Ymca Johnston Afterschool

10A NCAC 09 .0803 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .3205 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .3222 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/30/2026 Number Present: 28 Completed Date: 3/30/2026 Age: From 5 To 10 Total Minutes: 227 Time In: 01:48 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance with Rated License Assessment visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant during the visit. Provider signature was not obtained due to a designee not present on-site. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, James “JR” Rhines, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school age only, meets enhanced ratios. Playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose will be removed from the license. This was discussed with Ms. Burke during the visit. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 3/20/26. The last lockdown drill was practiced on 2/11/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funny Daffer. Lead water testing was completed on 6/27/24 or with hazards. Mitigation has been completed. Lead paint and asbestos testing on-site visit results are pending. One (1) staff member was added to the Automated Criminal Background Check Management System (ABCMS) as of 3/29/26. Upon arrival, I greeted my presence and the purpose of the visit to Mr. Rhines. I met with Ms. Burke to review the staff and children’s record via TEAMS. After the review of staff information and children’s information, I met a staff member who identified self as a bus driver. Mr. Rhines was further interviewed as well as a phone call to Lily Elder, Program Director, was made regarding bus drivers. Two-to-three staff members drive the bus on a regular basis to transport children from Emma Elementary School to Johnston Elementary school. During this time, bus drivers are the only caretakers. I requested Ms. Elder to list all the bus drivers to be listed on the Staff and Training Worksheet and further review of the staff files via TEAMS. Staff and Training Worksheet: I met with Ms. Burke to review the staff files. One (1) new staff file and one (1) existing staff file was reviewed through TEAMS meeting. Later during the visit, I met with Ms. Elder via TEAMS meeting to review four (4) additional staff members files. Two (2) of them were reviewed in full and two (2) of them were reviewed partially. I met additional staff member on-site who was not listed as a staff member. The staff member identified self as a bus driver. Due to this staff member and additional staff members who have bus driving responsibilities were not listed on the Staff and Trainng Worksheet, additional Staff and Training Worksheet listing the bus drivers were requested from Ms. Elder and Nick Erwin, Program Director during the visit. The following discrepancies were noted: J. Rhines: CBC expiration date – 9/4/30 M. Fuller: CBC expiration date – 1/29/31 BSAC – 3/23/26 CPR/FA expiration date – 2/18/28. A. Deter: CBC issued date – 11/4/25, expiration date – 11/4/30 L. Elder: CPR/FA expiration date – 1/22/28 N. Erwin: CPR/FA expiration date – 12/17/27 On-going training hours (8/26/24 – 8/25/25) – sixteen (16) hours was verified. M. Dodson: 11/5/25 is listed as a date of employment. However, Ms. Elder stated that this staff member was working in the unlicensed intermediate school until 3/12/26. Therefore, this staff member was transferred to a license program starting 3/12/26. HQ/EI: 10/29/25 OP/PP/AQ review: 10/29/25 Children’s files: Four (4) children’s files were reviewed. Observation: Children arrived at the gym. Fourteen children (14) in group #1 and fourteen (14) children in group #2 transitioned to the playground. After returning from outside, children in group #1 transitioned to cafeteria and children in group #2 remained in the gym. In cafeteria, children played with magnetic tiles, Legos, pretend dinosaurs, weaving loom and hook, marble tower, Plus blocks and art materials, including paper, scissors, coloring page, and various writing tools. In the gym, children played with pretend BBQ/Camping tools, Keva structures, train tracks, Duplo blocks, pretend parking garage, play house, basketball and games. Four (4) emergency medications were maintained in the backpack for group #2. Permission forms, action plans and expiration dates of the medications were reviewed. Today, WOW butter, sunflower kernels, apple cinnamon graham crackers, apple sauce and veggie juice blend were served for snacks. Items were accurately listed on the menu. Supervision and interaction were adequate. Rated License Assessment: Permit restriction: The program currently licensed with a restriction – meet enhanced staff/child ratios. Program meeting five-star level must meet reduced staff/child ratios. A request for reduced staff child ratios was submitted by Ms. Burke via email on 3/27/26. During today’s visit, reduced staff/child ratio was met. Ms. Burke submitted an application for the Rated License Assessment via email on March 20, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Program Handbook was attached to verify Family and Community Engagement Standards. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program were also attached. I conducted a review of Family and Community Engagement Standards using the handbook as a reference. I verified that all foundational practices in the handbook. Three (3) additional standards for three (3) – C-1, C-4 and EL-8 were also included in the handbook. Two (2) flyers for events were verified for verification of EO-3. EL-6 was also selected and was verified by additional evidence shared by Ms. Burke via email on 3/27/26. Overall, all the foundational practices and five (5) additional options were Based on the information obtained from the Staff Information and Education Worksheet, I reviewed three (3) staff members’ WORKS letters/account on 3/27/26. One (1) group leader had not been issued a letter as of today. CQIs for three (3) individuals –were reviewed during today’s visit. The CQI plan for the facility has been started and is in process; the form has been collected. All individual CQIs have been reviewed and initialed. Additional CQI must be submitted for the bus drivers who transport children more than once weekly. Based on newly acquired information during today’s visit, CQI for L. Elder, N. Erwin, M. Dodson, A. Deter are required. Ms. Burke stated that none of the substitute staff members fall under the definition of “staff members with caregiving responsibilities on a routine schedule of at least once Per week”. Therefore, CQI for substitute staff members had not been completed. Funny Daffer is used for this program. The printout of activities were in a binder and maintained in the office during the visit. Activities, such as “Road Trip”, “The hunter and the Springbok”, and “This is Me” were listed on the activity plan. Props required for each activity, such as two (2) chairs for “Road trips”, a map of Africa/Botswana, a picture of Springbok” for “The hunter and …” and magazines for “This is Me” were not available or offered to the children during observation. Evidence of conducting on-going formative assessments that have been approved by the Commission and sharing results with parents at least twice annually – does not apply to school-age only programs. The parent handbook provides information to parents that parent/teacher conferences is provided under the behavior management policy heading. The training certificate reviewed for D. Burke for Funny Daffer was dated 1/13/26. Regarding the evidence of the administrator participating in one activity regarding classroom and instructional quality practices as outlined in the child care rule .3205 (f,10), Ms. Burke stated you will be participating in a mentorship with Jon Williams, Director of School-age Programs for Southwestern Child Development Commission. As verification methods, Mr. Williams send Ms. Burke a summary after each meeting. The requirements outlined in 10A NCAC 09 .3205(f)(11) does not apply to program coordinators or group leaders. 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 program does provide transportation. Fourteen (14) students from Emma Elementary School were transported during today’s visit. The bus was not monitored during today’s visit since the vehicle did not station on-site. The following violations were documented during today’s visit: Violation Number Comment Rule 847 Parent's medication authorization did not include required information. Authorization form for an epi-pen was not on file for a child in group #2. 10A NCAC 09 .0803(4)(6-9) 1043 All staff records, except financial records, were not made available for review. Four (4) staff members who routinely counts in staff/child ratios as bus drivers were not identified prior to visit in the Staff and Training Worksheet or during the file review. G.S. 110-91( 9) Technical assistance was provided as follows: 847: Authorization form No medications can be administered to children without authorization form. Upon receiving any types of medications, signed authorization form that contains all required information must be submitted with the medication. To comply, please obtain parent’s authorization form for the epi-pen for a child in group #2. In your compliance letter, please verify that the authorization form for the epi-pen was on file. 1043: Accurate Record Each child care facility shall keep accurate records on each staff member or other person delegated responsibility for the care of children in accordance with a form furnished or approved by the Commission, and shall submit records as required by the Department. You must disclose all staff members, including substitute staff members, bus drivers who count in staff/child ratios, administrators and agency representative (principal, CEO, etc.) accurately. To comply, please state your plan to comply with rule G.S. 110-91(9) and maintain/share accurate records with the Division. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 4/13/26. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Until all violations are corrected, your Rated License Assessment will not be processed. Additional information – CQI for bus drivers who transport children more than once/weekly must be submitted to me before processing the Rated License Assessment. 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. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .3222 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/15/2025 Number Present: 22 Completed Date: 10/15/2025 Age: From 5 To 10 Total Minutes: 192 Time In: 01:18 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by JR Rhine, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Operations Director. Today, Mr. Rhine was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-three (93) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios. The last annual compliance visit was conducted on 4/22/25. The last fire drill was practiced on 10/10/25. The last shelter-in-place drill was practiced on 9/4/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/24 without hazards. The results of on-site visit were pending for lead paint and asbestos testing. Upon arrival, I greeted Mr. Rhine and contacted Ms. Burke. Ms. Burke directed me to contact Lily Elder, Program Director, due to schedule conflict. I contacted Ms. Elder via text. Ms. Elder was on her way to Johnston Elementary School. Children arrived at the gym and put their personal belongings in the basket. The children were separated into two groups and waited for additional children from Emma Elementary School. When all children arrived, the children in group #1 transitioned to cafeteria. Children stopped at the bathroom in the hallway before cafeteria and washed