Mission Health Child Care Development Center

10A NCAC 09 .1801 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0326-100L Visit Date: 3/17/2026 Number Present: 99 Completed Date: 3/17/2026 Age: From 0 To 5 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit was to obtain information related to a self-report received by the Division. During today’s visit, Kelsey Barton, Assistant Director, accompanied me during a walk-through of the facility. During the visit, I discussed the information with Porsche Rice, Administrator, and additional staff members. Limited monitoring of child care requirements was conducted today to include supervision. There is a concern of inadequate supervision. Based on information obtained, the following was determined. On 3/3/26 at approximately 3:00-4:00pm a two-year-old child was left in the hallway for less than one (1) minute during a transition from the hallway bathroom to the classroom. I interviewed two (2) staff. I conducted a walkthrough of all caregiving spaces. I observed children from classroom space 5 transition from the hallway restroom to the classroom. The staff member was positioned so that they could see all children and render assistance throughout the transition. I observed children who were waiting to use the restroom or waiting to return to the classroom play with toys and read books. Upon reentering the classroom, a name to face check was conducted by the staff member and was documented on the My Bright Day app. Supervision was adequate in all caregiving spaces today. Based on the self-report and interviews, the concern regarding supervision is confirmed. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. On 3/3/26 at approximately 3:00pm a two-year-old child was left in the hallway for less than one (1) minute during a transition from the hallway bathroom to classroom space 5. .1801(a)(1-5) Technical assistance was provided as follows: Item #303: Adequate supervision must be maintained at all times according to rule .1801(a)(1-5). We discussed an additional child was added to the group of children during the transition to the bathroom, disrupting the head count upon returning to the classroom. To avoid confusion, the teachers in the classroom agreed to refrain from adding children to a group already in transition and to wait to move additional children to the restroom until the current transition is completed. Additionally, we discussed the operator’s response as follows: -A supervision “counsel” was conducted by Kathy Twiss, Legal Operator with the staff involved in the incident. Counsel includes documentation of the incident as well as resources needed and steps to be taken to avoid similar incidents moving forward. -The staff member involved in the incident was placed on Administrative leave for one (1) day and was included in the “counsel” prior to returning to work. -Administrative staff observes the classroom involved in the incident periodically throughout the day, targeting known transition times. -Name to face counts are documented on the My Bright Day app during transitions. -The staff involved in the incident were assigned and completed trainings regarding supervision. The trainings are provided by Bright Horizons and were delivered virtually. -Procedures during the transition in the hallway bathroom were modified to include positioning children in a line on the wall, giving them transition toys while they wait to use the restroom or wait to reenter the classroom. -An all-staff meeting is planned for 3/17/26 to review supervision procedures. I suggest adding a procedure to the transition in which a staff member sweeps the restroom to ensure no children are left in the stalls. The stalls are enclosed by half-walls, however a small child crouching down could be missed. Mirrors are positioned to help see into the stalls. Plan to have staff physically sweep the bathroom or utilize the mirrors to ensure no children are left in the hallway bathrooms. In your letter of compliance, include information that captures all you have done to respond to the incident and any procedures you have put in place to ensure compliance moving forward. If you create an agenda or roster from the all-staff meeting on 3/17/26, plan to include that documentation with your letter of compliance as well. Achieving Compliance: The facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). 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# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 3/31/26. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) 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: 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 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0326-100L Visit Date: 3/17/2026 Number Present: 99 Completed Date: 3/17/2026 Age: From 0 To 5 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit was to obtain information related to a self-report received by the Division. During today’s visit, Kelsey Barton, Assistant Director, accompanied me during a walk-through of the facility. During the visit, I discussed the information with Porsche Rice, Administrator, and additional staff members. Limited monitoring of child care requirements was conducted today to include supervision. There is a concern of inadequate supervision. Based on information obtained, the following was determined. On 3/3/26 at approximately 3:00-4:00pm a two-year-old child was left in the hallway for less than one (1) minute during a transition from the hallway bathroom to the classroom. I interviewed two (2) staff. I conducted a walkthrough of all caregiving spaces. I observed children from classroom space 5 transition from the hallway restroom to the classroom. The staff member was positioned so that they could see all children and render assistance throughout the transition. I observed children who were waiting to use the restroom or waiting to return to the classroom play with toys and read books. Upon reentering the classroom, a name to face check was conducted by the staff member and was documented on the My Bright Day app. Supervision was adequate in all caregiving spaces today. Based on the self-report and interviews, the concern regarding supervision is confirmed. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. On 3/3/26 at approximately 3:00pm a two-year-old child was left in the hallway for less than one (1) minute during a transition from the hallway bathroom to classroom space 5. .1801(a)(1-5) Technical assistance was provided as follows: Item #303: Adequate supervision must be maintained at all times according to rule .1801(a)(1-5). We discussed an additional child was added to the group of children during the transition to the bathroom, disrupting the head count upon returning to the classroom. To avoid confusion, the teachers in the classroom agreed to refrain from adding children to a group already in transition and to wait to move additional children to the restroom until the current transition is completed. Additionally, we discussed the operator’s response as follows: -A supervision “counsel” was conducted by Kathy Twiss, Legal Operator with the staff involved in the incident. Counsel includes documentation of the incident as well as resources needed and steps to be taken to avoid similar incidents moving forward. -The staff member involved in the incident was placed on Administrative leave for one (1) day and was included in the “counsel” prior to returning to work. -Administrative staff observes the classroom involved in the incident periodically throughout the day, targeting known transition times. -Name to face counts are documented on the My Bright Day app during transitions. -The staff involved in the incident were assigned and completed trainings regarding supervision. The trainings are provided by Bright Horizons and were delivered virtually. -Procedures during the transition in the hallway bathroom were modified to include positioning children in a line on the wall, giving them transition toys while they wait to use the restroom or wait to reenter the classroom. -An all-staff meeting is planned for 3/17/26 to review supervision procedures. I suggest adding a procedure to the transition in which a staff member sweeps the restroom to ensure no children are left in the stalls. The stalls are enclosed by half-walls, however a small child crouching down could be missed. Mirrors are positioned to help see into the stalls. Plan to have staff physically sweep the bathroom or utilize the mirrors to ensure no children are left in the hallway bathrooms. In your letter of compliance, include information that captures all you have done to respond to the incident and any procedures you have put in place to ensure compliance moving forward. If you create an agenda or roster from the all-staff meeting on 3/17/26, plan to include that documentation with your letter of compliance as well. Achieving Compliance: The facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). 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# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 3/31/26. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) 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: 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 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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 .3222 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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

