NC GS 110-90 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: 0426-370L Visit Date: 5/1/2026 Number Present: 27 Completed Date: 5/1/2026 Age: From 0 To 2 Total Minutes: 125 Time In: 10:00 AM Time Out: 12:05 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: There is a concern that emergency medical care documentation was not provided when a child was injured in care. There is a concern that equipment available to children is not developmentally appropriate. There is a concern that children are not provided with the opportunity to play outdoors daily. Regarding the allegation that emergency medical care documentation was not provided when a child was injured in care as required, I observed incident log book, incident reports, and interviewed staff members. The facility had two (2) incident reports filled out that had not been signed by the parent/guardian dated 4/24/26. One (1) report was documented by the teacher that witnessed the incident, the second report was documented by a staff member that reviewed the camera footage. I received a copy of both reports during the visit, eight (8) days after the incident. During the visit the parent/ guardian reviewed and signed both incident reports. Based on the above information the allegation is confirmed. Regarding the allegation that equipment available to children is not developmentally appropriate, I observed camera footage for 4/24/26. The camera footage showed a young child walking toward a foldable table along the wall in the gross motor room; the child then grabbed the table with both hands and pulled toward their body; the table and child fell over backwards. The child’s hand was cut by the hinge of the table leg. Based on the above information the allegation is confirmed. Regarding the allegation that children are not provided with the opportunity to play outdoors daily, I observed classroom schedules, children outdoors, daily schedules, camera footage, and interviewed staff. Based on the above information the allegation is unconfirmed. During the visit, I interviewed teaching staff, and A. Barnes, Director. Camera footage was reviewed for indoor and outdoor spaces on the following dates: 4/24/26, and 4/28/26. Children were observed during indoor and outdoor free play. Enrollment: Space #1 Nine (9) children one year of age enrolled: Two (2) children one year of age present. Thirteen (13) children two years of age enrolled: Seven (7) children two years of age present Staff: C. Neal, G. Baker Space #2 Six (6) children one year of age enrolled: Five (5) children one year of age present. Staff: A. Tacinelli, D. Patrick Space #3 Seven (7) children under one year of age enrolled: Seven (7) children under one year of age present. Staff: L. Colorado, S. Perkins Space #4 Eleven (11) children one year of age enrolled: Six (6) children one year of age present. Staff: M. Baggett Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. A non-sturdy folding table with collapsible legs was in the gross motor room where children one year of age were engaged in indoor gross motor play. .0601(c) 1911 An incident report was not completed and mailed to a Division representative within seven days after the incident when medical treatment was required. An incident report had not been submitted to the Division of Child Development within seven (7) days of the incident. .0802(f) 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. On or before 5/15/26. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Incident Report - When an injury occurs in the facility that results in first aid or medical attention for a child or adult, the facility should complete an incident report. An incident log must be completed any time an incident report is completed. It must include the child’s name, date of the incident, the date the incident report was submitted to the Division (if applicable), the name of the staff member who completed the incident report, be cumulative and maintained in a separate file and available for review by a representative of the Division. Injury patterns and child abuse and neglect can be discerned from such records and can be used to prevent future problems. On 4/24/26 a child cut their finger on the metal hinge of a table in the gross motor room. The child required four (4) stitches. An incident report had not been submitted to the Division of Child Development within seven (7) days of the incident. You stated that you had forgotten to send it. You provided me with a copy of both incident reports during the visit. You are to complete incident reports at the time of the incident. If medical care is provided the incident report is to be submitted to you Child Care Consultant within seven (7) days. Equipment and furnishings that are not sturdy, safe, or in good repair, may cause falls, entrap a child’s head or limbs, or contribute to other injuries. Disrepair may expose objects that are hazardous to children. If equipment and furnishings have deteriorated to a state of disrepair, where they are no longer sturdy or safe, they should be removed from all areas of a child care facility to which children have access. On 4/24/26 a child cut their finger on the metal hinge of a folding table in the gross motor room. You stated that staff had been informed to remover the table from the gross motor room and it had not been removed at the time. You stated it was removed that day after the incident. Staff should check on a regular basis to ensure that toys and equipment used by children have not been recalled. A list of recalls can be accessed at http://www.cpsc.gov. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Michelle O’Kelley, Child Care Consultant, 252-508-3955, Michelle.okelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0806 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: 1025-370L Visit Date: 11/5/2025 Number Present: 55 Completed Date: 11/5/2025 Age: From 0 To 5 Total Minutes: 98 Time In: 07:22 AM Time Out: 09:00 AM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: There is a concern that staff/ child ratios were not being followed. There is a concern that diapers are not being changed as required. Regarding the allegation that staff/ child ratios were not being followed, I monitored staff/ child ratios via camera footage, classroom observation, and interviewed staff. Upon reviewing cameras at arrival, there were 11 children present ages 0-1 with two (2) staff members. Within 10 minutes after arrival there were 18 children present with two (2) staff members. Based on the above information the allegation is confirmed. Regarding the allegation that diapers were not being changed as required, I observed diaper changing, diaper changing logs in ProCare app, notes on white board in classrooms, and interviewed staff. Based on the above information the allegation is confirmed. Space 1; Enhanced Ratio 1:5; 18 children ages 3 months to 1 year of age: 2 staff The following violation(s) were documented: Violation Number Comment Rule 401 Diapers were not changed whenever they were soiled or wet and/or were changed on a shift basis. Upon reviewing the times that children were changed in the Pro Care App for four children during the dates of 10/21/25- 11/4/25, there were instances where children had not been changed between two and a half hours to four hours. 10A NCAC 09 .0806(a) 1756 Enhanced staff/child ratios and group sizes were not met. