Ymca W.W. Estes Afterschool

10A NCAC 09 .3205 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 6/4/2026 Number Present: 52 Completed Date: 6/4/2026 Age: From 5 To 12 Total Minutes: 140 Time In: 02:10 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Rated License Assessment Announced/Unannounced: Announced The purpose of today’s visit was to discuss Rated License Assessment. 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 Alexis McCall, Program Coordinator, during the visit. A signed copy of the visit summary was sent to Delaney Burke, Senior Operations Director via email. I asked Ms. Burke to sign the visit summary and return it to me. Today, Ms. McCall was available during the visit. Limited monitoring of child care rules, including but not limited to supervision, staff/child ratios, CPR/First Aid, BSAC, storage of medication, approved space, criminal background letters, license and other permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-seven (97) percent as of today prior to this visit. The center operates with a five-star center license issued on 8/15/25 with restrictions: daytime care, school-age only, meets enhanced space and ratios. Walk-through: Upon arrival, I announced my presence and the purpose of the visit. During today’s visit, gym could not be used due to preparation for events for the elementary school; therefore, children arrived at cafeteria instead. Twenty-two (22) children in group #1 engaged in creative art with air-dry clays and straws. After the focused activity, children transitioned to free play with camping themed pretend food and accessories, magnetic tiles, pretend animals, art materials and manipulative materials. The group was supervised by two (2) group leaders. Eleven (11) children in group #2 and a group leader transitioned to the playground and engaged in free play. They played with balls, play structures and chalks. Ten (10) children in group #3 engaged in free play in the theater. They played games, such as Monopoly, Floor Lava and Disney Pop-up game, car tracks, magnetic tiles and other manipulatives. The group was supervised by a group leader. One (1) group leader walked to the Koontz Intermediate School and escorted children to W.W. Estes Elementary School. Nineteen (19) children in group #4 transitioned from Koontz to Estes Elementary. Upon arrival, they used the bathroom to wash their hands and had snacks in the cafeteria. When they played outside, the group played four (4) square game. Three (3) emergency medications – (two epi-pens and one inhaler) were maintained. Authorization forms, action plans and medications were valid. During today’s visit, gym, library or art room were not used. License was posted, approved space was used, staff/child ratios were met and supervision was adequate. Staff files: Eight staff files were monitored partially. Criminal background letters (expiration dates): D. Burke- 1/25/27 H. Ramsey- 2/13/28 A. McCall- 9/5/30 L. Mata- 11/18/30 A. Adwaters- 3/13/30 S. Smith- 9/5/30 A. McGarry- 7/20/28 R. Parrish- 4/25/30 BSAC certificates: D. Burke- 10/10/09 H. Ramsey- 2/19/23 A. McCall- 1/7/23 L. Mata- 12/18/25 A. Adwaters- 3/26/26 S. Smith- 10/17/25 A. McGarry- 9/29/25 R. Parrish- 10/29/25 CPR/First Aid certificates (expiration dates): D. Burke- 2/1/27 H. Ramsey- 12/11/26 A. McCall- 9/18/27 L. Mata- 2/18/28 A. Adwaters- 9/8/27 S. Smith- 2/18/28 A. McGarry- 2/3/27 R. Parrish- 5/23/26* Rated License Assessment: Ms. Burke submitted an application for the Rated License Assessment via email on May 12, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program and four (4) individuals were also attached. Family and Community Engagement Standards were verified recently for the YMCA program during annual compliance with Rated License Assessment visit conducted on March 30, 2026. Through program handbook, I verified that all foundational practices were met. 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 March 23, 2026. Overall, all the foundational practices and five (5) additional options – C-1, C-4, EL-6, EL-8 and EO-3, were met. Based on the information obtained from the Staff Information and Education Worksheet, I reviewed four (4) staff members’ WORKS letters/accounts on May 20, 2026, and June 1, 2026. CQIs for three (3) individuals –were reviewed during today’s visit. All individual CQIs have been reviewed but unable to be initialed due to YMCA staff files are electronic files. Additional CQI was submitted by Ms. Burke for Hope Ramsey, Program Director. 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 was in a binder and maintained in the office during the visit. Focused activities for today were physical fitness and creative art. For physical fitness, kickball, bouncing with focuses on coordinated movements and participating in group activities were listed. For creative art, air-dry clay with straws or toothpicks for sculpting was listed. Sculpting activity was offered to children in cafeteria and observed during today’s visit. 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 are 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. She stated that she has met with Mr. Williams in January, March and May thus far. Ms. Burke maintains email communication with Mr. Williams as evidence of coaching/mentoring. The requirements outlined in 10A NCAC 09 .3205(f)(11) do not apply to program coordinators or group leaders. Recognition of Quality Initiatives was submitted along with other documents via email. Supporting documents for YMCA program were submitted via email on March 23, 2026, including program benefit guide, staff members’ professional development log, and a note on YMCA staff professional development pertains to T.E.A.C.H. scholarship and college courses. All checked sections were verified prior to today’s visit. Star-Level Assessment for Child Care Centers was reviewed with Ms. Burke and signed on June 3, 2026. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. Staff/child ratio information was not posted in the cafeteria. .0713(a)(10), (c) & (f)(3); .2818(e) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. A group leader's First Aid certification expired on 5/23/26 and had not been renewed. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. A group leader's CPR certification expired on 5/23/26 and had not been renewed. .1102(d) Technical assistance was provided as follows: 319: Staff/child information Staff/child ratios applicable to a classroom, were not posted in each classroom. During today’s visit, I printed the staff/child ratio form, and Ms. McCall posted it in cafeteria; therefore, this violation was corrected during visit. No compliance statement is required for this item. 1048: First Aid 1049: CPR First aid and CPR certifications must be obtained within ninety (90) days of employment and maintain the qualification thereafter. To comply, R. Parrish must renew CPR and First Aid training immediately. Per Ms. Burke, the staff member registered for CPR and First Aid training on June 19, 2026. On or prior to due date of June 18, 2026, for compliance statement, please contact me and request for an extension for these items. In your compliance letter, please verify completion of this action. Please note that achieving compliance means not only the completion of the training but also filing the training certificates in the staff file. 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 6/18/26. 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: Rated License Assessment: Please note that Rated License Assessment will not be processed until all compliances are met. After final review, a different star level may be determined. Any discrepancies would be reviewed with you. A rated license is evaluated every three years and the facility will be due again for a rated license assessment by June 2029. At each annual compliance visit, rated license components chosen will be monitored for meeting compliance. 10A NCAC 09 .3222 MAINTAINING THE STAR RATING The program will earn four-star license based on the staff education level. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 6/4/2026 Number Present: 52 Completed Date: 6/4/2026 Age: From 5 To 12 Total Minutes: 140 Time In: 02:10 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Rated License Assessment Announced/Unannounced: Announced The purpose of today’s visit was to discuss Rated License Assessment. 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 Alexis McCall, Program Coordinator, during the visit. A signed copy of the visit summary was sent to Delaney Burke, Senior Operations Director via email. I asked Ms. Burke to sign the visit summary and return it to me. Today, Ms. McCall was available during the visit. Limited monitoring of child care rules, including but not limited to supervision, staff/child ratios, CPR/First Aid, BSAC, storage of medication, approved space, criminal background letters, license and other permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-seven (97) percent as of today prior to this visit. The center operates with a five-star center license issued on 8/15/25 with restrictions: daytime care, school-age only, meets enhanced space and ratios. Walk-through: Upon arrival, I announced my presence and the purpose of the visit. During today’s visit, gym could not be used due to preparation for events for the elementary school; therefore, children arrived at cafeteria instead. Twenty-two (22) children in group #1 engaged in creative art with air-dry clays and straws. After the focused activity, children transitioned to free play with camping themed pretend food and accessories, magnetic tiles, pretend animals, art materials and manipulative materials. The group was supervised by two (2) group leaders. Eleven (11) children in group #2 and a group leader transitioned to the playground and engaged in free play. They played with balls, play structures and chalks. Ten (10) children in group #3 engaged in free play in the theater. They played games, such as Monopoly, Floor Lava and Disney Pop-up