their hands. The children in group #2 played on the playground. During today’s observation, one (1) YMCA staff member was present to observe. He/she did not count in staff/child ratios or interact with the children. Children had WOW Butter, sunflower kernels, WG tortilla, jelly packet, apple sauce and veggie blend juice for snacks. Some children also had snacks brought from home. However, all children were offered snacks provided by the program. Two (2) emergency medications were monitored during the visit. One (1) was an inhaler for a child. Both action plan and the permission form were current. One (1) was an epi-pen. Both action plan (allergy & anaphylaxis Emergency Plan) and the permission plan were maintained with the medication. Both forms were current. However, several items on the permission form were missing, including name of medication, side effects and details for as needed criteria. Storage of the medications were in compliance. Ms. Elder sat with me and reviewed the staff files. Two (2) new staff files were reviewed in full and one (1) staff file was reviewed partially. No safety concerns were observed during the visit. Supervision and interaction 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 program provides transportation for fourteen (14) children from Emma Elementary School to Johnston Elementary School. YMCA Transportations were monitored on 6/4/25. The following violations were documented during today’s visit: Violation Number Comment Rule 837 The EMC plan did not name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. A former group leader, who was no longer employed, was listed as an alternate on the EMC plan. .0802(a)(1)(A-B); 847 Parent's medication authorization did not include required information. The names of the authorized prescription medication and the criteria for the administration of the medication were not filled out on the authorization for an epi-pen. 10A NCAC 09 .0803(4)(6-9) 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. The skin test was not administered for a staff member, MF's initial TB screening, though the staff answered yes to one of the questionnaires. The staff member's date of employment is unknown, but the staff member was present during the visit. .0701(a) Technical assistance was provided as follows: 837: Emergency Medical Care (EMC) Plan The EMC plan must name the person responsible, and at least one alternate, for choosing and carrying out the plan of action to obtain appropriate medical care. This item was corrected during the visit. 847: Medication permission form All sections of the permission form must be filled out. Please request the parent to add the following information: Potential side effects of the medication, frequency of administering medication and the name of the medication. If the frequency of administering the medication is as needed, the details of when the medication is administered shall be listed. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. 1033: TB screening On or before first day of employment, staff members must submit the document verifying that they are free of TB. When you use the TB screening form provided by the Division, the staff members may not have to receive the skin test if all the answers to the questionnaire are no. Staff member, MF, must receive the skin test to verify since he/she answered yes to one of the questionnaires. To comply, please instruct the staff member to receive the TB Skin test. In your compliance letter, please state the date the test results were analyzed. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 10/29/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Permit update: The following restrictions were removed from your permit: Playground does not meet child care playground safety standards and child prohibited in the kitchen for any purpose. Rated License Assessment: Your next annual compliance visit will be prior to 4/22/26. To reduce the number of visit required, it is best for you to apply for the Rated License Assessment in March 2026. I will remind you of the timeline in Early March. Even though Weikart Assessment, curriculums and formative assessments are reviewed for approval currently, it may take some time. It is best for the program to choose the pathway 1 for upcoming Rated License Assessment. To do: Please start collecting artifacts for Family & Community Engagement practice. Screen shots of communication, flyers, conference documents, etc. are recommended. Continuous Quality Improvement (CQI) plan – please create CQI for the program and all staff members. Self-study – Please visit NCRLAP and start self-study process. The process typically takes three (3) months, which means that you shall start the process by December 2025. Epi-pen: Based on the information on the action plan for a child with an epi-pen, the cause of allergy is unknown. The plan instructs the medication to be administered based on the symptoms alone. However, the child also has asthma, and no asthma medication for the child was maintained at school. There are many overlapping symptoms for anaphylaxis and asthma attack. Due to the child’s allergy is unknown, child’s symptoms alone may not be enough to differentiate anaphylaxis shock from asthma attacks. The action plan was completed by a parent/guardian. For this particular case, it may be beneficial to ask the parent to request a review by the child’s physician. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. New and terminated staff notification requirement: 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. 