G.S.110-105 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/4/2026 Number Present: 96 Completed Date: 3/4/2026 Age: From 0 To 5 Total Minutes: 336 Time In: 09:24 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Kelsey Barton, Assistant Director, during the visit. Kaoru Eddins and Lee Marshall, Child Care Consultants, accompanied me on the visit today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton 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 ninety-six percent (96%) as of 3/3/26. The North Carolina Secretary of State website was viewed prior to today’s visit and the Limited Liability Company, Bright Horizons Children's Centers LLC, is current/active as of 3/3/26. Permit type – Five (5) star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 3/12/25. The last fire drill was practiced on 2/25/26. The last shelter-in-place drill was practiced on 2/11/26. The last playground inspection was documented on 2/25/26. The last fire inspection was approved on 7/10/25. The last sanitation inspection was conducted on 11/5/25 with six (6) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum is “World at their Fingertips” Lead water testing was completed on 8/14/23 without hazards. Lead paint testing has not been completed. The Clean Classrooms for Carolina Kids website states the status as “Waiting for on-site visit results”. Continue to work with RTI to complete the required testing. Asbestos testing was completed but a date is not provided on the Clean Classrooms for Carolina Kids website. The program does not provide transportation. Upon arrival we were greeted by Ms. Barton. Ms. L. Marshall monitored twelve (12) children’s files. Ms. Eddins monitored three (3) new staff files and nine (9) existing staff files. Ms. Barton accompanied me on the walkthrough of caregiving spaces. In classroom spaces 12 and 4, children explored their environment through crawling and walking, explored mouthable toys, shook rattling toys and were fed and soothed by caregivers. Children from classroom space 5 explored bubbles and riding toys on the playground for infants and toddlers. In classroom space 6, children out on various articles of clothing and pretended to cook in dramatic play. In classroom space 8, children transitioned to the indoor learning environment, washed hands, and listened to a book read aloud by a teacher. In classroom space 9, children built small structures with interlocking blocks and explored magna tiles on a light table. In classroom space 3, children participated in a music and movement activity with scarves, built large structures with various blocks and drew pictures on an easel with dry erase markers. In classroom space 2, children cleaned up center play and transitioned to lunch. In classroom space 10, children transitioned indoors from outdoor play. A name to face check was conducted at each threshold crossing. In classroom space 11, children ate lunch that consisted of chicken curry with mixed vegetables, rice, applesauce and milk. 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 815 Electrical cords were accessible to infants and toddlers. The electrical cord for a speaker was accessible to two-year-old children in classroom space 8. The electrical cord for the light table in classroom space 9 was accessible to two-year-old children. 10A NCAC 09 .0604(f) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The orientation log for two-week orientation for a staff member who was hired on 7/21/25 was blank for Child Maltreatment Reporting. .1101(a)(b) Technical assistance was provided as follows: Item #815: We discussed rule .0604(f) which states electrical cords cannot be accessible to infants and toddlers. By definitions in rule section .0102 children ages 13 months to 35 months are considered toddlers. For classrooms with children under three years old, electrical cords must be made inaccessible. We discussed this can be accomplished by placing the cords behind furniture or behind cord hiders that adhere to the wall. The cords in the classrooms noted in the violations were moved to be made inaccessible during the visit today. This is corrected. Item #1067: The date was located on another documentation sheet. This was corrected today. Moving forward plan to document the dates all topics were discussed on the orientation documentation page. Consultation is provided as follows: QRIS Discussion: We revisited the topic of the Rated License process. As a reminder, all facilities with expired Rated Licenses must go through the new Quality Rating and Improvement System by December 2026. We discussed interest in Pathway 1: Program Assessment. We revisited the QRIS website during the visit today. We discussed you will plan to apply for the Rated License assessment by October 2026. Medication: We discussed one (1) epinephrine pen and they permissions for the medication that expired today. The parent was contacted during the visit to replace the medication and permission. In classroom space 2, the permission for one (1) Epipen expires today. In classroom space 2, the Medical Action Plan for one (1) child with food allergies will expire 3/17/26. In classroom space 3, the Medical Action Plan for one (1) child with food allergies will expire 3/31/26. EPR Plan: Plan to update the facility’s EPR plan in the Risk Management Portal. Staff and Training Worksheet: A. Hartle: SDP: 11/5/25 2-week orientation: 11/4/25 6-week 0rientation: 11/7/25 A. Galey Required on-going training hours: 10 M. Holcombe: Health and Safety Training: 12/9/25 RRSCM training: 6/6/25 A. Mitchell: OP/PP: 7/24/25 P. Rice SDP: 9/9/25 ASE: 12/1/25 K. Barton SDP: 11/20/25 ASE: 12/1/25 L. Riddick Medical: 2/15/23 T. Riddick Required training:10 SDP: 11/16/25 For this staff member, the last completed training period was September 5, 2024, through September 4, 2025. During the 2024–2025 cycle, ongoing training requirements were waived from September 2024 through April 2025. For staff members required to complete ten (10) hours of annual training, it was determined that approximately three and one-half (3.5) hours were required during May, 2025, through September 4, 2025, training period. During today’s visit, one (1) hour of ongoing training was verified. Per conversation, Ms. Burton indicated she believed the ongoing training period ran from one (1) licensing visit to the next licensing visit. Due to this misunderstanding, consultation was provided regarding ongoing training requirements during today’s visit rather than citing a violation. Orientation for reporting of child maltreatment: You must review what pertains to your center related to the orientation topics listed on the orientation checklist and no genetic training can replace them. You cannot use the Recognizing and Responding to Suspicions of Child Maltreatment training for orientation for recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S.110-105.4 and G.S.7B-301. Instead, you shall review the rules G.S.110-105.4 and G.S. 7B-301. The topic shall cover to ensure that each staff member is a mandatory reporter of child abuse and maltreatment by law. On-going training On-going training hours are based on each staff member’s hire date. During annual compliance monitoring visits, we check last completed training period for ten (10) percent of existing staff members. For example, if a staff member was hired on 1/1/2017, the staff member’s training period is from January 1 one year to December 31 the following year. Training certificates are required to verify the training. 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 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, 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 .1803 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0625-128L Visit Date: 6/19/2025 Number Present: 65 Completed Date: 6/19/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 09:40 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of violations of child care requirements. 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 Kelsey Barton, Assistant Director, during the visit. A signed copy of the visit summary was emailed to you. Ms. Barton and Porsche Rice, Administrator, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three percent (93%) as of 6/16/25. The facility operates with a five-star license issued on 11/8/23. The Special Services/Restrictions include 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The facility is licensed to serve 160 children ages 0-6. The complaint was received by the Division of Child Development and Early Education on 6/13/25 and sent to me on 6/13/25. There are allegations of child care requirements including nurture/care, discipline and a safe environment. For nurture/care, there was an allegation of a staff member screaming at and rough handling a child. For discipline, there were allegations of two (2) separate staff members shaming, humiliating or frightening children. For safe environment, there was an allegation that a child was released to an individual not listed as an approved pick up person on the child’s application. Video footage of the incidents were not available during the visit today. A request was made for the video footage of both cameras on the large, back playground for 10:00am-11:00am on 5/28/25. Please contact me when the footage is available for review. Ten (10) staff were interviewed at the facility during the visit today. One (1) staff was interviewed over the phone during the visit today. Based on the interviews during the visit today, the allegations regarding discipline are substantiated. Based on the interviews during the visit today, the allegation regarding nurture/care is unsubstantiated. Based on the interviews and observations during the visit today, the allegations regarding a safe environment were unsubstantiated. The following violations were documented during today’s visit: Violation Number Comment Rule 904 A child was handled in a rough way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. On 5/28/25 at approximately 12:00pm on the