game, car tracks, magnetic tiles and other manipulatives. The group was supervised by a group leader. One (1) group leader walked to the Koontz Intermediate School and escorted children to W.W. Estes Elementary School. Nineteen (19) children in group #4 transitioned from Koontz to Estes Elementary. Upon arrival, they used the bathroom to wash their hands and had snacks in the cafeteria. When they played outside, the group played four (4) square game. Three (3) emergency medications – (two epi-pens and one inhaler) were maintained. Authorization forms, action plans and medications were valid. During today’s visit, gym, library or art room were not used. License was posted, approved space was used, staff/child ratios were met and supervision was adequate. Staff files: Eight staff files were monitored partially. Criminal background letters (expiration dates): D. Burke- 1/25/27 H. Ramsey- 2/13/28 A. McCall- 9/5/30 L. Mata- 11/18/30 A. Adwaters- 3/13/30 S. Smith- 9/5/30 A. McGarry- 7/20/28 R. Parrish- 4/25/30 BSAC certificates: D. Burke- 10/10/09 H. Ramsey- 2/19/23 A. McCall- 1/7/23 L. Mata- 12/18/25 A. Adwaters- 3/26/26 S. Smith- 10/17/25 A. McGarry- 9/29/25 R. Parrish- 10/29/25 CPR/First Aid certificates (expiration dates): D. Burke- 2/1/27 H. Ramsey- 12/11/26 A. McCall- 9/18/27 L. Mata- 2/18/28 A. Adwaters- 9/8/27 S. Smith- 2/18/28 A. McGarry- 2/3/27 R. Parrish- 5/23/26* Rated License Assessment: Ms. Burke submitted an application for the Rated License Assessment via email on May 12, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program and four (4) individuals were also attached. Family and Community Engagement Standards were verified recently for the YMCA program during annual compliance with Rated License Assessment visit conducted on March 30, 2026. Through program handbook, I verified that all foundational practices were met. 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 March 23, 2026. Overall, all the foundational practices and five (5) additional options – C-1, C-4, EL-6, EL-8 and EO-3, were met. Based on the information obtained from the Staff Information and Education Worksheet, I reviewed four (4) staff members’ WORKS letters/accounts on May 20, 2026, and June 1, 2026. CQIs for three (3) individuals –were reviewed during today’s visit. All individual CQIs have been reviewed but unable to be initialed due to YMCA staff files are electronic files. Additional CQI was submitted by Ms. Burke for Hope Ramsey, Program Director. 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 was in a binder and maintained in the office during the visit. Focused activities for today were physical fitness and creative art. For physical fitness, kickball, bouncing with focuses on coordinated movements and participating in group activities were listed. For creative art, air-dry clay with straws or toothpicks for sculpting was listed. Sculpting activity was offered to children in cafeteria and observed during today’s visit. 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 are 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. She stated that she has met with Mr. Williams in January, March and May thus far. Ms. Burke maintains email communication with Mr. Williams as evidence of coaching/mentoring. The requirements outlined in 10A NCAC 09 .3205(f)(11) do not apply to program coordinators or group leaders. Recognition of Quality Initiatives was submitted along with other documents via email. Supporting documents for YMCA program were submitted via email on March 23, 2026, including program benefit guide, staff members’ professional development log, and a note on YMCA staff professional development pertains to T.E.A.C.H. scholarship and college courses. All checked sections were verified prior to today’s visit. Star-Level Assessment for Child Care Centers was reviewed with Ms. Burke and signed on June 3, 2026. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. Staff/child ratio information was not posted in the cafeteria. .0713(a)(10), (c) & (f)(3); .2818(e) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. A group leader's First Aid certification expired on 5/23/26 and had not been renewed. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. A group leader's CPR certification expired on 5/23/26 and had not been renewed. .1102(d) Technical assistance was provided as follows: 319: Staff/child information Staff/child ratios applicable to a classroom, were not posted in each classroom. During today’s visit, I printed the staff/child ratio form, and Ms. McCall posted it in cafeteria; therefore, this violation was corrected during visit. No compliance statement is required for this item. 1048: First Aid 1049: CPR First aid and CPR certifications must be obtained within ninety (90) days of employment and maintain the qualification thereafter. To comply, R. Parrish must renew CPR and First Aid training immediately. Per Ms. Burke, the staff member registered for CPR and First Aid training on June 19, 2026. On or prior to due date of June 18, 2026, for compliance statement, please contact me and request for an extension for these items. In your compliance letter, please verify completion of this action. Please note that achieving compliance means not only the completion of the training but also filing the training certificates in the staff file. 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 6/18/26. 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: Rated License Assessment: Please note that Rated License Assessment will not be processed until all compliances are met. After final review, a different star level may be determined. Any discrepancies would be reviewed with you. A rated license is evaluated every three years and the facility will be due again for a rated license assessment by June 2029. At each annual compliance visit, rated license components chosen will be monitored for meeting compliance. 10A NCAC 09 .3222 MAINTAINING THE STAR RATING The program will earn four-star license based on the staff education level. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 6/4/2026 Number Present: 52 Completed Date: 6/4/2026 Age: From 5 To 12 Total Minutes: 140 Time In: 02:10 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Rated License Assessment Announced/Unannounced: Announced The purpose of today’s visit was to discuss Rated License Assessment. 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 Alexis McCall, Program Coordinator, during the visit. A signed copy of the visit summary was sent to Delaney Burke, Senior Operations Director via email. I asked Ms. Burke to sign the visit summary and return it to me. Today, Ms. McCall was available during the visit. Limited monitoring of child care rules, including but not limited to supervision, staff/child ratios, CPR/First Aid, BSAC, storage of medication, approved space, criminal background letters, license and other permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-seven (97) percent as of today prior to this visit. The center operates with a five-star center license issued on 8/15/25 with restrictions: daytime care, school-age only, meets enhanced space and ratios. Walk-through: Upon arrival, I announced my presence and the purpose of the visit. During today’s visit, gym could not be used due to preparation for events for the elementary school; therefore, children arrived at cafeteria instead. Twenty-two (22) children in group #1 engaged in creative art with air-dry clays and straws. After the focused activity, children transitioned to free play with camping themed pretend food and accessories, magnetic tiles, pretend animals, art materials and manipulative materials. The group was supervised by two (2) group leaders. Eleven (11) children in group #2 and a group leader transitioned to the playground and engaged in free play. They played with balls, play structures and chalks. Ten (10) children in group #3 engaged in free play in the theater. They played games, such as Monopoly, Floor Lava and Disney Pop-up game, car tracks, magnetic tiles and other manipulatives. The group was supervised by a group leader. One (1) group leader walked to the Koontz Intermediate School and escorted children to W.W. Estes Elementary School. Nineteen (19) children in group #4 transitioned from Koontz to Estes Elementary. Upon arrival, they used the bathroom to wash their hands and had snacks in the cafeteria. When they played outside, the group played four (4) square game. Three (3) emergency medications – (two epi-pens and one inhaler) were maintained. Authorization forms, action plans and medications were valid. During today’s visit, gym, library or art room were not used. License was posted, approved space was used, staff/child ratios were met and supervision was adequate. Staff files: Eight staff files were monitored partially. Criminal background letters (expiration dates): D. Burke- 1/25/27 H. Ramsey- 2/13/28 A. McCall- 9/5/30 L. Mata- 11/18/30 A. Adwaters- 3/13/30 S. Smith- 9/5/30 A. McGarry- 7/20/28 R. Parrish- 4/25/30 BSAC certificates: D. Burke- 10/10/09 H. Ramsey- 2/19/23 A. McCall- 1/7/23 L. Mata- 12/18/25 A. Adwaters- 3/26/26 S. Smith- 10/17/25 A. McGarry- 9/29/25 R. Parrish- 10/29/25 CPR/First Aid certificates (expiration dates): D. Burke- 2/1/27 H. Ramsey- 12/11/26 A. McCall- 9/18/27 L. Mata- 2/18/28 A. Adwaters- 9/8/27 S. Smith- 2/18/28 A. McGarry- 2/3/27 R. Parrish- 5/23/26* Rated License Assessment: Ms. Burke submitted an application for the Rated License Assessment via email on May 12, 2026. The application indicated the assessment with Pathway 2- Classroom and Instructional Quality Pathway. Staff Information and Education Worksheet and Continuous Quality Improvement (CQI) for Program and four (4) individuals were also attached. Family and Community Engagement Standards were verified recently for the YMCA program during annual compliance with Rated License Assessment visit conducted on March 30, 2026. Through program handbook, I verified that all foundational practices were met. 