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) 814-6401 and someone will assist you. No staff members were listed on the ABCMS roster as of 10/14/25. Date of employment: Per definition by the Division, the date of employment shall be the first day on payroll. However, YMCA program is unique in a way that the staff members can be employed at non-licensed programs as well as other YMCA related tasks. Initial hiring orientations and paperwork are completed at off-side locations. Therefore, the first day of employment for YMCA staff member may not always be the first day on a licensed program. Clarification of date of employment must be discussed further. 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. 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. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 4/22/2025 Number Present: 26 Completed Date: 4/22/2025 Age: From 5 To 10 Total Minutes: 120 Time In: 02:40 PM Time Out: 04:40 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 Kaoru Eddins, Child Care Consultant and also signed by Peyten Glisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operation. Ms. Payton, Program Coordinator, was available during the visit. 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-one (91) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/21/25. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 3/18/25. The last shelter-in-place drill was practiced on 3/7/25. The last fire inspection was approved on 2/10/25. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/27/25 without hazards. Lead paint and asbestos testing has not been completed. Upon arrival, I announced my presence and the purpose of the visit. Seventeen (17) children with two (2) staff members were present. The children played with manipulative materials, pretend animals, cups, magnetic tiles and other materials. At approximately 3:00 pm, Ms. Glissor arrived with nine (9) additional children who rode a bus from the other elementary school. At the point, a total number of children were Twenty-five (25) with three (3) staff members due to one (1) child leaving before 3:00 pm. At 3:20, children in group #2 headed to the cafeteria. The children stopped at the bathroom closest to the cafeteria and washed their hands. The children had milk, apple sauce, been dip, corn chips, veggie blend juice for snacks. The items were accurately listed on the menu. The children in group #1 remained in the gym and continued to engage in free play. When the children needed to use the bathroom, which were located outside of the gym, the group leader supervised the group in the gym as well as the child in the bathroom by standing at the doorway of the gym. Supervision and interaction were adequate. One (1) emergency medication was maintained at this facility. Medication expiration date, medication authorization, action plan and storage were in compliance. Two (2) staff members’ files were reviewed in full, and one (1) staff file was reviewed partially via TEAMS meeting with Ms. Burke. For the dates that did not match the documents are noted on the attached documentation page. The two (2) staff members were new staff members at the time of routine unannounced visit conducted on January 8, 2025. However, their file was not reviewed due to technology challenges. Therefore, their files were reviewed in full during today’s visit. Three (3) children’s files were monitored. The playground was monitored and no safety hazards were found. 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 program provides transportation for ten (10) children from Emma Elementary School to Johnston Elementary school. All children are school-age. YMCA vehicles were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The most recent Health Questionnaire form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. The most recent emergency information form created for a staff member hired on 1/2/24 was dated 1/4/24. .0701(a) 1914 The person identified as the person or alternate person responsible for carrying out the emergency medical care plan was not on the premises at all times and/or did not accompany children for off premise activities. Per Emergency Medical Care Plan, N.E.(program director) and P. G(program coordinator) were identified as the person/alternate responsible for carrying out the medical care. When I arrived, P.G. was not on site due to driving a bus to pick up students from Emma Elementary School. N.E was not present on-site during the visit. .0802(b)(1-2) Technical assistance was provided as follows: 1034: Health Questionnaire The health questionnaire in file for a staff member hired on 1/2/24 was dated 1/4/24. The health questionnaire form is required at the start of each staff member’s 2nd year of employment. The form must be renewed annually thereafter. Refer to 10A NCAC 09 .0701(a). On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1035: Emergency information The emergency information in file for a staff member hired on 1/2/24 was dated 1/4/24. The emergency information form is required for all staff members on or prior to first day of employment. The form must be renewed annually thereafter. On your compliance letter, please state the date a health questionnaire was filled out for the staff member and state how you will prevent this violation in the future. 1914: Designated personnel for Emergency Medical Care (EMC) Plan The person identified as the person or alternate person responsible for carrying out the emergency medical care plan must be on the premises at all times and/or when accompany children for off premise activities. It is greatly recommended to assign multiple people for certain tasks on the EMC form. You can also write the positions, such as program coordinator or group leader instead of names. Please refer to 10A NCAC 09 .0802(b). On your compliance letter, please explain how you came to compliance with this item as well as how to prevent the same violation in the future. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Legal Designee form: Staff and Training Worksheet was submitted by Delaney Burke, administrator. However, Ms. Burke did not sign the worksheet. I obtained the signature of Ms. Glissor during the visit. Please make sure that any individuals who may sign the Staff and Training Worksheet are authorized to do so by checking “other” and list Staff and Training Worksheets on their legal designee form. 