preschool playground, a staff member handled a three year old child roughly by lifting them up by their arms and dragging them. .1803(a)(1) 1876 A child was yelled at, shamed, humiliated, frightened, threatened or bullied. On 6/10/25 at approximately 5:30pm, a two year old child was told to put soap in their hair and to eat soap by a staff member. The staff member laughed at them. On 6/12/25 at approximately 9:00am on the preschool playground, a different staff member yelled at and intimidated a three year old child until they urinated. .1803(a)(9) Technical assistance was provided as follows: Item #902 and #1876: We discussed age appropriate ways of addressing unwanted behavior which include speaking to the child in a calm tone and modeling appropriate behavior. Additionally, we discussed appropriate ways of handling children which include picking children up under the arms by their trunk or holding hands. You can reach out to our Health Social Behaviors Specialists for additional guidance and resources regarding challenging behavior. Please see the contact information below: Melissa Maybin, Behavior Specialist 828-477-4509 maybin.melissa@swcdcinc.org Sharon FitzGerald, Behavior Specialist 828-354-0367 fitzgerald.sharon@swcdcinc.org Additionally, you can visit https://www.childcarerrnc.org/special-projects/healthy-social-behaviors/ to learn more about available resources. Achieving Compliance: The facility received two (2) violations regarding discipline today. A follow-up visit will be conducted in the near future to determine if staff are using appropriate disciplinary actions with children per Child Care Rule 10A NCAC 09 .1803(a) and per the facility’s Discipline Policy. Based on today’s findings, this child care facility received a substantiated complaint regarding discipline. 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 7/3/25. 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: Please send any documentation you have regarding your response to the incidents documented today. This will aide in our Administrative Action decision process. 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 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 .2201 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0625-128L Visit Date: 6/19/2025 Number Present: 65 Completed Date: 6/19/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 09:40 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of violations of child care requirements. 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 Kelsey Barton, Assistant Director, during the visit. A signed copy of the visit summary was emailed to you. Ms. Barton and Porsche Rice, Administrator, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three percent (93%) as of 6/16/25. The facility operates with a five-star license issued on 11/8/23. The Special Services/Restrictions include 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The facility is licensed to serve 160 children ages 0-6. The complaint was received by the Division of Child Development and Early Education on 6/13/25 and sent to me on 6/13/25. There are allegations of child care requirements including nurture/care, discipline and a safe environment. For nurture/care, there was an allegation of a staff member screaming at and rough handling a child. For discipline, there were allegations of two (2) separate staff members shaming, humiliating or frightening children. For safe environment, there was an allegation that a child was released to an individual not listed as an approved pick up person on the child’s application. Video footage of the incidents were not available during the visit today. A request was made for the video footage of both cameras on the large, back playground for 10:00am-11:00am on 5/28/25. Please contact me when the footage is available for review. Ten (10) staff were interviewed at the facility during the visit today. One (1) staff was interviewed over the phone during the visit today. Based on the interviews during the visit today, the allegations regarding discipline are substantiated. Based on the interviews during the visit today, the allegation regarding nurture/care is unsubstantiated. Based on the interviews and observations during the visit today, the allegations regarding a safe environment were unsubstantiated. The following violations were documented during today’s visit: Violation Number Comment Rule 904 A child was handled in a rough way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. On 5/28/25 at approximately 12:00pm on the preschool playground, a staff member handled a three year old child roughly by lifting them up by their arms and dragging them. .1803(a)(1) 1876 A child was yelled at, shamed, humiliated, frightened, threatened or bullied. On 6/10/25 at approximately 5:30pm, a two year old child was told to put soap in their hair and to eat soap by a staff member. The staff member laughed at them. On 6/12/25 at approximately 9:00am on the preschool playground, a different staff member yelled at and intimidated a three year old child until they urinated. .1803(a)(9) Technical assistance was provided as follows: Item #902 and #1876: We discussed age appropriate ways of addressing unwanted behavior which include speaking to the child in a calm tone and modeling appropriate behavior. Additionally, we discussed appropriate ways of handling children which include picking children up under the arms by their trunk or holding hands. You can reach out to our Health Social Behaviors Specialists for additional guidance and resources regarding challenging behavior. Please see the contact information below: Melissa Maybin, Behavior Specialist 828-477-4509 maybin.melissa@swcdcinc.org Sharon FitzGerald, Behavior Specialist 828-354-0367 fitzgerald.sharon@swcdcinc.org Additionally, you can visit https://www.childcarerrnc.org/special-projects/healthy-social-behaviors/ to learn more about available resources. Achieving Compliance: The facility received two (2) violations regarding discipline today. A follow-up visit will be conducted in the near future to determine if staff are using appropriate disciplinary actions with children per Child Care Rule 10A NCAC 09 .1803(a) and per the facility’s Discipline Policy. Based on today’s findings, this child care facility received a substantiated complaint regarding discipline. 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 7/3/25. 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: Please send any documentation you have regarding your response to the incidents documented today. This will aide in our Administrative Action decision process. 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 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0625-128L Visit Date: 6/19/2025 Number Present: 65 Completed Date: 6/19/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 09:40 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of violations of child care requirements. 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 Kelsey Barton, Assistant Director, during the visit. A signed copy of the visit summary was emailed to you. Ms. Barton and Porsche Rice, Administrator, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three percent (93%) as of 6/16/25. The facility operates with a five-star license issued on 11/8/23. The Special Services/Restrictions include 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The facility is licensed to serve 160 children ages 0-6. The complaint was received by the Division of Child Development and Early Education on 6/13/25 and sent to me on 6/13/25. There are allegations of child care requirements including nurture/care, discipline and a safe environment. For nurture/care, there was an allegation of a staff member screaming at and rough handling a child. For discipline, there were allegations of two (2) separate staff members shaming, humiliating or frightening children. For safe environment, there was an allegation that a child was released to an individual not listed as an approved pick up person on the child’s application. Video footage of the incidents were not available during the visit today. A request was made for the video footage of both cameras on the large, back playground for 10:00am-11:00am on 5/28/25. Please contact me when the footage is available for review. Ten (10) staff were interviewed at the facility during the visit today. One (1) staff was interviewed over the phone during the visit today. Based on the interviews during the visit today, the allegations regarding discipline are substantiated. Based on the interviews during the visit today, the allegation regarding nurture/care is unsubstantiated. Based on the interviews and observations during the visit today, the allegations regarding a safe environment were unsubstantiated. The following violations were documented during today’s visit: Violation Number Comment Rule 904 A child was handled in a rough way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. On 5/28/25 at approximately 12:00pm on the preschool playground, a staff member handled a three year old child roughly by lifting them up by their arms and dragging them. .1803(a)(1) 1876 A child was yelled at, shamed, humiliated, frightened, threatened or bullied. On 6/10/25 at approximately 5:30pm, a two year old child was told to put soap in their hair and to eat soap by a staff member. The staff member laughed at them. On 6/12/25 at approximately 9:00am on the preschool playground, a different staff member yelled at and intimidated a three year old child until they urinated. .1803(a)(9) Technical assistance was provided as follows: Item #902 and #1876: We discussed age appropriate ways of addressing unwanted behavior which include speaking to the child in a calm tone and modeling appropriate behavior. Additionally, we discussed appropriate ways of handling children which include picking children up under the arms by their trunk or holding hands. You can reach out to our Health Social Behaviors Specialists for additional guidance and resources regarding challenging behavior. Please see the contact information below: Melissa Maybin, Behavior Specialist 828-477-4509 maybin.melissa@swcdcinc.org Sharon FitzGerald, Behavior Specialist 828-354-0367 fitzgerald.sharon@swcdcinc.org Additionally, you can visit https://www.childcarerrnc.org/special-projects/healthy-social-behaviors/ to learn more about available resources. Achieving Compliance: The facility received two (2) violations regarding discipline today. A follow-up visit will be conducted in the near future to determine if staff are using appropriate disciplinary actions with children per Child Care Rule 10A NCAC 09 .1803(a) and per the facility’s Discipline Policy. Based on today’s findings, this child care facility received a substantiated complaint regarding discipline. 