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 March 23, 2026. Overall, all the foundational practices and five (5) additional options – C-1, C-4, EL-6, EL-8 and EO-3, were met. Based on the information obtained from the Staff Information and Education Worksheet, I reviewed four (4) staff members’ WORKS letters/accounts on May 20, 2026, and June 1, 2026. CQIs for three (3) individuals –were reviewed during today’s visit. All individual CQIs have been reviewed but unable to be initialed due to YMCA staff files are electronic files. Additional CQI was submitted by Ms. Burke for Hope Ramsey, Program Director. 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 was in a binder and maintained in the office during the visit. Focused activities for today were physical fitness and creative art. For physical fitness, kickball, bouncing with focuses on coordinated movements and participating in group activities were listed. For creative art, air-dry clay with straws or toothpicks for sculpting was listed. Sculpting activity was offered to children in cafeteria and observed during today’s visit. 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 are 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. She stated that she has met with Mr. Williams in January, March and May thus far. Ms. Burke maintains email communication with Mr. Williams as evidence of coaching/mentoring. The requirements outlined in 10A NCAC 09 .3205(f)(11) do not apply to program coordinators or group leaders. Recognition of Quality Initiatives was submitted along with other documents via email. Supporting documents for YMCA program were submitted via email on March 23, 2026, including program benefit guide, staff members’ professional development log, and a note on YMCA staff professional development pertains to T.E.A.C.H. scholarship and college courses. All checked sections were verified prior to today’s visit. Star-Level Assessment for Child Care Centers was reviewed with Ms. Burke and signed on June 3, 2026. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. Staff/child ratio information was not posted in the cafeteria. .0713(a)(10), (c) & (f)(3); .2818(e) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. A group leader's First Aid certification expired on 5/23/26 and had not been renewed. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. A group leader's CPR certification expired on 5/23/26 and had not been renewed. .1102(d) Technical assistance was provided as follows: 319: Staff/child information Staff/child ratios applicable to a classroom, were not posted in each classroom. During today’s visit, I printed the staff/child ratio form, and Ms. McCall posted it in cafeteria; therefore, this violation was corrected during visit. No compliance statement is required for this item. 1048: First Aid 1049: CPR First aid and CPR certifications must be obtained within ninety (90) days of employment and maintain the qualification thereafter. To comply, R. Parrish must renew CPR and First Aid training immediately. Per Ms. Burke, the staff member registered for CPR and First Aid training on June 19, 2026. On or prior to due date of June 18, 2026, for compliance statement, please contact me and request for an extension for these items. In your compliance letter, please verify completion of this action. Please note that achieving compliance means not only the completion of the training but also filing the training certificates in the staff file. 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 6/18/26. 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: Rated License Assessment: Please note that Rated License Assessment will not be processed until all compliances are met. After final review, a different star level may be determined. Any discrepancies would be reviewed with you. A rated license is evaluated every three years and the facility will be due again for a rated license assessment by June 2029. At each annual compliance visit, rated license components chosen will be monitored for meeting compliance. 10A NCAC 09 .3222 MAINTAINING THE STAR RATING The program will earn four-star license based on the staff education level. 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 .0701 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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. 110-90 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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. 110-99 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 3/23/2026 Number Present: 69 Completed Date: 3/23/2026 Age: From 5 To 12 Total Minutes: 208 Time In: 01:32 PM Time Out: 05:00 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 Kaoru Eddins, Child Care Consultant. Operator signature was not obtained due to a designee not present on-site during the visit. A signed copy of the visit summary was left on-site and electronically emailed to Delaney Burke, Senior Director of Operations and request for a signature. Today, Alexis McCall, 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. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80) percent as of today prior to this visit. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced space and ratios. The last annual compliance visit was conducted on 10/16/25. The last fire drill was practiced on 3/5/26. The last shelter-in-place drill was practiced on 3/10/26. The Emergency Medical Care plan was posted and current. The approved curriculum is Funnydaffer. Activity plans for STEAM lessons, sports lessons, neighborhood lessons, visual art lessons, graphs, Character Ed lessons, Read Aloud, Search & Create Lessons for February and March 2026 were reviewed during today’s visit. Lead water testing was completed on 6/24/26 without hazards. Lead paint testing was completed on 2/20/25 for W.W. Estes Elementary School. Asbestos testing was completed on 6/12/25. W.W. Estes Elementary School. However, the facility summary still shows pending on-site results for asbestos testing. Please contact RTI and update the status on the asbestos testing. Voice message can be left at 1-888-997-9290. Two (2) staff members were listed on the Automated Criminal Background Check Management System (ABCMS). Upon arrival, I announced my presence and greeted Ms. McCall. I attempted to meet with Ms. Burke via TEAMS, but I was unable to due to poor Wi-Fi connections. Ms. Burke agreed to meet with me on-site to review the staff files. At approximately 2:30 pm, a group of children arrived and lined up against the walls outside of the gym. Ms. McCall signed children in and took name-to-face counts as the children walked into the gym. Twenty-two (22) children in group #1 transitioned to theater with two (2) staff members. The children played with chess, magnetic tiles, manipulatives, rocks/gems matching games, Jenga and other materials. The group later transitioned to cafeteria and had snacks. Today, BBQ Jack links, Chili-Lime crackers, sunflower kernels, veggie blend juice, apple sauce and milk were served to the children. On the menu, a posted note listing the correct items were posted to reflect the items. Seventeen (17) children in group #2 remained in the gym were supervised by one (1) staff member. The children played gross motor games and free played at centers. Pretend food/dishes, manipulatives, games, dolls were available to the children. Children in group #3 and #4 were on the blacktop playground. One (1) group leader was available for each group of children. They played basketball, swings and walked around. Ms. McCall walked around, transitioned to different groups and aided group leaders throughout the visit. Supervision and interaction were adequate. No safety hazards were found. The slides noted during annual compliance visit conducted on 10/16/25 were not accessible to the children (no children from this program was on the playground with damaged slides). Four (4) prescriptions were reviewed – two (2) epi-pens, one (1) inhaler and two (2) seizure nasal sprays were present. All action plans and permission forms were valid, no medications had expired. Three (3) new staff files were reviewed in full, and five (5) existing staff files were reviewed partially for criminal background letters and special trainings. Ms. Burke submitted Staff and Training Worksheet for new staff members during the visit. The following information was missing or discrepancies were found: D. Parrish: TB screening – TB screening questionnaire was completed and reviewed by a physician on 10/27/25. However, one (1) of the questionnaire was answered yes, but the TB skin test was not completed. EI: 10/14/25 HQ: 10/14/25 A. McCall: CBC issued on: 9/5/25, expires on 9/5/30 CPR/FA: expires on 9/18/27 R. Parrish: CBC issued on 4/25/25, expires on 4/25/30 CPR/FA will expire on 5/23/26 BSAC issued on 10/29/25 S. Smith: CPR/FA expires on 2/18/28 BSAC: 10/17/25 L. Mata: CPR/FA expires on 2/18/28 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 during summer. No children takes bus during regular school year. No buses were monitored during today’s visit. The following violations were documented during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. G.S. 110-99(a1) 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. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment (the staff member answered yes to one (1)n of the questions on the form). .0701(a) 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. One (1) staff member who was employed on 3/13/26, took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, had not complete BSAC training. .2510(j) Technical assistance was provided as follows: 102: current license Current license must be posted in the prominent place. The posted license was dated 6/17/24. The most recent license was issued on 8/15/25. Ms. McCall printed a copy of the most recent license and posted during visit. Therefore, this violation was corrected during visit. 