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. Please coordinate with Johnston Elementary School and complete the enrollment surveys for lead-based paint and asbestos. New and terminated staff notification requirement: 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) 814-6401 and someone will assist you. 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. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS110-91 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/8/2025 Number Present: 29 Completed Date: 1/8/2025 Age: From 5 To 10 Total Minutes: 165 Time In: 02:30 PM Time Out: 05:15 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 an routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Payten Gilisson, Program Coordinator, during the visit. A signed copy of the visit summary was left on-site and emailed to Delaney Burke, Senior Operations Director. Ms. Gilisson was available to ask and answer questions during the visit. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-four (94) percent as of today prior to this visit. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, meets enhanced ratios, school age only and playground does not meet child care playground safety standards; child prohibited in the kitchen for any purpose. The last annual compliance visit was conducted on 5/2/24. The last fire drill was practiced on 12/16/24. The last lockdown drill was practiced on 12/18/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/17/24 with ten (10) demerits for a superior classification. The Emergency Medical Care plan was posted and current. Upon arrival, I announced my presence and the purpose of the visit. The children from Johnston Elementary School gathered in the gym. Nine (9) children from Emma Elementary arrived on the bus later. The children put their belongings in the basket and engaged in free play with balls, manipulatives and pretend food. The children in group #1 transitioned to the cafeteria. They used the bathroom and washed their hands on the way to the cafeteria. The children had sunflower kernels, WOW butter, WG tortilla, jelly packet, apple sauce, veggie juice blend and milk for snacks. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. The children in group #2 started with discussion group then transitioned to free play in the gym. Due to frigid temperature and lack of appropriate clothing, the children stayed indoor today. One (1) emergency medication was maintained at this facility. The action plan, authorization form, storage are in compliance. Lily Elder, Program Director, met with me via TEAMS to review the staff files. One (1) existing staff member’s file was monitored for criminal background letter, CPR/First Aid certificate and BSAC certificate. Due to insufficient internet connection, two (2) new staff files could not be monitored during the visit. 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 program does not provide transportation. Transportations for YMCA program were monitored on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. There are two doors leading into the kitchen area, as well as two additional doors that separate the serving areas from the seating areas. All chemicals are stored in the kitchen area. When the children arrived in the cafeteria, one of the doors separating the serving and seating areas was unlocked, and both doors to the kitchen area were open. Additionally, the janitor's closet in the kitchen was open. Inside the closet, various chemicals were stored, including but not limited to ECO LAB Drying Rinse Additive, Dishwasher Rinse Additive, Lime-A-Way, Freezer Cleaner, aerosol Aseptic-Care, and Vomit Control. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. An inhaler for a child in group #2 was not maintained in its original pharmacy labeled container. 15A NCAC 18A .2820(d) 1043 All staff records, except financial records, were not made available for review. Due to sufficient internet connection, two (2) new staff member's files could not be reviewed during the visit. G.S. 110-91( 9) 9995 A violation was found for which there is no item number. One (1) door to the serving area was unlocked and two (2) doors to the kitchen areas were open during the visit. As a result, a hot water heater in the kitchen area was accessible to the children. Technical assistance was provided as follows: 840: storage of chemicals Per 15A NCAC 18A .2820(b), chemicals, such as cleaning solutions with more than one warning and aerosol cans must be stored in a locked storage. In the cafeteria, the doors to the kitchen areas must be locked, the doors to the serving areas must be locked or the janitors’ closet must be locked. It is ideal for the doors to the kitchen area to be locked during your program hours due to the restrictions on the license. If that is not possible, both doors that separates serving areas and the seating areas must be locked. You shall ask for a key to the doors. 844: original pharmacy labeled container Prescription medications must be stored in an original pharmacy labeled container per rule 10A NCAC 09 .0803(2)(a). Please ask the parent to provide you the original box for the inhaler. If not, please ask the pharmacy to print the label for the medication. 1043: File for review Per rule GS110-91(9), all staff records, except financial records must be made available for review. Please create Staff and Training Worksheet for M. Hess and J. Garvin and submit it within two (2) weeks. Upon reception of the worksheet, a desk audit will be conducted, and additional violations may be added to today’s visit if necessary. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 1/21/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins Address: PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Fire inspection: Your fire inspection is due on or before January 30, 2025. Upon completion of the inspection, please forward the form to me. 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. 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 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 kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 5/2/2024 Number Present: 27 Completed Date: 5/2/2024 Age: From 5 To 10 Total Minutes: 135 Time In: 02:30 PM Time Out: 04:45 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 Kaoru Eddins, Child Care Consultant and also signed by Marissa Snyder, program coordinator, during the visit. An electronic signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Operations Director. Ms. Snyder was available during today’s visit. Additionally, Ms. Burke met with me on TEAMS and reviewed the paperwork. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-nine (89) percent as of 4/26/24. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit organization, The Young Men’s Christian Association of Western North Carolina, Inc., is current/active as of 4/26/24. Permit type – Four-star licensed on 5/24/23. Special Services/Restrictions – daytime, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License visit was conducted on 5/9/23. The last fire drill was practiced on 4/15/24. The last shelter-in-place drill was practiced on 3/29/24. The last fire inspection was approved on 1/30/24. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and is current. Upon arrival, I announced my presence and the purpose of the visit. The children arrived in the gym. When all the children arrived, they transitioned from the gym to the cafeteria. When the children arrived in the cafeteria, the children put their personal stuff in a basket against the wall, while a staff member cleaned and sanitized the tables. The group walked to the nearest bathroom and washed their hands before returning to the cafeteria for snacks. BBQ Jack Links, sunflower kernels, bean and veggie crackers, apple sauce and veggie juice blend were served. The items were accurately listed on the menu. After snack time, the children engaged in free play with Legos, pretend food, manipulatives, games and other toys. The playground was monitored. There are two (2) slide structures, swings, climbers, monkey bars, blacktop with basketball goal and grass field with soccer goals were available to the children. No hazardous products were found on the playground. No medications are maintained by this program. Two (2) existing staff member’s files were reviewed, and three (3) children’s files were reviewed. Staff member, CF has not completed Health and Safety training, though he/she was hired on 6/7/22. Per Ms. Burke, this staff has taken time-off multiple times throughout the year and ended up not completing the training. The staff member hired on 3/13/23 did not complete the Health and Safety training prior to 3/12/24. ABCMS system was reviewed during the visit, and both staff members’ criminal background letters were current. Supervision and interaction were 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/ This program offers transportation services to the children. Buses monitoring for all YMCA programs is scheduled to be completed on 6/4/24. The following violations were documented during today’s visit: Violation Number Comment Rule 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. Health Questionnaire for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Emergency information form for the staff member hired on 3/13/23 expired on 3/7/24. .0701(a) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired on 3/13/23 and the staff member hired on 6/7/22 did not complete Health and Safety training within one (1) years of employment. .1102(a) Technical assistance was provided as follows: 1034: Health Questionnaire Health questionnaire shall be renewed annually. MS shall renew his/her health questionnaire form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Health Questionnaire, a statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children is required for all staff, including the director annually following the initial medical statement. 1035: Emergency Information Emergency information forms shall be renewed annually. MC shall renew his/her emergency information form. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional is required for child care providers, including the director, uncompensated providers, substitute providers, and volunteers on or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1898: Health and Safety training within the first year of employment Health and Safety training shall be complete within twelve (12) months of employment. Both staff members, MS and CF shall complete the training within the next two (2) weeks. The due date is 5/16/24. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and all of the topic areas set forth in 10A NCAC 09 .1102(b) will be covered. (3) substitute providers who provide services for less than 10 days in a 12-month period. 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 5/16/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Required training hours: Based on the chart below, required training hours for CF is ten (10) hours annually. The same staff member has not completed the required hours of training for 6/7/23 – 6/6/24. However, this staff member shall complete the Health and Safety Training within the next two (2) weeks. Therefore, no other training is required for this staff member before 6/7/24. (d) Any staff working less than 40 hours per week may choose to complete on-going training requirements as outlined in Paragraph (a) of this Rule, or the training requirement may be prorated as follows: WORKING HOURS PER WEEK: 0-10 CLOCK HOURS REQUIRED: 5 WORKING HOURS PER WEEK: 11-20 CLOCK HOURS REQUIRED: 10 WORKING HOURS PER WEEK: 21-30 CLOCK HOURS REQUIRED: 15 WORKING HOURS PER WEEK: 31-40 CLOCK HOURS REQUIRED: 20 Rated License cohort: YMCA Johnston Afterschool is in cohort three (3). Your prep-year will be July 2025 through June 2026, and the assessment year will be July 2026 through June 2027. The new QIRS system is being developed. There is a change you will go through the next Environmental Rating Scale with SACERS-3. 