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 7/3/25. 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: Please send any documentation you have regarding your response to the incidents documented today. This will aide in our Administrative Action decision process. 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 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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 .0302 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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 .0304 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 3/12/2025 Number Present: 86 Completed Date: 3/12/2025 Age: From 0 To 5 Total Minutes: 345 Time In: 09:15 AM Time Out: 03:00 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 me, Kaitlyn Marshall, Child Care Consultant and also signed by Porsche Rice, during the visit. Dawn McCrary, Child Care Consultant, accompanied me today. A signed copy of the visit summary was emailed to you. Ms. Rice and Kelsey Barton, Assistant Director, 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 ninety-two percent (92%) as of 3/10/25. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons, LLC, is current/active as of 3/10/25. Permit type – Five (5) star license issued 11/8/23 Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The last annual compliance visit was conducted on 4/2/24. The last fire drill was practiced on 3/10/25. The last shelter-in-place drill was practiced on 1/30/25. The last playground inspection was documented on 2/7/25. The last fire inspection was approved on 8/20/24. The last sanitation inspection was conducted on 12/16/24 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is “World at their Fingertips” The program does not provide transportation. Upon arrival I was greeted by Ms. Rice. In classroom space 12, children explored soft balls, crinkled tubes, rattling toys and mouthable toys. Two (2) children were sleeping. Sleep checks were conducted during the observation. In classroom space 1, children explored floor mobiles, toy phones with buttons, and participated in routine caregiving activities such as diapering and handwashing. Children from classroom spaces 5 and 6 were playing outside on playground space 2. Children pushed trucks, explored riding toys and played peekaboo with caregivers. Children from classroom space 10 were playing outside on playground space 3. Children observed and compared their shadows, kicked soccer balls and played chasing games. Children from classroom space 8 were playing outside on playground space 4. Children engaged in pretend play pretending to be babies and mamas and climbed on the climbers. Children from classroom space 11 were split into two (2) groups. A group of nine (9) children with one (1) caregiver were outside on playground space 3. Children balanced on stepping stones, built obstacle courses with large foam blocks, and rolled hula hoops on the ground. A group of nine (9) children were inside classroom space 11 engaged in independent center play. Children explored a water table, solved age-appropriate puzzles, engaged in pretended play with animal figurines in the blocks center, and built small structures with magnatiles. In classroom space 3, children were engaged in independent center play. Children drew pictures with paint pens on an easel, traced stencils of animal shapes with markers and pencils, and read books. Children cleaned up centers to prepare for lunch. In classroom space 2, children cleaned up centers and washed hands to prepare for lunch. Interactions were positive and nurturing. Children were actively supervised at all times. 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. One (1) diaper cream in classroom space 12 expired 11/2024. .0803(12) Technical assistance was provided as follows: The following item was cited as a violation during the visit today. The violation was corrected during the visit: Item #849 Expired Medication: Plan to monitor all expiration dates of over the counter and prescription medications at least monthly. The medication was removed from the classroom during the visit today. This was corrected. The following items were not cited as violations during the visit today. Due to Tropical Storm Helene, additional time and guidance is given to reach compliance with certain items. Please note that violations may be cited during future visits if compliance is not met: Emergency Information form: Staff, J.”N”. H., hired 2/12/25 had an Emergency Information Form which was not dated, nor had a chosen Health Care Professional. Staff, J. “N”. H., documented a Health Care Professional and dated the Emergency Information Form during today’s visit. Moving forward, plan to screen all Emergency information forms to ensure a choice of health professional is included. We discussed, if the staff does not have a primary care physician, they can list a local hospital or urgent care facility. Consultation is provided as follows: Shelter-in-place/Lockdown Drills: 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). A lockdown drill was practiced 6/27/24. The facility was closed due to Tropical Storm Helene 9/26/24 to 10/29/24. A shelter-in-place drill was practiced 12/12/24. A lockdown drill was practiced 12/19/24. A shelter in place drill was practiced 1/30/25. We discussed that a shelter in place or lockdown drill was not practiced every three months as required by rule, due to the closure caused by Tropical Storm Helene. You stated that you have plotted your work calendar to ensure the drills will be practiced as required, moving forward. Diaper Cream Storage: Non prescription diaper creams must be stored five feet or above to be inaccessible to children. Non prescription diaper cream was stored in a drawer below five feet with a child safety latch in space #5. During the visit, a magnetic lock was installed. We discussed that the diaper creams were inaccessible with the child safety latch. Evacuation Diagram: The evacuation diagram for space #2 was not posted upon arrival. You stated the evacuation diagram was previously posted and must have fallen off the wall and possibly been discarded. A evacuation diagram for space #2 was posted during the visit. We discussed that the evacuation diagram is a fire code requirement. CPR/First Aid: Staff JR holds a CPR/First Aid certificate from an unapproved source. “National CPR Foundation” is not included on the list of approved trainers available on the Division’s website. This staff has until 4/22/25 to take an approved course. Staff MB holds a CPR/First Aid certificate titled “Lifeguarding (Including Deep Water) with CPR/AED for Professional Rescuers and First Aid”. The staff member stated that the training included children and infants. We discussed this staff member can reach out the trainer to request a statement indicating the training included the age range of children in their care. Alternatively, the staff member can take a new course that is listed on the Division’s website. The staff member must reach compliance with this item by 4/13/25. Criminal Background Checks due soon: The following staff will have Criminal Background Check qualifying letters that expire soon: B. Bunn expires 8/3/25 S. Donati expires 8/4/25 S. McAbee expires 10/2/25 We recommend beginning the background check process up to six (6) months prior to the expiration date of the current letter. 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 Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. Attention is needed to complete the lead-in-paint and asbestos testing. Please visit https://www.cleanwaterforuskids.org/en/carolina/ to complete the survey to determine if testing is needed. Safe Sleep Checks: You are required to maintained sleep checks for thirty (30) days. We discussed maintaining sleep checks on your digital app. Please ensure the digital sleep checks comply with rule section .0606. Please note, the safe sleep policy must be updated to to reflect how sleep checks will be documented. Parents must sign off on the new safe sleep policy two (2) weeks before implementing. 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: 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: 0125-293L Visit Date: 2/5/2025 Number Present: 80 Completed Date: 2/5/2025 Age: From 0 To 5 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of non-compliance with child care requirements. 