1033: TB screening TB screening must be completed prior to employment. One (1) Group Leader who was employed on 3/13/25 did not complete the test prior to the first day of employment. Additionally, one (1) Group Leader who was employed on 10/24/25, did not complete the skin test prior to the first day of employment. To comply, you must review the requirement 10A NCAC 09 .0701(a) with HR department and anyone who is involved in hiring procedures. 1921: BSAC New employees must complete BSAC training within three (3) months of employment. This violation was cited because one (1) staff member took BSAC training but the certificate was not on file, and one (1) staff member whose employment date of 10/24/25, did not complete BSAC training. To comply, a Group Leader with employment date of 3/13/25 shall upload a copy of BSAC certificate and maintain it on file. Also, a Group Leader whose employment date of 1024/25 shall complete BSAC training immediately. In your compliance letter, please verify the completion of both task. 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 4/6/26. 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: Annual Staff Evaluation (ASE) and Staff Development Plan (SDP): ASE and SDP were not completed for A. Adwater. Ms. Burke stated that the staff member left employment for two (2) months (October and November 2025) and returned. Requirement is that ASE and SDP are required annually from the date of employment. Please complete ASE and SDP for the staff member immediately. 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. 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 was required to be completed by May 31, 2025 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 .0514 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 .0701 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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. 110-91 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 10/16/2025 Number Present: 75 Completed Date: 10/16/2025 Age: From 5 To 12 Total Minutes: 223 Time In: 01:17 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins Child Care Consultant and also signed by Alexis McCall, 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, Ms. McCall 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 eighty-four (84) 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, Young Men’s Christian Association of Western North Carolina, is current/active as of today. Permit type – five-star center license issued on 8/15/25. Special Services/Restrictions – daytime care, school-age only, meets enhanced ratios and space. The last annual compliance visit was conducted on 11/13/24. The last fire drill was practiced on 8/29/25. The last shelter-in-place drill was practiced on 6/3/25. The Emergency Medical Care plan was posted and current. Lead water testing was completed on 6/26/24 without hazards. On-site visit results are pending for lead paint and asbestos testing. Upon arrival, I greeted Ms. McCall. I met with Nick Erwin, Program Director, via TEAMS to review the staff and children’s files. Two (2) new staff members were monitored. Many records were either inaccessible to Mr. Erwin or difficult to locate. As a result, I was unable to review most of the records for both staff and children. The Staff and Training Worksheet (STW) submitted by Ms. Burke prior to this visit listed three (3) current staff members. An additional five (5) staff members were either present on-site or mentioned during the review. Due to time constraints, the number of files requiring review, and technical challenges with accessing electronic records, I was only able to conduct a partial review of some existing staff files. No children’s files were reviewed during this visit. During the visit, children were observed arriving and gathering in the gym and in the hallway outside the gym. One (1) Group Leader walked to Koontz Intermediate School to pick up additional children. Twenty-one (21) children attended in group #1. The children and two (2) group leaders conducted a circle activity in the gym. Seventeen (17) children in group #2 gathered in the hallway and transitioned to theater with one (1) group leader. The children played with manipulatives, pretend toys, Legos, etc. Nineteen (19) children in group #3 gathered in the gym and transitioned to outside playground. The children played on the blacktop with balls and played games. Eighteen (18) children in group #5 walked from Koontz Intermediate School to W.W. Estes Elementary School with a group leader. The children gathered in the cafeteria and had snacks. Today, the children had BBQ Jack Links, sunflower kernels, WG crackers, apple sauce, veggie blend juice and milk. The playgrounds were monitored. The fenced-in playground, which includes two (2) slide structures, monkey bars, a balance board, and a see-saw structure, is occasionally used by the children, according to Ms. McCall. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Children using the slides may be at risk of scratches or cuts from the rusted metal, which could require additional medical attention, including potential tetanus shots. Emergency medications were monitored. All permission forms and action plans were current. One (1) of the epi-pens were expired. 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. The following violations were documented during today’s visit: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. The coating on the platforms of both slide structures was observed to be peeling, exposing the underlying metal surfaces. Portions of the exposed metal were rusted and deteriorated, creating sharp edges. Both slides were located in the fenced in playground by the garden. .0601(c) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last fire drill logged was dated 8/29/25. .0604(t); .0302(d)(5) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An epi-pen for a child in group #4 expired in September, 2025. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's medical statement was dated 12/21/21. Medical statement for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A staff member who was employed in 2021 was re-hired on 9/8/25. The staff member's TB screening was dated 12/21/21. TB screening for for a staff member who was hired on 7/7/21 could not be located during file review on 10/17/25. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members' health questionnaire was not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .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 following staff members' emergency information forms were not located during file review on 10/17/25: S. G-M - hired 9/21/21, HR- hired 2/2/23. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff file records and children's records were not fully reviewed within today's visit due to time constraints, technical issues with electronic files and lack of access to the files by the administrative staff member. G.S. 110-91( 9) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The following staff members' First Aid certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The following staff members' CPR certificates were not located during file review on 10/17/25: RP - hired 4/25/25, CM - hired 7/7/21, HR - hired 2/2/23. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. The following staff members staff development plan and annual evaluation were not located during file review on 10/17/25: AM - hired 9/16/22, S.G-M- hired 9/21/21, CM - hired 7/7/21 and HR - hired 2/2/23. 10A NCAC 09 .0514(f) 1430 Assistant group leaders were not 16 years of age and/or had not completed Basic School Age Care (BSAC) training. BSAC training certificate was not located for RP -hired 4/25/25. .2510(d) 1757 A valid qualification letter was not on file and available to review at the facility. A valid qualification letters were not located during file review on 10/17/25 for the following staff members: FG - hired 8/25/25, HR - hired 2/2/23. G.S. 110-90.2(b) & (d) & .2703(e) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last Shelter-in-Place drill was dated on 6/3/25. .0604(u);.0302(d)(8) 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. The following staff member's BSAC certificate was not located during file review on 10/17/25: HR-hired on 2/2/23. .2510(j) Technical assistance was provided as follows: 705: Equipment All equipment used by children must be sturdy and in good repair. The coating for the platforms for two (2) slide structures on the fenced in playground peeled and the exposed metal were rusted and deteriorated. To be in compliance, deteriorated/rusted metal must be covered appropriate to eliminate the sharp points, then the coating of the metal must be re-applied or repaired. In your compliance letter, please state how you met the compliance. 805: Fire Drills 1811: Shelter-in-place/Lockdown drills Fire drills must be conducted monthly, and a shelter-in-place or a lockdown drill must be conducted every three months. The records of drills shall include the date, time, the length of time taken to evacuate the building, and the signature of the person who conducted the drill. Electric records provide documentation in case staff members forget to log the drills. However, on-site staff must document the drills including the signature. To comply, please conduct a fire drill to make up for the missed September drill, if one was not conducted. If a drill was conducted but not documented, please record it on the posted emergency drill form. Please note that the make-up drill does not replace the fire drill required for October. As for the shelter-in-place/lockdown drill, you must conduct one of the drills for September if you did not complete one. If you completed one and did not document, please document the details of the drill. In your compliance letter, please state when and how you met the compliance. 849: expired medication An epi-pen for a child expired in September 2025. To comply, please send the epi-pen home with the child and request unexpired epi-pen. In your compliance letter, please state the date you met the compliance. 