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. 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 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 want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0302 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2510 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: YMCA JOHNSTON AFTERSCHOOL Facility ID: 11000935 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/31/2023 Number Present: 20 Completed Date: 10/31/2023 Age: From 5 To 10 Total Minutes: 120 Time In: 02:15 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of the visit conducted on 10/31/23 was to monitor compliance during a routine unannounced visit. A computerized generated report of the visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Will Deter, Administrator. Hand-written summary of the visit created on 10/31/23 was signed by Marissa Snyder, program coordinator. The indoor and outdoor areas were monitored on 10/31/23, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Permit type – four-star center license issued on 5/24/23. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios, playground does not meet child care playground safety standards, child prohibited in the kitchen for any purpose. The last annual compliance with Rated License Assessment visit was conducted on 5/9/23. The last fire drill was practiced on 7/27/23. The last shelter-in-place drill was practiced on 10/18/23. Per Mr. Deter, The last fire inspection was approved on 1/25/23. The last sanitation inspection was conducted on 9/18/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted. Upon arrival, I announced my presence and the purpose of the visit. Two (2) groups of children were combined. The group played on the playground and then in the gym. Slide structures, climbers, gross motor accessories were available to children. In the gym, the children engaged in play using magnetic tiles, pretend animals, housekeeping toys, books games, blocks, and manipulative toys. The cafeteria was closed due to being painted and was not able to monitor the menu. Per interview, the children had snacks at the picnic table outside. Due to cafeteria being closed, the menu was not monitored. Due to Buncombe County School operating on a half-day schedule, the program is operating on a slightly different schedule. Therefore, snack time was not monitored. No medications are maintained at this program. One (1) new staff file was reviewed in full, and one (1) existing staff file for special training. Both staff members have valid criminal background letters, CPR/First Aid certificate and BSAC training. One (1) staff member hired on 3/13/23 completed BSAC training on 10/28/23. This staff member did not work during summer and returned to the program when school resumed in August/September. Considering the leave time, the staff member was supposed to complete the training in September. ABCMS system was monitored during the visit and both staff members CBC letter is current. 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/ YMCA transportation monitoring was conducted on 4/27/23 at Beaverdam location at 201 Beaverdam Rd. Asheville, NC 28804 for 1) B-1, 2) B-2, 3) B-4, 4) B-5, 5) B-11, 6) M-2, 7) M-3, 8) M-4, 9) M-8, 10) M-9, 11) M-15. All buses have valid insurance from West Bend Mutual Insurance. All vehicles have valid registration cards, except for B1. The registration card for B1 License plate number KCH-4867 has been misplaced. However, the registration process has been completed and the sticker on the tag is dated December 2023. The following violations were documented during today’s visit: Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill recorded on the emergency drill log sheet was 7/27/23. .0604(t); .0302(d)(5) 1921 Staff working in part-time, full-day or track out school age care programs required to complete BSAC training, did not complete it within three months of employment. BSAC training for a a staff member hired on 3/13/23 was completed on 10/28/23. .2510(j) Technical assistance was provided as follows: 805: Fire drills Fire drill shall be completed monthly. If there is one (1) day of school in a month, a fire drill shall be completed. The alarm must be used for the practice, but on rare occasions when alarm system is not available, other methods to notify participants can be used to practice emergency drills. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly, and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 1921: BSAC training: BSAC training shall be completed within three (3) months of employment. Assuming that Ms. Snyder did not work approximately from May 30, 2023, to August 30, 2023, she had to complete BSAC training around mid-September. Due to completing BSAC training on 10/28/23 was outside of three (3) months/90 days window, a violation was cited though it was already corrected. Please pay attention to deadlines for each training course to be completed. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (j) Staff in part-time, full day, or track-out school-age care programs required to complete BSAC training shall do so within three months of becoming employed. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 11/14/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the programs’ operation on teacher work days. Mr. Deter will email the list of sites operates on the teacher work days. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times