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 Kelsey Barton, Assistant Director, during the visit. Angela Donohue, Environmental Health Program Specialist accompanied me today. An electronic signed copy of the visit summary was emailed to you. Ms. Barton and Beth Moore, Field Administrator, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one percent (91%) as of 2/5/25. The facility operates with a five-star license issued on 11/8/23. The Special Services/Restrictions includes 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The complaint was received by the Division of Child Development and Early Education on 1/28/25 and sent to me on 1/28/25. There is a concern regarding sanitation and health. Ms. Barton and Ms. Donohue accompanied me on a walkthrough of all caregiving spaces, nursing room, kitchens, staff lounge, and a utility closet. During the walkthrough, fungal growth was found on the walls and ceiling of a utility closet off of classroom space 11. A determination on the substantiation of allegations was not reached during the visit on 2/5/25. David Lipton, Industrial Hygiene Consultant with the Occupational and Environmental Epidemiology Branch was contacted during the visit, via email. Mr. Lipton responded at 2:18pm on 2/5/25 with guidance and Technical Assistance regarding protocols around mold testing and mitigation. Due to the guidance from Mr. Lipton and that the fungal growth could not be identified as "black mold", the concerns are unsubstantiated. 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. A substance that appears to be fungal growth was found in the utility room off of classroom space 11. 15A NCAC 18A .2825(a) Technical assistance was provided as follows: Item #620: 15A NCAC 18A .2825 WALLS AND CEILINGS (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Achieving Compliance: Based on today’s findings, the facility has visible fungal growth in one (1) utility closet that houses an HVAC system. David Lipton, Industrial Hygiene Consultant with the Occupational and Environmental Epidemiology Branch was contacted for further guidance. The guidance received on 2/5/25 was forwarded to you for support in reaching compliance. Please reach out to me, Ms. Donohue or Mr. Lipton if you have any questions. 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 2/19/25. 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: 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 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/22/2024 Number Present: 79 Completed Date: 8/22/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 09:15 AM Time Out: 01:45 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 Jen Silva, Administrator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Silva 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, CPR / First Aid, special training, CBC qualification, ITS – SIDS, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine percent (89%) as of 8/20/24. The last fire drill was practiced on 7/31/24. The last emergency drill, lockdown drill, was practiced on 6/27/24. The last fire inspection was approved on 8/20/24. The program’s most recent sanitation inspection was completed on 12/7/23, with thirteen (13) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There are five (5) new staff. Five (5) new staff files were monitored today. Upon arrival I was greeted by Ms. Silva. In classroom space 12, children were engaged in tummy time, stacking rubber blocks and being soother by caregivers verbally and through touch. In classroom space 1, children were engaged in tummy time, being fed by caregivers and exploring rattling toys. In classroom space 5, children were reading books with caregivers and preparing to play outside. Once outside, children explored riding and push toys. Seven (7) children from classroom space 11 and seven (7) children from classroom space 3 were playing on playground space 3. Children were observed riding tricycles with helmets and engaged in pretend play with wooden blocks. Children from classroom spaces 7 and 8 were observed playing outside on playground space 4. Children built structures with large interlocking blocks, kicking and throwing smaller rubber balls and running races. In classroom space 3, eight (8) children were present and were observed building small structures with interlocking blocks and pretending to swaddle and care for babies. In classroom space 10, children were observed building small structures with wooden blocks and explained the process to the teacher. In classroom space 11, six (6) children were observed sorting objects by color, exploring playdoh with various tools, and scooping and pouring sand in the sand table. Children from classroom space 6 were playing on playground space 2. Children were observed taking turns climbing and jumping off of small blocks. Interactions were positive and nurturing. Children’s needs were met promptly. 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 cited during the visit today: 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 most recent fire inspection was approved on 8/20/24. The previous fire inspection was approved on 7/12/23. 10A NCAC 09 .0304(a) 847 Parent's medication authorization did not include required information. The medication administration authorization form for one (1) sunscreen in classroom space 11 expired on 5/22/24. 10A NCAC 09 .0803(4)(6-9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(d) Technical Assistance provided as follows: Item #106 In your letter of compliance, include a statement that indicates how you will ensure that the fire inspection is conducted and approved within twelve (12) months of the center’s previous inspection 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 #847 Plan to receive an updated medication authorization form for the one (1) sunscreen in classroom space 11. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Item #1048 and #1049 One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. The one (1) staff must received CPR/First Aid certificate immediately. We discussed that the staff member has taken the online portion of the certification. Plan to schedule the in-person training immediately. Until this staff member has a CPR/First Aid certificate on file, they cannot be left alone with children. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website 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 9/5/24. 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: It is imperative that you ensure staff stay current with their CPR/First Aid certifications. We discussed that back-to-back violations regarding CPR/First Aid may result in an Administrative Action. We discussed that training certificates should be printed and filed immediately upon completions. Many rules regarding training certificates include the requirement that the training certificate is placed in the staff’s file within the required timeframe. Failure to maintain certificates in the staff member’s personnel file could result in future violations. As a reminder, staff medical records including TB test/screening, medical report and health questionnaire must be placed in a separate, confidential file. This includes new staff as their files are coming together. Plan to file medical documents in the separate file immediately upon receipt. We discussed the safe sleep rule regarding cribs, cots and mats. Please see below: 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: (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; According to the rule above, infants can be placed on a cot for rest. However, your facility’s safe sleep policy states that they will be placed in cribs, specifically. Guidance regarding how to document special cases in which a child may need a cot or mat instead of a crib is forthcoming. The facility received a Prior Notice for an Administrative Action, Provisional License on 8/16/24. We discussed that if the Provisional License is issued, a full monitoring visit would need to be conducted in order to restore your star rated license. We discussed an upcoming change in Administrator. Ms. Silva’s last day will be 9/13/24. The new Administrator will begin on 9/3/24. Paperwork for this change is included in the email containing this Visit Summary. Please let me know if you have any questions. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/22/2024 Number Present: 79 Completed Date: 8/22/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 09:15 AM Time Out: 01:45 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 Jen Silva, Administrator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Silva 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, CPR / First Aid, special training, CBC qualification, ITS – SIDS, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine percent (89%) as of 8/20/24. The last fire drill was practiced on 7/31/24. The last emergency drill, lockdown drill, was practiced on 6/27/24. The last fire inspection was approved on 8/20/24. The program’s most recent sanitation inspection was completed on 12/7/23, with thirteen (13) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There are five (5) new staff. Five (5) new staff files were monitored today. Upon arrival I was greeted by Ms. Silva. In classroom space 12, children were engaged in tummy time, stacking rubber blocks and being soother by caregivers verbally and through touch. In classroom space 1, children were engaged in tummy time, being fed by caregivers and exploring rattling toys. In classroom space 5, children were reading books with caregivers and preparing to play outside. Once outside, children explored riding and push toys. Seven (7) children from classroom space 11 and seven (7) children from classroom space 3 were playing on playground space 3. Children were observed riding tricycles with helmets and engaged in pretend play with wooden blocks. Children from classroom spaces 7 and 8 were observed playing outside on playground space 4. Children built structures with large interlocking blocks, kicking and throwing smaller rubber balls and running races. In classroom space 3, eight (8) children were present and were observed building small structures with interlocking blocks and pretending to swaddle and care for babies. In classroom space 10, children were observed building small structures with wooden blocks and explained the process to the teacher. In classroom space 11, six (6) children were observed sorting objects by color, exploring playdoh with various tools, and scooping and pouring sand in the sand table. Children from classroom space 6 were playing on playground space 2. Children were observed taking turns climbing and jumping off of small blocks. Interactions were positive and nurturing. Children’s needs were met promptly. 