1043: Records for review All records must be available for review. I am requesting a virtual meeting to review the staff files listed below: A. McCall: • 2-week orientation and 6-week orientation records • Staff development plan • Annual evaluation • Health Questionnaire • Emergency information form • On-going training documentation (all certificates between 9/16/24 through 9/15/25). • Documentation of review of EMC plan • Documentation of review of EPR plan • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement for job description • Job Application dated 10/7/22 F. Grady: • Job application fated 8/6/25 • 2-week orientation • 6-week orientation • Emergency information form • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description S. Smith: • Job application • 2-week orientation • 6-week orientation • Emergency information form • Medical statement • TB Screening – skin test page • Documentation of review of EPR • Documentation of review of EMC • Review of aquatic policy • Review of operational/personnel policy • Acknowledgement of job description B. Garcia: This staff member was not mentioned prior to visit. I need to check all documents on his/her staff file. Additionally, please create a staff and training worksheet for B. Garcia, S. Mickems, R. Parrish, S. Guinea-Marsh, and H. Ramsey. I must review 10% of enrolled children’s files. Please see attached children’s record checklist for details. I texted to ask if I could review their files prior to 5 pm, but it was not possible due to Mr. Erwin being subbed for a staff member at another location. I requested an announced follow-up visit via email during the visit. Please note that additional violations may be cited upon file reviews. The following technical assistance was provided during annual compliance follow-up visit conducted on 10/17/25: Technical Assistance were provided as follows: 1032: medical statement Medical statement must be on file for new staff members on or prior to the first day of employment. If a staff member leaves employment for more than 90 days, he/she is considered new employee. Medical statement is only valid if it was completed within twelve (12) months prior to the new employment date. B. Garcia needs to complete new medical exam. Please locate TB screening for C. Mickens. In your compliance letter, please state that date you placed B. Garcia’s medical statement. If he/she leaves employment, please state so. 1033: TB records All staff members must provide documentation indicating they are free of active TB or TB tests on or prior to first day of work. You may use the form provided by the Division. If you answer yes to any of the questionnaires, a follow-up skin test is required. S. Smith shall complete additional TB screening and verify that he/she is free of active TB. To comply, he/she must submit the screening result completed by a medical professional, such as physician’s office or a health department. B. Garcia needs to complete new TB screening as the one on file was completed approximately three (3) years prior to his/her re-hire date. Please locate TB screening for C. Mickens. In your compliance letter, please state the date the staff member submitted/located the document. 1034: Health Questionnaire 1035: emergency information form Health questionnaire is required for all staff members for 2nd year of employment and annually thereafter. Emergency information is required for all staff members on or prior to first day of employment. If the staff members do not have preferred hospital, he/she can write “closest hospital” or “no preference”. To comply, either create new forms or locate the current forms for S. Guinea-Marsh and H. Ramsey. In your compliance letter, please state how you met the compliance. 1048: First Aid 1049: CPR All staff must successfully complete certification in First Aid/CPR appropriate to the age of children in care. Verification of staff completion of First Aid/CPR training from an approved training organization shall be maintained in the staff file. To comply, please either complete the first aid/CPR training or locate the existing training certificate and maintain it in the staff file for R. Parrish, C. Mickens, and H. Ramsey. 1232: Staff Development Plan/Annual Staff Evaluation Each employee must contain staff development plan and annual evaluation in file. To comply, either complete or locate the development plan and evaluation and maintain them in each staff file for A. McCall, S. Guinea-Marsh, C. Mickens and H. Ramsey. In your compliance letter, please state either you created one or located the documents. Also, please state that those documents are maintained in their files. 1757: Criminal background letter Valid criminal background letters must be on file for all staff members. To comply, please print the letter for F. Grady and H. Ramsey and maintain them in their files. In your compliance letter, please state how you met the compliance. 1897: Recognizing and Responding to Suspicions of Child Maltreatment training This training must be completed within ninety (90) days of employment. The training certificate must be maintained in staff files. To comply, please complete the training or locate the completed training certificate for S. Mickens. In your compliance letter, please verify S. Mickens’ completion date of the training. 1430: BSAC (assistant group leader) 1921: BSAC for regular staff BSAC training must be completed by assistant group leaders. Regular staff members must complete the training within three (3) months of employment. To comply, please either complete or locate the training certificate for BSAC for R. Parrish and C. Mickens. In your compliance letter, please verify the dates R. Parrish and C. Mickens completed the training. 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 10/30/25. 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: 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. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 .1801 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 11/13/2024 Number Present: 61 Completed Date: 11/13/2024 Age: From 5 To 12 Total Minutes: 225 Time In: 02:15 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Announced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. A signed copy of the visit summary was electronically emailed to Delaney Burke, Senior Director of Operations. Mr. Turner was available during the visit today. 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-seven (87) 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 11/12/24. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space. No children allowed in kitchen, SA playground does not meet safety standards, PS children served June-Aug only. The last annual compliance visit was conducted on 11/8/24. Due to Tropical Storm Helene, no routine visits were conducted in October 2024. The routine visits were resumed on November 4th, 2024. However, du to constraint schedule, the annual compliance visit was unable to be conducted within the required timeline. The last fire drill was practiced on 10/28/24. The last shelter-in-place drill was practiced on 9/6/24. The last fire inspection was approved on 9/24/24. The last sanitation inspection was conducted on 9/19/24 with four (4) 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. At that time, the children were gathered in the gym and separated into three (3) groups, each stationed along a different wall. One (1) group leader was positioned near the entrance door farthest from the bathroom, the second group leader was by the rock-climbing wall, and the third group leader stood between two (2) groups—one (1) on the opposite wall and the other by the bathroom. The group leaders instructed the children to sit down, but the children frequently got up, retrieved balls from the cart, hit mats to make loud noises, screamed, and chased each other. When Mr. Turner entered the gym, one (1) of the group leaders left to pick up the children from Koontz Intermediate School. Shortly after, the children from groups #2 and #3 moved to the playground, where they played with balls and other equipment. The children in group #1 remained in the gym and played with balls and Legos. Snack time was held in the cafeteria. The menu for today included WOW butter, a whole-grain tortilla, sunflower kernels, veggie blend juice, a jelly packet, applesauce, and milk. Two (2) emergency medications are maintained at this facility, the storage of the medications, permission form, action plan and the medication expiration dates were in compliance. No hazardous products were accessible to the children. Staff and Training Worksheet was reviewed with Lily Elder, Program Director via TEAM. One (1) new staff member’s file and one (1) existing staff member’s file were monitored. Eight (8) children’s files were monitored. Some of the dates listed on the Staff and Training Worksheet do not match the documents reviewed. Handwashing station was set up in the gym outside of the bathroom and in the cafeteria. Young children cannot reach the soup dispenser and has challenges washing hands while using the foot pump. Close supervision and assistance are required to make sure that the children can use the handwashing stations sufficiently. 