the hallway, and the child played with the climbers. The other teacher had ten (10) children in the classroom. With prompt, the child finished playing with climbers and came back into the classroom with the lead teacher. In the classroom, the child stayed with the lead teacher throughout free play time. The child played with housekeeping toys and then played with the block area. Other children, three-to-five years of age played with building blocks, toy animals, manipulative toys, art materials, and housekeeping toys. The lead teachers gave the group of children a five-minute and one-minute warning before clean-up time started around 9:58 am. The child joined others to clean up block areas without prompts. The children grabbed their water bottles after cleaning and lined up by the door. The children then went to the playground. The child played with other children on the playground using a shovel and a bucket. There is a large structure on the playground and toys vehicles, plates, buckets, shovels, cups, blocks, balls are available for children to use. The child on the report played happily with the lead teacher throughout the observation. The lead teacher spoke calmly and attentively to the child. Interaction and supervision were adequate. Appropriate prompts were given to all children through observation. There are some social/emotional materials in the classroom. Rather than the quiet area, a poster, and soft materials, there are some social/emotional books, such as “The BAD SEED”, “The Pout-Pout Fish” and “Side by Side”. I interviewed Ms. Olwell and Ms. Moore. The lead teacher and the teacher’s statement were previously submitted in writing prior to this visit. Per the interview, the child on the report has displayed some challenging behaviors in recent months. The program has worked with a specialist from Sunshine Project and has been referred to therapy. No diagnosis has been made. The program has worked with the child’s mother regarding the child’s behaviors. The facility’s discipline policy was reviewed. The discipline policy is based on positive reinforcement techniques and does not state the policy or procedures for extremely challenging behaviors, such as hitting, kicking, biting, and throwing things. The incident report/log was monitored. There is no incident report created for the incident reported on the complaint report. Per the written statement and interview, the child on the report displays violent behaviors sometimes. Per the written statement submitted by the lead teacher, the child was removed from the group of children during a transition due to some physical violence toward other children in line. When the child was brought to the quiet area, the child became increasingly aggressive toward the lead teacher resulting in kicking, biting, and slapping. When the child bit the lead teacher’s elbow, the lead teacher pulled his/her elbow away. As a result, the child’s loose tooth started bleeding. No incident report was created. This incident occurred on 8/2/23 around 10:40 am. A picture of the child’s gum was submitted to the facility. Reviewing the picture, the injury itself was difficult to see. There was a small red spot on the child’s gun, approximately the size of a freckle. The cause of the red spot has not been determined. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable childcare requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09), and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ There is no sufficient evidence of a link between the child’s injury (red spot) and the teacher’s action. In addition, pulling away when bitten is a natural human reaction, and it is determined not to be an intentional act to harm a child. Therefore, the allegation of a violation regarding discipline is unsubstantiated. The following violations were documented during today’s visit. Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Per written statement submitted by the facility, a child's month started bleending after a teacher pulled his/her elbow away from the child upon being bitten. There was nobincident report created for the incident. .0802 (e) Technical assistance was provided as follows: 852: Incident report: An incident report shall be created each time a child is hurt. Anytime you have to apply first aid, such as band-aid, ice, etc. an incident report must be created. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (e) The child care provider shall complete an incident report each time a child is injured as a result of an incident occurring while the child is in care. This incident report shall include: (1) facility identifying information; (2) the child's name; (3) date and time of the incident; (4) witness to the incident; (5) time the parent is notified of the incident and by whom; (6) piece of equipment involved, if applicable; (7) cause of injury, if applicable; (8) type of injury, if applicable; (9) body part injured, if applicable; (10) where the child received medical treatment, if applicable; (11) description of how and where the incident occurred, and the First Aid received; and (12) steps taken to prevent reoccurrence. This report shall be signed by the person completing it and by the parent, a copy given to the parent or a parent signature declining a copy, and the report maintained in the child's file. A copy of the form may be found on the Division's website at http://ncchildcare.ncdhhs.gov/ Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 8/22/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Review of discipline policy: Per the interview, it is apparent that the child on the report is removed from one place and placed in other areas or gets restrained when the child is considered dangerous to self or others. The action is not listed on the facility’s current discipline policy. I advise you to create a policy for extreme behavior policy to keep children, teachers, and staff members safe. The teachers should always follow the facility’s discipline policy. If there are discrepancies between written policies and practice, the facility should review the policy and update or re-train teachers to follow the written policies. If policies are updated, you shall inform staff members and review the policy. If and when a child has to be forcefully removed or restrained, detailed documentation should be taken. Please know that restraining a child should be the last result and every other option shall be explored before restraining occurs. The options include prevention, re-directing the child, removing other children away from the child, calling for additional staff members, switching teachers, etc. Discipline: It is always the best practice to remove other children rather than the child who has violent outbursts to avoid unnecessary injuries or misunderstandings. Forcefully removing should be a last effort and the purpose shall be to prevent injuries of the child and others. Please consult with the specialist from the Sunshine project on how to appropriately deal with such a situation. Removal of children shall be included in your discipline policy. Also, teach the child appropriate to release anger and frustration. The appropriate social rules shall be taught to the child by calmly but firmly telling the child what is appropriate and not. The child shall be taught alternative ways to express himself/herself. The teachers should discuss and agree on the approach and keep it consistent. Materials: I observed the child frequently jump up and down during the observation. The child may benefit from some sensory materials. An unauthorized weighted blanket is not appropriate for the classroom. Please follow the manufacturer’s information and make sure that the weighted blanket is age appropriate. If the parent(s) or the teachers see the need for a weighted blanket/vest, etc. make a referral to Occupational Therapist to evaluate the child. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times