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 cited during the visit today: 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 most recent fire inspection was approved on 8/20/24. The previous fire inspection was approved on 7/12/23. 10A NCAC 09 .0304(a) 847 Parent's medication authorization did not include required information. The medication administration authorization form for one (1) sunscreen in classroom space 11 expired on 5/22/24. 10A NCAC 09 .0803(4)(6-9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(d) Technical Assistance provided as follows: Item #106 In your letter of compliance, include a statement that indicates how you will ensure that the fire inspection is conducted and approved within twelve (12) months of the center’s previous inspection 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 #847 Plan to receive an updated medication authorization form for the one (1) sunscreen in classroom space 11. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Item #1048 and #1049 One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. The one (1) staff must received CPR/First Aid certificate immediately. We discussed that the staff member has taken the online portion of the certification. Plan to schedule the in-person training immediately. Until this staff member has a CPR/First Aid certificate on file, they cannot be left alone with children. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website 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 9/5/24. 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: It is imperative that you ensure staff stay current with their CPR/First Aid certifications. We discussed that back-to-back violations regarding CPR/First Aid may result in an Administrative Action. We discussed that training certificates should be printed and filed immediately upon completions. Many rules regarding training certificates include the requirement that the training certificate is placed in the staff’s file within the required timeframe. Failure to maintain certificates in the staff member’s personnel file could result in future violations. As a reminder, staff medical records including TB test/screening, medical report and health questionnaire must be placed in a separate, confidential file. This includes new staff as their files are coming together. Plan to file medical documents in the separate file immediately upon receipt. We discussed the safe sleep rule regarding cribs, cots and mats. Please see below: 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: (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; According to the rule above, infants can be placed on a cot for rest. However, your facility’s safe sleep policy states that they will be placed in cribs, specifically. Guidance regarding how to document special cases in which a child may need a cot or mat instead of a crib is forthcoming. The facility received a Prior Notice for an Administrative Action, Provisional License on 8/16/24. We discussed that if the Provisional License is issued, a full monitoring visit would need to be conducted in order to restore your star rated license. We discussed an upcoming change in Administrator. Ms. Silva’s last day will be 9/13/24. The new Administrator will begin on 9/3/24. Paperwork for this change is included in the email containing this Visit Summary. Please let me know if you have any questions. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/22/2024 Number Present: 79 Completed Date: 8/22/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 09:15 AM Time Out: 01:45 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 Jen Silva, Administrator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Silva 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, CPR / First Aid, special training, CBC qualification, ITS – SIDS, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine percent (89%) as of 8/20/24. The last fire drill was practiced on 7/31/24. The last emergency drill, lockdown drill, was practiced on 6/27/24. The last fire inspection was approved on 8/20/24. The program’s most recent sanitation inspection was completed on 12/7/23, with thirteen (13) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There are five (5) new staff. Five (5) new staff files were monitored today. Upon arrival I was greeted by Ms. Silva. In classroom space 12, children were engaged in tummy time, stacking rubber blocks and being soother by caregivers verbally and through touch. In classroom space 1, children were engaged in tummy time, being fed by caregivers and exploring rattling toys. In classroom space 5, children were reading books with caregivers and preparing to play outside. Once outside, children explored riding and push toys. Seven (7) children from classroom space 11 and seven (7) children from classroom space 3 were playing on playground space 3. Children were observed riding tricycles with helmets and engaged in pretend play with wooden blocks. Children from classroom spaces 7 and 8 were observed playing outside on playground space 4. Children built structures with large interlocking blocks, kicking and throwing smaller rubber balls and running races. In classroom space 3, eight (8) children were present and were observed building small structures with interlocking blocks and pretending to swaddle and care for babies. In classroom space 10, children were observed building small structures with wooden blocks and explained the process to the teacher. In classroom space 11, six (6) children were observed sorting objects by color, exploring playdoh with various tools, and scooping and pouring sand in the sand table. Children from classroom space 6 were playing on playground space 2. Children were observed taking turns climbing and jumping off of small blocks. Interactions were positive and nurturing. Children’s needs were met promptly. 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 cited during the visit today: 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 most recent fire inspection was approved on 8/20/24. The previous fire inspection was approved on 7/12/23. 10A NCAC 09 .0304(a) 847 Parent's medication authorization did not include required information. The medication administration authorization form for one (1) sunscreen in classroom space 11 expired on 5/22/24. 10A NCAC 09 .0803(4)(6-9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(d) Technical Assistance provided as follows: Item #106 In your letter of compliance, include a statement that indicates how you will ensure that the fire inspection is conducted and approved within twelve (12) months of the center’s previous inspection 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 #847 Plan to receive an updated medication authorization form for the one (1) sunscreen in classroom space 11. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Item #1048 and #1049 One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. The one (1) staff must received CPR/First Aid certificate immediately. We discussed that the staff member has taken the online portion of the certification. Plan to schedule the in-person training immediately. Until this staff member has a CPR/First Aid certificate on file, they cannot be left alone with children. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website 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 9/5/24. 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: It is imperative that you ensure staff stay current with their CPR/First Aid certifications. We discussed that back-to-back violations regarding CPR/First Aid may result in an Administrative Action. We discussed that training certificates should be printed and filed immediately upon completions. Many rules regarding training certificates include the requirement that the training certificate is placed in the staff’s file within the required timeframe. Failure to maintain certificates in the staff member’s personnel file could result in future violations. As a reminder, staff medical records including TB test/screening, medical report and health questionnaire must be placed in a separate, confidential file. This includes new staff as their files are coming together. Plan to file medical documents in the separate file immediately upon receipt. We discussed the safe sleep rule regarding cribs, cots and mats. Please see below: 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: (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; According to the rule above, infants can be placed on a cot for rest. However, your facility’s safe sleep policy states that they will be placed in cribs, specifically. Guidance regarding how to document special cases in which a child may need a cot or mat instead of a crib is forthcoming. The facility received a Prior Notice for an Administrative Action, Provisional License on 8/16/24. We discussed that if the Provisional License is issued, a full monitoring visit would need to be conducted in order to restore your star rated license. We discussed an upcoming change in Administrator. Ms. Silva’s last day will be 9/13/24. The new Administrator will begin on 9/3/24. Paperwork for this change is included in the email containing this Visit Summary. Please let me know if you have any questions. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/22/2024 Number Present: 79 Completed Date: 8/22/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 09:15 AM Time Out: 01:45 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 Jen Silva, Administrator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Silva 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, CPR / First Aid, special training, CBC qualification, ITS – SIDS, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine percent (89%) as of 8/20/24. The last fire drill was practiced on 7/31/24. The last emergency drill, lockdown drill, was practiced on 6/27/24. The last fire inspection was approved on 8/20/24. The program’s most recent sanitation inspection was completed on 12/7/23, with thirteen (13) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There are five (5) new staff. Five (5) new staff files were monitored today. Upon arrival I was greeted by Ms. Silva. In classroom space 12, children were engaged in tummy time, stacking rubber blocks and being soother by caregivers verbally and through touch. In classroom space 1, children were engaged in tummy time, being fed by caregivers and exploring rattling toys. In classroom space 5, children were reading books with caregivers and preparing to play outside. Once outside, children explored riding and push toys. Seven (7) children from classroom space 11 and seven (7) children from classroom space 3 were playing on playground space 3. Children were observed riding tricycles with helmets and engaged in pretend play with wooden blocks. Children from classroom spaces 7 and 8 were observed playing outside on playground space 4. Children built structures with large interlocking blocks, kicking and throwing smaller rubber balls and running races. In classroom space 3, eight (8) children were present and were observed building small structures with interlocking blocks and pretending to swaddle and care for babies. In classroom space 10, children were observed building small structures with wooden blocks and explained the process to the teacher. In classroom space 11, six (6) children were observed sorting objects by color, exploring playdoh with various tools, and scooping and pouring sand in the sand table. Children from classroom space 6 were playing on playground space 2. Children were observed taking turns climbing and jumping off of small blocks. Interactions were positive and nurturing. Children’s needs were met promptly. 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 cited during the visit today: 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 most recent fire inspection was approved on 8/20/24. The previous fire inspection was approved on 7/12/23. 10A NCAC 09 .0304(a) 847 Parent's medication authorization did not include required information. The medication administration authorization form for one (1) sunscreen in classroom space 11 expired on 5/22/24. 10A NCAC 09 .0803(4)(6-9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(d) Technical Assistance provided as follows: Item #106 In your letter of compliance, include a statement that indicates how you will ensure that the fire inspection is conducted and approved within twelve (12) months of the center’s previous inspection 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 #847 Plan to receive an updated medication authorization form for the one (1) sunscreen in classroom space 11. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Item #1048 and #1049 One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. The one (1) staff must received CPR/First Aid certificate immediately. We discussed that the staff member has taken the online portion of the certification. Plan to schedule the in-person training immediately. Until this staff member has a CPR/First Aid certificate on file, they cannot be left alone with children. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website 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 9/5/24. 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: It is imperative that you ensure staff stay current with their CPR/First Aid certifications. We discussed that back-to-back violations regarding CPR/First Aid may result in an Administrative Action. We discussed that training certificates should be printed and filed immediately upon completions. Many rules regarding training certificates include the requirement that the training certificate is placed in the staff’s file within the required timeframe. Failure to maintain certificates in the staff member’s personnel file could result in future violations. As a reminder, staff medical records including TB test/screening, medical report and health questionnaire must be placed in a separate, confidential file. This includes new staff as their files are coming together. Plan to file medical documents in the separate file immediately upon receipt. We discussed the safe sleep rule regarding cribs, cots and mats. Please see below: 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: (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; According to the rule above, infants can be placed on a cot for rest. However, your facility’s safe sleep policy states that they will be placed in cribs, specifically. Guidance regarding how to document special cases in which a child may need a cot or mat instead of a crib is forthcoming. The facility received a Prior Notice for an Administrative Action, Provisional License on 8/16/24. We discussed that if the Provisional License is issued, a full monitoring visit would need to be conducted in order to restore your star rated license. We discussed an upcoming change in Administrator. Ms. Silva’s last day will be 9/13/24. The new Administrator will begin on 9/3/24. Paperwork for this change is included in the email containing this Visit Summary. Please let me know if you have any questions. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 8/22/2024 Number Present: 79 Completed Date: 8/22/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 09:15 AM Time Out: 01:45 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 Jen Silva, Administrator, during the visit. A signed copy of the visit summary was emailed to you. Ms. Silva 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, CPR / First Aid, special training, CBC qualification, ITS – SIDS, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine percent (89%) as of 8/20/24. The last fire drill was practiced on 7/31/24. The last emergency drill, lockdown drill, was practiced on 6/27/24. The last fire inspection was approved on 8/20/24. The program’s most recent sanitation inspection was completed on 12/7/23, with thirteen (13) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There are five (5) new staff. Five (5) new staff files were monitored today. Upon arrival I was greeted by Ms. Silva. In classroom space 12, children were engaged in tummy time, stacking rubber blocks and being soother by caregivers verbally and through touch. In classroom space 1, children were engaged in tummy time, being fed by caregivers and exploring rattling toys. In classroom space 5, children were reading books with caregivers and preparing to play outside. Once outside, children explored riding and push toys. Seven (7) children from classroom space 11 and seven (7) children from classroom space 3 were playing on playground space 3. Children were observed riding tricycles with helmets and engaged in pretend play with wooden blocks. Children from classroom spaces 7 and 8 were observed playing outside on playground space 4. Children built structures with large interlocking blocks, kicking and throwing smaller rubber balls and running races. In classroom space 3, eight (8) children were present and were observed building small structures with interlocking blocks and pretending to swaddle and care for babies. In classroom space 10, children were observed building small structures with wooden blocks and explained the process to the teacher. In classroom space 11, six (6) children were observed sorting objects by color, exploring playdoh with various tools, and scooping and pouring sand in the sand table. Children from classroom space 6 were playing on playground space 2. Children were observed taking turns climbing and jumping off of small blocks. Interactions were positive and nurturing. Children’s needs were met promptly. 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 cited during the visit today: 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 most recent fire inspection was approved on 8/20/24. The previous fire inspection was approved on 7/12/23. 10A NCAC 09 .0304(a) 847 Parent's medication authorization did not include required information. The medication administration authorization form for one (1) sunscreen in classroom space 11 expired on 5/22/24. 10A NCAC 09 .0803(4)(6-9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. .1102(d) Technical Assistance provided as follows: Item #106 In your letter of compliance, include a statement that indicates how you will ensure that the fire inspection is conducted and approved within twelve (12) months of the center’s previous inspection 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 #847 Plan to receive an updated medication authorization form for the one (1) sunscreen in classroom space 11. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Item #1048 and #1049 One (1) staff, hire date 3/11/24, does not have a CPR/First Aid certificate on file. The one (1) staff must received CPR/First Aid certificate immediately. We discussed that the staff member has taken the online portion of the certification. Plan to schedule the in-person training immediately. Until this staff member has a CPR/First Aid certificate on file, they cannot be left alone with children. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website 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 9/5/24. 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: It is imperative that you ensure staff stay current with their CPR/First Aid certifications. We discussed that back-to-back violations regarding CPR/First Aid may result in an Administrative Action. We discussed that training certificates should be printed and filed immediately upon completions. Many rules regarding training certificates include the requirement that the training certificate is placed in the staff’s file within the required timeframe. Failure to maintain certificates in the staff member’s personnel file could result in future violations. As a reminder, staff medical records including TB test/screening, medical report and health questionnaire must be placed in a separate, confidential file. This includes new staff as their files are coming together. Plan to file medical documents in the separate file immediately upon receipt. We discussed the safe sleep rule regarding cribs, cots and mats. Please see below: 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: (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; According to the rule above, infants can be placed on a cot for rest. However, your facility’s safe sleep policy states that they will be placed in cribs, specifically. Guidance regarding how to document special cases in which a child may need a cot or mat instead of a crib is forthcoming. The facility received a Prior Notice for an Administrative Action, Provisional License on 8/16/24. We discussed that if the Provisional License is issued, a full monitoring visit would need to be conducted in order to restore your star rated license. We discussed an upcoming change in Administrator. Ms. Silva’s last day will be 9/13/24. The new Administrator will begin on 9/3/24. Paperwork for this change is included in the email containing this Visit Summary. Please let me know if you have any questions. 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 .0601 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: LORI HERRICK Operation Type: Center Case Number: 0124-131A Visit Date: 5/9/2024 Number Present: 82 Completed Date: 5/9/2024 Age: From 0 To 5 Total Minutes: 135 Time In: 01:30 PM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Follow-Up Announced/Unannounced: Unannounced The purpose of this unannounced visit was to follow-up regarding allegations of violations of child care requirements at this child care facility. Kathy Twiss, Regional Director, Jen Silva, Field Director and Kelsey Barton, administrator, were on site. I observed the classrooms for infants and one-year-old children. During the visit I spoke with Ms. Twiss, Ms. Silva, Ms. Barton and two additional staff members. Limited monitoring of child care requirements occurred during today’s visit. Violation Number Comment Rule 807 A safe indoor and outdoor environment was not provided for the children. On April 22, 2024, an infant used shelving to assist with pulling up to stand. The child fell on two occasions, once hitting their head on the carpeted floor and once on the tile floor. On this occasion, staff failed to ensure a safe environment and the child sustained a skull fracture. (This is a repeated violation from January 17, 2024). 10A NCAC 09 .0601(a) You may contact me at Lori Herrick, Investigations Consultant, 828-782-0613, lori.herrick@dhhs.nc.gov or Natosha Lambeth, Natosha.lambeth@dhhs.nc.gov. Thank you for your time. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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 .0607 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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 .0701 · Violation

Name of Operation: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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: MISSION HEALTH CHILD CARE DEVELOPMENT CENTER Facility ID: 11000942 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 4/2/2024 Number Present: 76 Completed Date: 4/2/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 09:30 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 Jen Silva, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Silva 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, medication and routine caregiving activities. Due to time constraints, staff files were unable to be monitored today. A return visit will be made to complete the monitoring of staff files. An annual compliance monitoring checklist for child care centers will be emailed to you upon completion of the Annual Compliance process. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six percent (86%) as of 4/1/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the limited liability company, Bright Horizons Children's Centers LLC, is current/active as of 4/1/24. Permit type – Five (5) Star license issued 11/8/23. Special Services/Restrictions – 1st shift (daytime care), meets enhanced space, meets reduced staff/child ratios. The temporary license was issued 5/8/23. The last fire drill was practiced on 3/29/24. The last shelter-in-place drill was practiced on 3/29/24. The last playground inspection was documented on 3/29/24. The last fire inspection was approved on 7/12/23. The last sanitation inspection was conducted on 12/7/23 with thirteen (13) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response Plan was updated 8/15/23. The approved curriculum for four-year-old children is "World at Their Fingertips". The program does not provide transportation. There are one hundred eighteen (118) children enrolled. Twelve (12) children’s files were monitored today. Upon arrival I was greeted by Ms. Silva and Kelsey Barton, Assistant Director. Ms. Silva accompanied me on the walkthrough of caregiving spaces. In classroom space 12, children were being fed, engaged in tummy time, exploring nesting blocks and napping in cribs. Sleep checks were documented as required. In classroom space 1, children were exploring their environment by cruising and crawling, explored the properties of expanding plastic tubes, read books with caregivers and threw soft rubber balls. The children from classroom space 6 were gross motor play on playground space 2. Children danced to music and scooted on toy trucks. A diaper change was observed in this group. Diapering and handwashing steps were followed as required. Children from classroom spaces 7,, 3 and 9 were engaged in gross motor play on playground space 1. Children rode tricycles, climbed the structures, played hide and seek with peers, played ring around the rosie with caregivers, and threw bouncy balls. In classroom space 11, children were engaged in free choice center play. Children used a variety of tools to manipulate playdoh, explored the properties of wet sand in a sensory bin, scooped and poured dry sand in a sand table, built large structures with wooden blocks, and pretended to make and serve pizza in dramatic play. In classroom space 10, children were observed coming inside from outdoor play. Children and caregivers washed hands upon entering the classroom to prepare for lunch. Interactions were positive, nurturing and engaging. Children were actively supervised at all times. 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 1030 Application for employment and date of birth was not on file for all staff. Three (3) staff did not have an application in their staff file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff did not have a medical report on file prior to the first day of work. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Two (2) staff did not have a TB test on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. Three (3) staff did not have documentation of orientation on file for the first six (6) weeks of employment. .1101(a) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One (1) staff, hire date 1/8/18, had 2.5 hours out of the required 10 hours between 1/8/23-1/8/24. One (1) staff, hire date 2/15/21 had 0 hours out of the required 5 hours between 2/15/23-2/15/24. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff did not have documentation of orientation training topics for the first two (2) weeks of employment. .1101(a)(b) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The portion of the EPR plan that listed role assignments contained four (4) staff who are no longer present at the facility. .0607(e) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. Three (3) staff did not have health documents stored in a separate confidential file .0701(d) Technical assistance was provided as follows: Item #1824 Plan to update the EPR with current staff role assignments. Once the plan has been updated, plan to review the changes with all staff. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. 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 4/16/24. 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: Plan to conduct an audit of all sunscreen and permissions as the season changes. According to my observations today, the majority of sunscreen permissions will expire in April 2024. 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 2. Your Prep Year is 7/1/24- 6/30/25. Your reassessment year is 7/1/25-6/30/26. We discussed the importance of ensuring all staff submit education for evaluation to 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. 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