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. The transportation for YMCA programs were inspected on June 4, 2024. The following violations were documented during today’s visit: Violation Number Comment Rule 205 Storage space was not available for each child's personal belongings. The children put their backpacks on the floor in the gym. No storages for individual belongings were observed during the visit. G.S. 110-91(6) 303 Children were not adequately supervised at all times. Three (3) children went in the bathroom in the gym, and two (2) of them had backpack on them. One (1) of the children screamed loudly for at least 5 times, but the group leaders did not check on them. One (1) child came out of the bathroom and complained to me about other children in the same toilet room and screaming. The child was unable to reach soup dispenser on the handwashing station. At least least five (5) children came out of the bathroom without handwashing without group leaders' knowledge. Upon transition of group #2 from the gym to the hallway, two (2) children held the door. One (1) child was trying to keep the door open, and the other child was trying to close the door. Eventually, the door was closed, leaving one (1) child in the hallway alone unattended for approximately ten (10) seconds until the program coordinator opened the door. Later during observation, two (2) children, who played dodge ball came out of the gym to the hallway, chasing the ball rolled to the hallway twice. The children quickly went back to the gym after retrieving the ball each time. The group leader was sitting by the rock climbing wall during both incidents. .1801(a)(1-5) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. At least five (5) children between 2:48 pm to 2:52 pm went in the bathroom came out and did not wash their hands. No children were instructed to wash their hands upon arrival. 15A NCAC 18A .2803(c) Technical assistance was provided as follows: 205: Storage for personal belongings Per G.S.110-91(6) storage for each child’s personal belongings is required. Please use the baskets and allow children to store their backpack, jackets and other personal items. 303: Supervision Children shall be supervised at all times per 10A NCAC 09 .1801 (a) (1-5), Upon children’s use of bathroom, the group leader should position self near the bathroom so that he/she they can hear the children. Additionally, please aide children use the handwashing stations when the child needs help. The children shall not bring their belongings to the bathroom unless there are specific needs, such as changing clothes or other purposes. Due to noise level in the gym, staggering arrival or different meeting locations are recommended, if possible. Reduce children’s wait time by conducting small group discussion and offering a bucket of toys during wait time. The toys used prior to handwashing shall be sanitized before being used again. 608 Handwashing Handwashing is required upon arrival, before meals, after use of bathroom and after coming in from outside. Please instruct the children to use the handwashing station upon arrival and after using the bathroom. 1441: BSAC All staff members care for school-age children shall obtain BSAC training certificate within three (3) months of employment. Achieving Compliance: A follow-up visit will be conducted to verify compliance of supervision per 10A NCAC 09 .1801 (a) (1-5). 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 11/27/24. 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 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: Staff evaluation and annual development for a staff member hired on 9/21/20 is due on or prior to 11/23/24. CPR/First Aid training shall be renewed on or prior to 12/10/24 for a staff member hired on 9/21/20. 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 .0302 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0514 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0607 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0701 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0713 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0801 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .0803 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .1101 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .1801 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .2502 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 .2703 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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

G.S. 110-105 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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

G.S. 110-90 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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

G.S. 110-91 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/23/2024 Number Present: 119 Completed Date: 7/23/2024 Age: From 4 To 12 Total Minutes: 447 Time In: 08:48 AM Time Out: 04:15 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 a routine unannounced 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 Nick Erwin, Program Director, during the visit. A signed copy of the visit summary was electronically emailed to Dalaney Burke, Senior Director of Operations. Mr. Turner was available during today’s visit. A routine unannounced visit was conducted by Kaitlyn Marshall, Child Care Consultant on 5/7/24. This visit was to monitor a preschool program, which operates during summer month. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions in the preschool classroom. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-six (96) percentage as of today prior to this visit. Permit type – Five-star center license issued on 6/17/24. Special Services/Restrictions – daytime care, meets enhanced ratios and space, no children allowed in the kitchen, SA playground does not meet safety standards, PS served June-Aug only. The last annual compliance visit was conducted on 11/8/23. The last fire drill was practiced on 6/26/24. This record was maintained electronically. The last shelter-in-place drill was practiced on 6/7/24. This record was maintained electronically. The last playground inspection was documented on 6/14/24 for preschool playground. This record was maintained electronically. The last fire inspection was approved on 9/19/23. The last sanitation inspection was conducted on 9/13/23 with six (6) demerits for a superior classification. The bulletin board where license, EMC and other documents were posted was not available during the visit due to the section of the hallway being blocked off by DPI program for waxing. No copies of EMC were maintained electronically. Upon arrival, I announced my presence and the purpose of the visit. Due to preschool components needed to be monitored, this Routine Unannounced visit was conducted even though the last RU visit was conducted on 5/7/2024. The children were observed. The children in group #1 and #2 had breakfast in the cafeteria. Today’ breakfast was banana nut bread, a whole apple and milk. The kitchen area was not accessible to the children, and no hazardous products were observed. The children in group #3 played Sprout Ball in the gym. The children in group #4, 5, 6 participated in science experiments. A program coordinator demonstrated coke and mentos/other materials reactions to the children. Upon arrival, the children were signed in by one (1) of the program coordinators stationed in the parking lot. The other staff members guided the children to wash their hands upon entering the building. Supervision and interactions were adequate. There were three (3) children, thirteen (13) years of age, were present. Thirteen-year-old children are allowed in the program as long as all information is in file as other enrollees. Preschool classroom was observed. Ten (10) children, four-to-five years of age, were present with three (3) teachers. The children engaged in free play with Legos, art materials, puzzles, and pretend animals. The classroom is used by a different licensed program during the school year, and YMCA is running a summer-only preschool program using the same classroom. No posters other than the class schedule were posted in the classroom. The children later played on the fenced playground by the classroom. The children played with gross motor accessories, such as hula hoops and balls and a slide structure. Supervision and interaction were adequate. Medications were monitored. Seven (7) emergency medications and one (1) non-emergency medication were maintained. The action plan and the permission form for Epi-pen for a child in group #3 expired on 6/7/24. The epi-pen also expired in June 2024. The action plan and the permission form for Auvi-Q in group #2 expired on 8/22/24. The action plan for Epi-pen is group #5 does not have a signature or a date. The action plan and the permission form for an inhaler for a child in group #5 were not in the file. A Children’s Benadryl was not stored in a locked storage. There were sixteen (16) staff members, three (3) volunteers were present. Ms. Burke, Administrator, was not present during the visit but available via TEAM and phone. YMCA staff members typically work at multiple sites. I have considered six (6) staff members I have seen at other sites as existing staff members. I monitored their criminal background check (CBC), First Aid/CPR certificates and BSAC certificates for the existing staff members. Other eleven (11) staff members’ files were monitored in full as well as three (3) volunteers’ files. Some staff members were returned staff members. If they were no longer employed at YMCA programs for ninety (90) days, they were considered new employees. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. Due to some hallways being blocked off by DPI program for waxing, the bulletin board where the license and EMC were posted could not be monitored. G.S. 110-91(9); .0304(g); .2318 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. In preschool classroom, staff/child ratios for YMCA W.W. Estes Afterschool was not posted. .0713(a)(10), (c) & (f)(3); .2818(e) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A Children's Benadryl for a child in space #5 was stored with the child's epi-pen in the backpack. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. The permission plan for a child with an epi-pen in group #3 expired on 12/9/23. The permission form for Auvi-Q for a child in group #2 expired on 2/29/24. No permission form was in file for an inhaler for a child in group #5. No permission form for the Children's Benadryl was in file for a child in group #5. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. An Epi-pen for a child in group #3 expired in June 2024. An inhaler for a child in group #5 expired on May 2024. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The following staff members did not have medical statement in file for review: KC, BH, VM, SB. The following staff member was rehired, but the new medical record was not obtained: OI. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The following individual did not have TB records for review: VM, SB, DW, OI, BH, and KC. .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. The following staff members did not have current Health Questionnaire form in file: VM, RS. .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 following staff members did not have current Emergency information form in the file: RS, VM, DW. The emergency information form for SD expired on 5/26/23. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The first aid certificate for staff member, QT, expired on 6/28/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The CPR certificate for staff member, QT, expired on 6/28/24. .1102(d) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. The staff member who was re-hired did not have the record of new orientation (KC). The staff member, RS did not have the record of orientation for review. The substitute staff member, DW, did not have a record of orientation for review. The staff member, OI, did not have a record of orientation for review. .1101(a)(b) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. The following staff members did not have a written acknowledgement of reception of operational and personnel policies: KC(Rehire), VM, DW. 10A NCAC 09 .0514(g) 1757 A valid qualification letter was not on file and available to review at the facility. Criminal background letter for staff members, GA and SB were not in file for review. GA's date of employment is 5/23/24. SB's date of employment was not clear, but it is assumed to be around 4/8/24 due to operational and personnel policy being signed on 4/8/24. G.S. 110-90.2(b) & (d) & .2703(e) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. The documentation of review of the facility's EPR plan was not available for review for substitute staff member, DW. .0607(g) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. An action plan was not in file for the inhaler for a child in group #5. .0801(b) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The action plan for Epi-pen for a child in group #3 expired on 6/7/24. The action plan for Auvi-Q expired on 8/22/24. The action plan for an Epi-pen for the child in group #5 did not have signature or a date. .0801(b) 1958 Substitute providers and volunteers did not have a health questionnaire on or before the first day of work and annually thereafter. The Health Questionnaire form for a substitute staff member, DS was not available in file for review. The Health Questionnaire for SD expired on 5/26/24. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 124: Record for review During the visit, the bulletin board where license, Emergency Medical Care Plan (EMC) and other documents were posted could not be reviewed due to the hallway being blocked off by DPI programs for waxing. While I understand that you don’t always have control over what DPI programs do, it is important to maintain access to emergency information, such as EMC. I advise you to keep electronic copy of the plan to be available to program directors and coordinators. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. 319: Staff/Child Ratio poster A Staff/Child Ratio poster is required to be posted in the preschool classroom where the parents can see. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (10) the staff/child ratio applicable to a classroom as described in this Paragraph shall be posted in that classroom in an area that parents are able to view at all times. 841: Medication storage Benadryl, per DCDEE as of today, is not considered an emergency medication even though the medication is listed on the action plans. Therefore, Benadryl shall be stored in a locked storage. I recommend it to be stored in a zipper cloth back with key and lock or a combination lock. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be stored out of reach of children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept out of reach of children when not in use, but are not required to be in locked storage. 847: Medication authorization form Medication authorization form (permission form) is required for each medication, including emergency medication and over-the-counter medication. Two (2) or more medications cannot be listed on one (1) permission form. Each medication must have a separate form. All sections of the form shall be included, including name of the medication, not general term of the medication (e.g. Equate decongestant vs cough syrup). The permission form is valid for is six (6) months and must be renewed before it expires. 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. 849: expired medications Expired medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration date. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 1032: Medical Statement Medical Statement is required for all staff members except for volunteers and substitute providers prior to their employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS Item Requirements: Medical Report; A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. A statement signed by a health care professional indicates that the person is emotionally and physically fit to care for children. Prior to employment. When submitted, the medical statement shall not be older than 12 months. All staff, including the director and individuals who volunteer more than once per week. 1033: TB screening TB screening is required for all staff members including volunteers who work more than once per week. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item requirement: Tuberculin (TB) Test or Screening Due date: The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. 1034: Health Questionnaire HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 1035: Emergency Information form An emergency information form is required for all staff members. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. What: 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. When: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. 1048: First Aid 1049: CPR First Aid and CPR certification shall be maintained and renewed before their expiration date. You have two (2) weeks to correct this item. Please register for the class immediately. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017. Training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ 1045: First six (6) weeks of orientation 1067: First Two (2) weeks of orientation Upon completion of each topic, the date of review of each topic shall be recorded, and the documents shall be available for review. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. (b) New staff orientation shall include an overview of the following topics, focusing on the operation of the center: Topics of training First 2 weeks: • Recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 • Center's operational policies • policy for transportation if any • center's identification of building and premises safety issues • the Emergency Preparedness and Response Plan • emergency medical care plan • Adequate supervision of children in accordance with 10A NCAC 09 .1801 • prevention of shaken baby syndrome and abusive head trauma and child maltreatment • Prevention and control of infectious diseases, including immunization 1233: Personnel and Operational Policies Acknowledgement of review of operational and personnel policies shall be maintained in each staff file. If an employee leaves the program and returns after ninety(90) days, the personnel and operational policies shall be reviewed again, and the written acknowledgement shall be obtained. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) All personnel files of employees hired after April 1, 1999, shall also include a signed and dated statement verifying that the employee received a copy of his or her job description and has reviewed the personnel and operational policies. 1757: Criminal background letters Criminal background letters shall be in each employee’s file prior to his/her employment. The division’s CBC site may be down currently. However, the CBC letter for employees shall be obtained prior to their employment. 10A NCAC 09 .2703 CRIMINAL HISTORY RECORD CHECK REQUIREMENTS FOR CHILD CARE PROVIDERS (e) Child care providers, as defined in G.S. 110-90.2(a), shall have a valid qualification letter prior to employment or living in a child care facility and the qualification letter shall be kept on file at the facility for review by representatives of the Division. 1826: Acknowledgement of EPR plan All substitute staff members and volunteers shall review the EPR plan and its location upon employment. Each substitute member who works at multiple sites shall know the location of the EPR plan at each site. Upon the review, documentation of the review shall be recorded and maintained in the staff file. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. 1834: Medical Action Plan A medical action plan is required for all emergency medical conditions, including life-threatening allergies, asthma, diabetes and seizures. The action plan shall have all required information, such as the signature of the person who filled out the form and a date. The action plan shall be renewed annually. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan shall be updated on an annual basis and when changes to the plan are made by the child's parent or health care professional. Sample medical action plans may be found on the Division's website at http://ncchildcare.ncdhhs.gov 1835: Required information on action plans Even though an action plan is in file, it is not in compliance if the form is missing the information listed below. Please make sure to ask the parent or the health care professional to fill out all sections of the form. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan shall be completed by the child's parent or a health care professional and may include the following: (1) a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; (2) contact information for the child's health care professional(s); (3) medications to be administered on a scheduled basis; and (4) medications to be administered on an emergency basis with symptoms, and instructions. 1920: BSAC BSAC shall be obtained within three (3) months of employment for staff members who work for the regular school year, and within four (4) weeks of employment for staff members who work for the summer program. The certification shall be maintained in the staff file and shall be available for review. 10A NCAC 09 .2502 SPECIAL PROVISIONS FOR SUMMER DAY CAMPS (f) Staff in summer day camp programs required to complete Basic School-Age Care (BSAC) training as defined in Rule .0102 of this Chapter shall do so within four weeks of becoming employed. 1958: Health Questionnaire for substitute staff members HQ is required for all staff members annually following the initial medical statement. If some staff members are not required to have medical statement, such as substitute providers and volunteers, they have to have HQ on or before the first day of employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Who: All staff, including the director What: Health Questionnaire: A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. When: Annually following the initial medical statement 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 8/6/24. 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: A follow-up visit: Due to the number of violations cited during today’s visit, a follow-up visit may be conducted within two (2) weeks. Reminder: The permission form for Albuterol Sulfate for the child in #1 will expire on 8/2/24. Please renew the form prior to its expiration date. Employment: We discussed requirements for new employees. We don’t consider staff members who take summer break while school is closed as new employees. Some records of the staff members who returns during summer months can be accepted. However, those staff member who leave the employment for more than ninety (90) days and the ones who are no longer employed per your program shall be considered a new staff member. New staff members shall meet all requirements, such as medical statement/TB screening within the past twelve (12) months, orientation, operational & personnel policy review, etc. 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 W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 5/7/2024 Number Present: 63 Completed Date: 5/7/2024 Age: From 5 To 12 Total Minutes: 150 Time In: 02:30 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Mr. Q was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, CPR / First Aid, special training, CBC qualification, Emergency Medical Care plan, administration of medication, storage of hazardous products, storage of medication, general safety, discipline, adequate / approved space, program records, license posted, and permit restrictions. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-eight percent (88%) as of 5/6/24. The last fire drill was practiced on 4/8/24. The last emergency drill, lockdown drill, was practiced on 3/6/24. The last fire inspection was approved on 9/19/23. The program’s most recent sanitation inspection was completed on 9/13/23, with six (6) demerits for a superior rating. The Emergency Medical Care Plan was posted and current. There is one (1) new staff. One (1) new staff file was reviewed today with Delaney Burke, Administrator, through TEAMS. Upon arrival I was greeted by Mr. Q and observed children as they arrived to the program. Attendance and arrival times were documented. The children broke into groups in the gym. In group 1, children washed hands in the bathroom and went outside to eat snack. Snack today consisted of bean dip, corn strips, applesauce, milk, and vegetable juice. In group 2, children were engaged in a large group gross motor activity, “hunter tag”, led by the group leader. In group 3, children were playing soccer and swinging on swings. Children from group 4 walked to the facility from a neighboring school by the Group Leader. Interactions were positive and encouraging. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were cited during the visit today: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. One (1) child in group 1 did not wash hands after playing in a puddle or before eating snack. 15A NCAC 18A .2803(c) Technical Assistance provided as follows: Item #608 In your letter of compliance, include a statement that indicates how you will ensure children’s hands are washing prior to eating in the outdoor environment. We discussed that hand antiseptic cannot be used for cleaning hands prior to eating. 15A NCAC 18A .2803 HANDWASHING (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages. (d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed when the child returns indoors. 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 5/21/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall P.O. Box 19531 Asheville, NC 28815 Please call me at 828-713-8192, or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: We discussed the transport from the neighboring school to the program. Plan to review procedures with the children regarding waiting for the Group Leader before entering the playground Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0607 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: YMCA W.W. ESTES AFTERSCHOOL Facility ID: 11000684 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 11/8/2023 Number Present: 50 Completed Date: 11/8/2023 Age: From 5 To 10 Total Minutes: 210 Time In: 02:00 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Qadhafi Turner, Program Coordinator, during the visit. An electronic signed copy of the visit summary was emailed to you. Q. Turner was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty (80%) percent as of 11/6/23. 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 11/6/23. Permit type – Five (5) star license issued 5/4/21. Special Services/Restrictions – 1st shift (daytime care), school age only, meets enhanced ratios, meets enhanced space, children are prohibited from being in the kitchen for any purpose, playground equipment does not meet child care safety requirements. The last annual compliance visit was conducted on 11/30/22. The last fire drill was practiced on 11/2/23. The last shelter-in-place drill was practiced on 9/5/23. The last fire inspection was approved on 9/30/22. The last sanitation inspection was conducted on 4/5/23 with zero (0) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The facility’s Emergency Preparedness and Response plan was updated on 8/19/21. Upon arrival I was greeted by Q. Turner. Children arrived to the gym and broke into groups. Children in group 1 sat in a circle reading books before transitioning to outdoor play. Once outside, children in group 1 rolled hula hoops on the ground, climbed on the jungle gym, and balanced on a stepping bridge. Children in group 2 ate snack at picnic tables outdoors. Children in group 3 transitioned to outdoors and participated in a child-led “Y chat” in which the topic of favorite games was discussed. The Group Leader offered fidget toys to children as they participated in the large group discussion. Children took turns sharing their favorite game and then decided to play the gross motor game “gauntlet”. Interactions were positive and supportive. Supervision was adequate. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program is approved to provide transportation. Bus monitoring for all YMCA sites was conducted on 4/27/23 by Kaoru Eddins, Child Care Consultant. Currently no children are being transported at this facility. The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 9/30/22. 10A NCAC 09 .0304(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff, hire date 9/2/21, did not have a current health questionnaire on file. .0701(a) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan on file at the facility was last update 8/19/21. .0607(e) Technical assistance was provided as follows: Item #106 Fire inspections must be submitted to the division within one week of the inspection visit. A fire inspection dated 9/19/23 was received during the visit today. This was corrected. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Item #1034 The one (1) staff member completed the Health Questionnaire. This was corrected today. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a)Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. Item #1824 Plan to maintain an updated Emergency Preparedness and Response Plan for the facility in the emergency files. Ensure the updated EPR plan is maintained in a location that can be easily accessed by staff, substitutes and volunteers. The updated plan was printed during the visit today. This was corrected. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. We discussed licensed space at this facility. Spaces 6 and 7 will be removed from the licensed space at YMCA WW Estes Afterschool. Spaces 6 and 7 are in a separate elementary school and are now part of another facility’s licensed space. In an email on 11/6/23, the provider stated that they would like include a trailer in the licensed space at this facility. Please provide a fire and sanitation inspection for this new space. Please also plan to provide a statement from the head of maintenance stating that the building continues to meet educational code. 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. Your facility has been placed in cohort 2. Your prep year will be 7/1/24-6/30/25. Your reassessment year will be 7/1/25-6/30/26. Please visit ncrlap.org to learn more about ways to prepare for the Environment Rating Scale assessments. We discussed the importance of ensuring all staff have their education evaluated by WORKS. Please let me know if you have any questions. 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 kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times