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. 10A NCAC 09 .2818 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. On or before 11/19/25. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Staff/Child Ratios: Staff/child ratios must be maintained at all times for the age of the youngest child present. As the children arrived at the center minimum staff/child ratios and group sizes for the number and ages of children in care were not met. At 7:22am in Space #1, eleven children ranging from three (3) months to one (1) year of age were cared for by two staff members. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. You should frequently monitor the number of children during your morning arrivals, ensuring staff/child ratios remain correct. Changes in staff hours must be adjusted to meet this requirement. I recommend having an additional teacher present at all times to not only ensure ratios are correct but to be available should an emergency arise. Diapering: Diapers should be checked for wetness and feces at least hourly, visually inspected at least every two hours, and whenever the child indicates discomfort or exhibits behavior that suggests a soiled or wet diaper. Diapers should be changed when they are found to be wet or soiled. It can be helpful to document when diapers are changed, as a visual to see when diapers should be changed next. Upon reviewing the times that children were changed in the Pro care App for four children during the dates of 10/21/25- 11/4/25, I found that in four of the children’s records they were not changed between two and a half hours to four hours. You stated that there is a new teacher in the older infant classroom, and they are learning how to use the Pro Care App. She is keeping track of diaper changes on the white board in the classroom until she learns to use the app. We discussed having the teacher use paper copies to keep track of diaper checks/ changes until they are consistently able to use the Pro Care App. During the visit, staff were provided with paper diaper changing logs to track when children are checked and changed. We discussed that children do not need to be woken to change their diaper, but they need to be changed or checked immediately after they wake if two hours have passed. Make classroom observations to ensure teachers are completing diaper changes at least every two hours when they are awake and that the times are documented. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Michelle O’Kelley, Child Care Consultant, 252-508-3955, Michelle.okelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .2818 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: 1025-370L Visit Date: 11/5/2025 Number Present: 55 Completed Date: 11/5/2025 Age: From 0 To 5 Total Minutes: 98 Time In: 07:22 AM Time Out: 09:00 AM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: There is a concern that staff/ child ratios were not being followed. There is a concern that diapers are not being changed as required. Regarding the allegation that staff/ child ratios were not being followed, I monitored staff/ child ratios via camera footage, classroom observation, and interviewed staff. Upon reviewing cameras at arrival, there were 11 children present ages 0-1 with two (2) staff members. Within 10 minutes after arrival there were 18 children present with two (2) staff members. Based on the above information the allegation is confirmed. Regarding the allegation that diapers were not being changed as required, I observed diaper changing, diaper changing logs in ProCare app, notes on white board in classrooms, and interviewed staff. Based on the above information the allegation is confirmed. Space 1; Enhanced Ratio 1:5; 18 children ages 3 months to 1 year of age: 2 staff The following violation(s) were documented: Violation Number Comment Rule 401 Diapers were not changed whenever they were soiled or wet and/or were changed on a shift basis. Upon reviewing the times that children were changed in the Pro Care App for four children during the dates of 10/21/25- 11/4/25, there were instances where children had not been changed between two and a half hours to four hours. 10A NCAC 09 .0806(a) 1756 Enhanced staff/child ratios and group sizes were not met. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. 10A NCAC 09 .2818 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. On or before 11/19/25. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Staff/Child Ratios: Staff/child ratios must be maintained at all times for the age of the youngest child present. As the children arrived at the center minimum staff/child ratios and group sizes for the number and ages of children in care were not met. At 7:22am in Space #1, eleven children ranging from three (3) months to one (1) year of age were cared for by two staff members. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. You should frequently monitor the number of children during your morning arrivals, ensuring staff/child ratios remain correct. Changes in staff hours must be adjusted to meet this requirement. I recommend having an additional teacher present at all times to not only ensure ratios are correct but to be available should an emergency arise. Diapering: Diapers should be checked for wetness and feces at least hourly, visually inspected at least every two hours, and whenever the child indicates discomfort or exhibits behavior that suggests a soiled or wet diaper. Diapers should be changed when they are found to be wet or soiled. It can be helpful to document when diapers are changed, as a visual to see when diapers should be changed next. Upon reviewing the times that children were changed in the Pro care App for four children during the dates of 10/21/25- 11/4/25, I found that in four of the children’s records they were not changed between two and a half hours to four hours. You stated that there is a new teacher in the older infant classroom, and they are learning how to use the Pro Care App. She is keeping track of diaper changes on the white board in the classroom until she learns to use the app. We discussed having the teacher use paper copies to keep track of diaper checks/ changes until they are consistently able to use the Pro Care App. During the visit, staff were provided with paper diaper changing logs to track when children are checked and changed. We discussed that children do not need to be woken to change their diaper, but they need to be changed or checked immediately after they wake if two hours have passed. Make classroom observations to ensure teachers are completing diaper changes at least every two hours when they are awake and that the times are documented. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Michelle O’Kelley, Child Care Consultant, 252-508-3955, Michelle.okelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: 1025-370L Visit Date: 11/5/2025 Number Present: 55 Completed Date: 11/5/2025 Age: From 0 To 5 Total Minutes: 98 Time In: 07:22 AM Time Out: 09:00 AM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: There is a concern that staff/ child ratios were not being followed. There is a concern that diapers are not being changed as required. Regarding the allegation that staff/ child ratios were not being followed, I monitored staff/ child ratios via camera footage, classroom observation, and interviewed staff. Upon reviewing cameras at arrival, there were 11 children present ages 0-1 with two (2) staff members. Within 10 minutes after arrival there were 18 children present with two (2) staff members. Based on the above information the allegation is confirmed. Regarding the allegation that diapers were not being changed as required, I observed diaper changing, diaper changing logs in ProCare app, notes on white board in classrooms, and interviewed staff. Based on the above information the allegation is confirmed. Space 1; Enhanced Ratio 1:5; 18 children ages 3 months to 1 year of age: 2 staff The following violation(s) were documented: Violation Number Comment Rule 401 Diapers were not changed whenever they were soiled or wet and/or were changed on a shift basis. Upon reviewing the times that children were changed in the Pro Care App for four children during the dates of 10/21/25- 11/4/25, there were instances where children had not been changed between two and a half hours to four hours. 10A NCAC 09 .0806(a) 1756 Enhanced staff/child ratios and group sizes were not met. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. 10A NCAC 09 .2818 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. On or before 11/19/25. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Staff/Child Ratios: Staff/child ratios must be maintained at all times for the age of the youngest child present. As the children arrived at the center minimum staff/child ratios and group sizes for the number and ages of children in care were not met. At 7:22am in Space #1, eleven children ranging from three (3) months to one (1) year of age were cared for by two staff members. At 7:33am in space #1, eighteen children ranging in age from three (3) months to one (1) year of age were cared for by two staff members. You should frequently monitor the number of children during your morning arrivals, ensuring staff/child ratios remain correct. Changes in staff hours must be adjusted to meet this requirement. I recommend having an additional teacher present at all times to not only ensure ratios are correct but to be available should an emergency arise. Diapering: Diapers should be checked for wetness and feces at least hourly, visually inspected at least every two hours, and whenever the child indicates discomfort or exhibits behavior that suggests a soiled or wet diaper. Diapers should be changed when they are found to be wet or soiled. It can be helpful to document when diapers are changed, as a visual to see when diapers should be changed next. Upon reviewing the times that children were changed in the Pro care App for four children during the dates of 10/21/25- 11/4/25, I found that in four of the children’s records they were not changed between two and a half hours to four hours. You stated that there is a new teacher in the older infant classroom, and they are learning how to use the Pro Care App. She is keeping track of diaper changes on the white board in the classroom until she learns to use the app. We discussed having the teacher use paper copies to keep track of diaper checks/ changes until they are consistently able to use the Pro Care App. During the visit, staff were provided with paper diaper changing logs to track when children are checked and changed. We discussed that children do not need to be woken to change their diaper, but they need to be changed or checked immediately after they wake if two hours have passed. Make classroom observations to ensure teachers are completing diaper changes at least every two hours when they are awake and that the times are documented. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Michelle O’Kelley, Child Care Consultant, 252-508-3955, Michelle.okelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0606 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: Visit Date: 7/1/2025 Number Present: 0 Completed Date: 7/1/2025 Age: From 0 To 0 Total Minutes: 308 Time In: 09:02 AM Time Out: 02:10 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 your program for compliance with applicable child care requirements for an annual compliance visit. Jamie Ferrell, Assistant Director assisted me with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 3 points in the education component, 6 points in the program standards component (meeting enhanced space and ratios) and 1 quality point for staff benefits package and Infrastructure of parent involvement. Your program was also monitored for compliance with implementing an approved curriculum as required for all four and five star licensed facilities where four-year-old children are enrolled. The sanitation inspection was completed 4/28/25 with a “Superior” classification. The last fire inspection was conducted 7/25/24. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. The information is current. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. The center's compliance history was reviewed with the operator. The program’s compliance history was ninety percent as of 6/30/25. The NC Secretary of State website was reviewed on 6/30/25 and PBLA, INC was listed as current- active. You visited each indoor and outdoor space with me. Children were engaged in free play in activity areas, transitions, and personal care routines. Children from space #1, # 4, #8 and #11 were engaged in outdoor activities. The outdoors included stationary climbers, ride on toys, balls, swings, storage for other materials. Children under twelve months old received care according to individual needs including tummy time, diapering and bottle feeding. Proper hand washing techniques and diaper changing procedures were observed. Lunch consisted of chicken and cheese quesadilla, mexicali corn, tropical fruit, whole grain tortillas, and milk. Violation Number Comment Rule 871 Center staff did not comply with the safe sleep policy. Three out of seven infants sleep charts documented visual checks not completed every fifteen (15) minutes. 10A NCAC 09 .0606(a) 1867 The depth of the loose surfacing was not based on critical height of the equipment. There were less than six inches of surfacing materials around the swing area on the playground space #2. .0605(k)(1-4) 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. On or before 7/15/25. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Surfacing - The number one cause of injury on playgrounds falls to the surface. Maintaining the correct depth of protective surfacing material is crucial for safety. During today’s inspection, there were less than six inches of surfacing materials around the swing area on the playground space #2. You stated that you would put in a work order to correct the depth. Properly laid out outdoor play spaces, age-appropriate, properly designed and maintained equipment, and installation of energy-absorbing surfaces help to reduce both the potential and the severity of injury. Sleep checks - Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Three out of seven infants sleep charts documented visual checks not completed every fifteen (15) minutes. Staff stated they use the clock to keep track of when they check on sleeping infants. We discussed putting timers above each crib to assist with checking every fifteen minutes. Additional Comments: NCID - Did you know that if you do not login on any DCDEE platforms (e.g., Moodle, WORKS, CBC) for a period of 12 months, your account will be archived? An archived account cannot be reinstated. You will need to create a new one and then email all platforms (e.g., Moodle, WORKS, CBC) to merge accounts. Pro Tip: Set your calendar to remind you every 6 months to login and out at https://myncid.nc.gov to keep your account activated and it will NOT be archived. Hold harmless has been extended until the new QRIS is implemented (SB 425). This means that you do not need to schedule a rated license assessment unless you voluntarily request one. The new QRIS has been approved by the Child Care Commission. The Division is working on implementation and training for the new system. You can find out more about the new QRIS on DCDEE’s website under what’s new. https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization North Carolina Rated License Assessment Project - NCRLAP’s mission is to promote the quality of child care by consistently and reliably assessing environments for the North Carolina Star Rated License. They collaborate with professionals in the early childhood education field to foster the development and learning of young children. Their website, ncrlap.org, offers resources, trainings, videos, worksheets, and help to get ready for the new ITERS-3, ECERS-3, and FCCRS-3 assessment tools that will be used in the new QRIS system. NCRLAP.org The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me Michelle O’Kelley, Child Care Consultant, (252) 508-3955, Michelle.OKelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, (252) 373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

NC GS 110-90 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: Visit Date: 7/1/2025 Number Present: 0 Completed Date: 7/1/2025 Age: From 0 To 0 Total Minutes: 308 Time In: 09:02 AM Time Out: 02:10 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 your program for compliance with applicable child care requirements for an annual compliance visit. Jamie Ferrell, Assistant Director assisted me with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 3 points in the education component, 6 points in the program standards component (meeting enhanced space and ratios) and 1 quality point for staff benefits package and Infrastructure of parent involvement. Your program was also monitored for compliance with implementing an approved curriculum as required for all four and five star licensed facilities where four-year-old children are enrolled. The sanitation inspection was completed 4/28/25 with a “Superior” classification. The last fire inspection was conducted 7/25/24. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. The information is current. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. The center's compliance history was reviewed with the operator. The program’s compliance history was ninety percent as of 6/30/25. The NC Secretary of State website was reviewed on 6/30/25 and PBLA, INC was listed as current- active. You visited each indoor and outdoor space with me. Children were engaged in free play in activity areas, transitions, and personal care routines. Children from space #1, # 4, #8 and #11 were engaged in outdoor activities. The outdoors included stationary climbers, ride on toys, balls, swings, storage for other materials. Children under twelve months old received care according to individual needs including tummy time, diapering and bottle feeding. Proper hand washing techniques and diaper changing procedures were observed. Lunch consisted of chicken and cheese quesadilla, mexicali corn, tropical fruit, whole grain tortillas, and milk. Violation Number Comment Rule 871 Center staff did not comply with the safe sleep policy. Three out of seven infants sleep charts documented visual checks not completed every fifteen (15) minutes. 10A NCAC 09 .0606(a) 1867 The depth of the loose surfacing was not based on critical height of the equipment. There were less than six inches of surfacing materials around the swing area on the playground space #2. .0605(k)(1-4) 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. On or before 7/15/25. 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. Email the information to: Michelle O’Kelley, Child Care Consultant Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Surfacing - The number one cause of injury on playgrounds falls to the surface. Maintaining the correct depth of protective surfacing material is crucial for safety. During today’s inspection, there were less than six inches of surfacing materials around the swing area on the playground space #2. You stated that you would put in a work order to correct the depth. Properly laid out outdoor play spaces, age-appropriate, properly designed and maintained equipment, and installation of energy-absorbing surfaces help to reduce both the potential and the severity of injury. Sleep checks - Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Three out of seven infants sleep charts documented visual checks not completed every fifteen (15) minutes. Staff stated they use the clock to keep track of when they check on sleeping infants. We discussed putting timers above each crib to assist with checking every fifteen minutes. Additional Comments: NCID - Did you know that if you do not login on any DCDEE platforms (e.g., Moodle, WORKS, CBC) for a period of 12 months, your account will be archived? An archived account cannot be reinstated. You will need to create a new one and then email all platforms (e.g., Moodle, WORKS, CBC) to merge accounts. Pro Tip: Set your calendar to remind you every 6 months to login and out at https://myncid.nc.gov to keep your account activated and it will NOT be archived. Hold harmless has been extended until the new QRIS is implemented (SB 425). This means that you do not need to schedule a rated license assessment unless you voluntarily request one. The new QRIS has been approved by the Child Care Commission. The Division is working on implementation and training for the new system. You can find out more about the new QRIS on DCDEE’s website under what’s new. https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization North Carolina Rated License Assessment Project - NCRLAP’s mission is to promote the quality of child care by consistently and reliably assessing environments for the North Carolina Star Rated License. They collaborate with professionals in the early childhood education field to foster the development and learning of young children. Their website, ncrlap.org, offers resources, trainings, videos, worksheets, and help to get ready for the new ITERS-3, ECERS-3, and FCCRS-3 assessment tools that will be used in the new QRIS system. NCRLAP.org The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me Michelle O’Kelley, Child Care Consultant, (252) 508-3955, Michelle.OKelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, (252) 373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: Visit Date: 2/18/2025 Number Present: 73 Completed Date: 2/18/2025 Age: From 0 To 5 Total Minutes: 207 Time In: 08:58 AM Time Out: 12:25 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced Observations Section – The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. J. Ferrell, Assistant Director, assisted with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 6 points in the education component, 6 points in the program standards component and 1 quality point for meeting a programmatic option: staff benefits package and infrastructure of parent involvement. The last annual compliance visit was conducted 8/7/24. The sanitation inspection was completed 12/4/24 with a “Superior” classification. The last fire inspection was conducted 7/25/24. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. The information is current. The center's compliance history was reviewed with the operator. The program’s compliance history was ninety-one percent as of 2/17/25. The NC Secretary of State website was reviewed on 2/17/25 and PBLA, Inc. was listed as current- active. You visited each indoor and outdoor space with me. Children throughout the center were engaged in free play indoors and outdoors, routines, and group time. Children under twelve months old received care according to individual needs including tummy time, diapering and bottle feeding. Proper hand washing was observed. The outdoor spaces were observed to include swings, riding toys, and stationary climber for the children to engage in gross motor activities. Lunch was observed and consisted of cheese pizza, corn, orange slices, whole grain muffins, and milk. The following violations were documented: Violation Number Comment Rule 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness expired on 9/4/24 in space 6. .0803(12) 1867 The depth of the loose surfacing was not based on critical height of the equipment. The depth of the mulch under the swings is less than one inch. .0605(k)(1-4) 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. On or before 3/4/25, 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. Mail or email the information to: Michelle O’Kelley, Child Care Consultant PO Box 56 Jamesville, NC 27846 Michelle.OKelley@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Surfacing - Parents/guardians expect that their child will not be exposed to hazardous play environments, yet will have the opportunity for free, creative play. The depth of the mulch under the swings is less than one inch. You stated that the children kick the mulch out while they swing with their feet. You stated that maintenance will blow the mulch around to the correct depth. We discussed using approved rubber mats on top of six-inch-deep mulch. Properly laid out outdoor play spaces, age-appropriate, properly designed and maintained equipment, and installation of energy-absorbing surfaces help to reduce both the potential and the severity of injury. Medication Authorization - Administering medication requires skill, knowledge, and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/ teacher written authorization to administer medication to the child. A 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness expired on 9/4/24 in space 6. You stated that you had looked at the wrong date on the authorization form. Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, such as expiration dates, which may be harmful to the child. Create a tool or designate a staff person to aid the facility with tracking required medication forms and permissions. Additional Comments: We discussed Clean Classrooms for Carolina Kids and you have completed Lead in Water, Lead-Based Paint and Asbestos testing. North Carolina Rated License Assessment Project - NCRLAP’s mission is to promote the quality of child care by consistently and reliably assessing environments for the North Carolina Star Rated License. They collaborate with professionals in the early childhood education field to foster the development and learning of young children. Their website, ncrlap.org, offers resources, trainings, videos, worksheets, and help to get ready for the new ITERS-3, ECERS-3, and FCCRS-3 assessment tools that will be used in the new QRIS system. Raise NC- Stay current with communication and email blasts from DCDEE. Be sure to check your email at least weekly. If you are not currently receiving the email, please visit the DCDEE home page. Add your contact information and click subscribe to be added to the mailing list. The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Michelle O’Kelley, Child Care Consultant, (252) 508-3955, Michelle.OKelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, (252) 373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0304 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 8/7/2024 Number Present: 87 Completed Date: 8/7/2024 Age: From 0 To 11 Total Minutes: 270 Time In: 08:15 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Michelle O’Kelley, Childcare Consultant, accompanied me during today’s visit. J. Ferrell, Assistant Director, assisted me with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 6 points in the education component, 6 points in the program standards component (meeting enhanced space and ratios) and 1 quality point for the programmatic option of the center having a staff benefits plan and infrastructure of parent involvement. The sanitation inspection was completed 6/24/24 with a “Superior” classification. The last fire inspection was conducted 7/25/24 and your facility was approved for daytime care only. Child Care programs are expected to achieve and maintain compliance at all times. Programs are also 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 program’s compliance history was ninety one percent as of 8/6/24. The NC Secretary of State website was reviewed on 8/6/24 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website and all information is current. Contact me if you need to make any changes to your contact information, e.g., phone numbers, mailing address. All indoor and outdoor learning environments were monitored today. Nine groups were observed today. Upon arrival groups were completing handwashing routines in preparation for breakfast. Oatmeal, strawberries and milk was served. After breakfast as the children transitioned, teachers assisted them with personal care routines and handwashing. During indoor free play, teachers moved about the spaces, engaging in conversation with children, joining the play, and redirecting. Proper hand washing procedures were observed. The children engaged in gross motor play in Space 12. Lunch was observed and consisted of chicken, rice, carrots, apples and milk. The following violations were documented. 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 fire inspection was completed on 7/25/24. The copy was provided to the Division on 8/7/24. 10A NCAC 09 .0304(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the unlocked bottom cabinet underneath the sink. .0604(q) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. An inhaler for a child was present without the original labeled container (prescription) in Space 1. 10A NCAC 09 .0803(2)(b)(i-v) 1887 Each infant was not served only bottles labeled with their individual name. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. .0902(d) * The violation(s) documented must be corrected immediately. On or before 8/21/2024, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Fire Inspections –You must schedule and obtain a fire inspection with the local fire inspector within 12 months of the previous fire inspection. You obtained the fire inspection within the 12-month timeframe on 7/25/24; however, when you obtain the fire inspection you must submit the original of the approved annual fire inspection report to me within one week of the inspection visit on the form provided by the Division. You indicated you were unaware it had to be submitted within one week of receipt. You provided a copy of the inspection during today’s visit. Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the bottom cabinet underneath the sink. A child safety latch was used on the cabinet. You indicated you would add a magnetic lock to those cabinets so items can be stored safely. If the teachers are going to use safety latches, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Medication- Medicines can be critical to the health and wellness of some children. They can also be very dangerous if the wrong type or wrong amount is given to the wrong person or at the wrong time. An inhaler for a child was present without the original labeled container (prescription) in Space 1. You indicated the original container was present the day before and were unaware that the parent had removed the original labeled container from the classroom. Any prescription or over-the-counter medication brought to the family child care home must be specific to the child who is to receive the medication, in its original container and be labeled with the appropriate information. Bottles - Bottles and sippy cups sent in from home must be prepared, labeled, and dated. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. The teacher indicated the parent’s brought them in that morning and the information rubbed off. Even though it is the parent’s responsibility to label their child’s bottles and sippy cups, we discussed that staff must check behind the parents to ensure that this is done daily. Keep masking tape or labels and a permanent marker accessible so they can be quickly labeled if a parent forgets to do it or the information rubs off. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 8/7/2024 Number Present: 87 Completed Date: 8/7/2024 Age: From 0 To 11 Total Minutes: 270 Time In: 08:15 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Michelle O’Kelley, Childcare Consultant, accompanied me during today’s visit. J. Ferrell, Assistant Director, assisted me with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 6 points in the education component, 6 points in the program standards component (meeting enhanced space and ratios) and 1 quality point for the programmatic option of the center having a staff benefits plan and infrastructure of parent involvement. The sanitation inspection was completed 6/24/24 with a “Superior” classification. The last fire inspection was conducted 7/25/24 and your facility was approved for daytime care only. Child Care programs are expected to achieve and maintain compliance at all times. Programs are also 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 program’s compliance history was ninety one percent as of 8/6/24. The NC Secretary of State website was reviewed on 8/6/24 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website and all information is current. Contact me if you need to make any changes to your contact information, e.g., phone numbers, mailing address. All indoor and outdoor learning environments were monitored today. Nine groups were observed today. Upon arrival groups were completing handwashing routines in preparation for breakfast. Oatmeal, strawberries and milk was served. After breakfast as the children transitioned, teachers assisted them with personal care routines and handwashing. During indoor free play, teachers moved about the spaces, engaging in conversation with children, joining the play, and redirecting. Proper hand washing procedures were observed. The children engaged in gross motor play in Space 12. Lunch was observed and consisted of chicken, rice, carrots, apples and milk. The following violations were documented. 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 fire inspection was completed on 7/25/24. The copy was provided to the Division on 8/7/24. 10A NCAC 09 .0304(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the unlocked bottom cabinet underneath the sink. .0604(q) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. An inhaler for a child was present without the original labeled container (prescription) in Space 1. 10A NCAC 09 .0803(2)(b)(i-v) 1887 Each infant was not served only bottles labeled with their individual name. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. .0902(d) * The violation(s) documented must be corrected immediately. On or before 8/21/2024, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Fire Inspections –You must schedule and obtain a fire inspection with the local fire inspector within 12 months of the previous fire inspection. You obtained the fire inspection within the 12-month timeframe on 7/25/24; however, when you obtain the fire inspection you must submit the original of the approved annual fire inspection report to me within one week of the inspection visit on the form provided by the Division. You indicated you were unaware it had to be submitted within one week of receipt. You provided a copy of the inspection during today’s visit. Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the bottom cabinet underneath the sink. A child safety latch was used on the cabinet. You indicated you would add a magnetic lock to those cabinets so items can be stored safely. If the teachers are going to use safety latches, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Medication- Medicines can be critical to the health and wellness of some children. They can also be very dangerous if the wrong type or wrong amount is given to the wrong person or at the wrong time. An inhaler for a child was present without the original labeled container (prescription) in Space 1. You indicated the original container was present the day before and were unaware that the parent had removed the original labeled container from the classroom. Any prescription or over-the-counter medication brought to the family child care home must be specific to the child who is to receive the medication, in its original container and be labeled with the appropriate information. Bottles - Bottles and sippy cups sent in from home must be prepared, labeled, and dated. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. The teacher indicated the parent’s brought them in that morning and the information rubbed off. Even though it is the parent’s responsibility to label their child’s bottles and sippy cups, we discussed that staff must check behind the parents to ensure that this is done daily. Keep masking tape or labels and a permanent marker accessible so they can be quickly labeled if a parent forgets to do it or the information rubs off. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 8/7/2024 Number Present: 87 Completed Date: 8/7/2024 Age: From 0 To 11 Total Minutes: 270 Time In: 08:15 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Michelle O’Kelley, Childcare Consultant, accompanied me during today’s visit. J. Ferrell, Assistant Director, assisted me with the visit. Your program currently operates with a five-star license, issued 2/22/24, earning 6 points in the education component, 6 points in the program standards component (meeting enhanced space and ratios) and 1 quality point for the programmatic option of the center having a staff benefits plan and infrastructure of parent involvement. The sanitation inspection was completed 6/24/24 with a “Superior” classification. The last fire inspection was conducted 7/25/24 and your facility was approved for daytime care only. Child Care programs are expected to achieve and maintain compliance at all times. Programs are also 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 program’s compliance history was ninety one percent as of 8/6/24. The NC Secretary of State website was reviewed on 8/6/24 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website and all information is current. Contact me if you need to make any changes to your contact information, e.g., phone numbers, mailing address. All indoor and outdoor learning environments were monitored today. Nine groups were observed today. Upon arrival groups were completing handwashing routines in preparation for breakfast. Oatmeal, strawberries and milk was served. After breakfast as the children transitioned, teachers assisted them with personal care routines and handwashing. During indoor free play, teachers moved about the spaces, engaging in conversation with children, joining the play, and redirecting. Proper hand washing procedures were observed. The children engaged in gross motor play in Space 12. Lunch was observed and consisted of chicken, rice, carrots, apples and milk. The following violations were documented. 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 fire inspection was completed on 7/25/24. The copy was provided to the Division on 8/7/24. 10A NCAC 09 .0304(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the unlocked bottom cabinet underneath the sink. .0604(q) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. An inhaler for a child was present without the original labeled container (prescription) in Space 1. 10A NCAC 09 .0803(2)(b)(i-v) 1887 Each infant was not served only bottles labeled with their individual name. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. .0902(d) * The violation(s) documented must be corrected immediately. On or before 8/21/2024, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Fire Inspections –You must schedule and obtain a fire inspection with the local fire inspector within 12 months of the previous fire inspection. You obtained the fire inspection within the 12-month timeframe on 7/25/24; however, when you obtain the fire inspection you must submit the original of the approved annual fire inspection report to me within one week of the inspection visit on the form provided by the Division. You indicated you were unaware it had to be submitted within one week of receipt. You provided a copy of the inspection during today’s visit. Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Spaces 1 and 2 (designated for children one year-of-age) plastic trash bags were stored in the bottom cabinet underneath the sink. A child safety latch was used on the cabinet. You indicated you would add a magnetic lock to those cabinets so items can be stored safely. If the teachers are going to use safety latches, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Medication- Medicines can be critical to the health and wellness of some children. They can also be very dangerous if the wrong type or wrong amount is given to the wrong person or at the wrong time. An inhaler for a child was present without the original labeled container (prescription) in Space 1. You indicated the original container was present the day before and were unaware that the parent had removed the original labeled container from the classroom. Any prescription or over-the-counter medication brought to the family child care home must be specific to the child who is to receive the medication, in its original container and be labeled with the appropriate information. Bottles - Bottles and sippy cups sent in from home must be prepared, labeled, and dated. In the classroom for the infants, there were four bottles that had not been labeled with each child’s name and the date. The teacher indicated the parent’s brought them in that morning and the information rubbed off. Even though it is the parent’s responsibility to label their child’s bottles and sippy cups, we discussed that staff must check behind the parents to ensure that this is done daily. Keep masking tape or labels and a permanent marker accessible so they can be quickly labeled if a parent forgets to do it or the information rubs off. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 2/2/2024 Number Present: 71 Completed Date: 2/2/2024 Age: From 0 To 5 Total Minutes: 425 Time In: 08:40 AM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the third temporary time period visit (TTP). W. Godley, Director of Facilities and A. Barnes, Administrator assisted me with the visit. This facility was issued a temporary license on August 21, 2023 to February 21, 2024. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The NC Secretary of State website was reviewed and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included cinnamon muffins, mixed fruit, and milk. Following breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included macaroni and cheese, roasted broccoli, pickled beets, and milk. The following violations were documented. Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner were not kept in locked storage in Space 1, Space 5, and Space 8. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. In Space 7, a bottle of over the counter Children's Liquid Melatonin was stored inside a bin on a high shelf. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on available in Space 7. 10A NCAC 09 .0803(4)(6-9) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. During the review of children’s files, a file for a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment available. GS110-91(1) * 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. On or before 2/16/24, 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. Mail or email the information to: Lakisha Skinner, Lead Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance with Documented Violations: Hazardous Materials - Over 2 million human poison exposures are reported to poison centers each year. Children under 6 years of age account for over half of the reports. Materials that are potentially harmful to children, such as cleaners and disinfectants, must always be kept in a locked storage. I observed the key left in the door lock of the designated storage space for items requiring locked storage in Space 1, Space 5, and Space 8. You indicated; this is a reminder that is expressed often. Hazardous items I observed when I opened the unlocked storage spaces included aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner. Storage of Medication - Each year, approximately 60,000 young children are treated in our nation’s emergency rooms due to accidental unsupervised medication ingestion. Safe Kids Worldwide compares this to approximately four busloads of children per day visiting the emergency room because they took medication on their own. The improper storage of medication was documented during your November 28, 2023 2nd Temporary Time Period visit. The correction verification letter you submitted documented implementation of the following procedures: “Medications will always be stored in a locked container and routine classroom compliance visits will be conducted weekly in each classroom to ensure that all medications are stored appropriately”. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. A. Barnes stated she was going to ask about how to store the medication that type of medication which requires refrigeration. I indicated medication requiring refrigeration can be stored in a locked medication box inside the refrigerator. You moved the medication to the refrigerator in the kitchen that has a keypad lock. In Space 7, a bottle of over the counter Melatonin was stored inside a bin on a high shelf. You indicated the medication was for a child enrolled in another classroom who was cared for the previous day in the room to maintain staff/child ratios. You took the medication to its designated classroom and placed it in locked storage. It is important to remember that wherever the child is served, the medication must be kept in locked storage. Medication must be stored in a locked cabinet or other locked container. Because this is a repeated violation, you must implement a procedure that is effective and will ensure compliance is met and maintained. Medication Authorization - Administering medication requires skill, knowledge, and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/ teacher written authorization to administer medication to the child. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on file in Space 7. Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, such as expiration dates, which may be harmful to the child. Create a tool or designate a staff person to aid the facility with tracking required medication forms and permissions. Medical Records/ Health Assessments – The required medical report ensures that children are healthy enough to be in care. During the review of children’s files, I observed a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment on file. You indicated because the 4-year-old child needed a physical to attend NC Pre-K, it was assumed to be had and not required in the file at the childcare. Utilize the Children’s File Checklist to ensure you have all required documents. If a physical is not obtained by the child’s 30th attendance day, the child should not be allowed to return until the physical is submitted. Rated License Process – Once ERS scores are received and all staff are evaluated in WORKS, the rated license assessment will be finalized. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

GS110-91 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 2/2/2024 Number Present: 71 Completed Date: 2/2/2024 Age: From 0 To 5 Total Minutes: 425 Time In: 08:40 AM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the third temporary time period visit (TTP). W. Godley, Director of Facilities and A. Barnes, Administrator assisted me with the visit. This facility was issued a temporary license on August 21, 2023 to February 21, 2024. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The NC Secretary of State website was reviewed and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included cinnamon muffins, mixed fruit, and milk. Following breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included macaroni and cheese, roasted broccoli, pickled beets, and milk. The following violations were documented. Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner were not kept in locked storage in Space 1, Space 5, and Space 8. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. In Space 7, a bottle of over the counter Children's Liquid Melatonin was stored inside a bin on a high shelf. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on available in Space 7. 10A NCAC 09 .0803(4)(6-9) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. During the review of children’s files, a file for a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment available. GS110-91(1) * 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. On or before 2/16/24, 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. Mail or email the information to: Lakisha Skinner, Lead Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance with Documented Violations: Hazardous Materials - Over 2 million human poison exposures are reported to poison centers each year. Children under 6 years of age account for over half of the reports. Materials that are potentially harmful to children, such as cleaners and disinfectants, must always be kept in a locked storage. I observed the key left in the door lock of the designated storage space for items requiring locked storage in Space 1, Space 5, and Space 8. You indicated; this is a reminder that is expressed often. Hazardous items I observed when I opened the unlocked storage spaces included aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner. Storage of Medication - Each year, approximately 60,000 young children are treated in our nation’s emergency rooms due to accidental unsupervised medication ingestion. Safe Kids Worldwide compares this to approximately four busloads of children per day visiting the emergency room because they took medication on their own. The improper storage of medication was documented during your November 28, 2023 2nd Temporary Time Period visit. The correction verification letter you submitted documented implementation of the following procedures: “Medications will always be stored in a locked container and routine classroom compliance visits will be conducted weekly in each classroom to ensure that all medications are stored appropriately”. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. A. Barnes stated she was going to ask about how to store the medication that type of medication which requires refrigeration. I indicated medication requiring refrigeration can be stored in a locked medication box inside the refrigerator. You moved the medication to the refrigerator in the kitchen that has a keypad lock. In Space 7, a bottle of over the counter Melatonin was stored inside a bin on a high shelf. You indicated the medication was for a child enrolled in another classroom who was cared for the previous day in the room to maintain staff/child ratios. You took the medication to its designated classroom and placed it in locked storage. It is important to remember that wherever the child is served, the medication must be kept in locked storage. Medication must be stored in a locked cabinet or other locked container. Because this is a repeated violation, you must implement a procedure that is effective and will ensure compliance is met and maintained. Medication Authorization - Administering medication requires skill, knowledge, and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/ teacher written authorization to administer medication to the child. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on file in Space 7. Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, such as expiration dates, which may be harmful to the child. Create a tool or designate a staff person to aid the facility with tracking required medication forms and permissions. Medical Records/ Health Assessments – The required medical report ensures that children are healthy enough to be in care. During the review of children’s files, I observed a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment on file. You indicated because the 4-year-old child needed a physical to attend NC Pre-K, it was assumed to be had and not required in the file at the childcare. Utilize the Children’s File Checklist to ensure you have all required documents. If a physical is not obtained by the child’s 30th attendance day, the child should not be allowed to return until the physical is submitted. Rated License Process – Once ERS scores are received and all staff are evaluated in WORKS, the rated license assessment will be finalized. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 2/2/2024 Number Present: 71 Completed Date: 2/2/2024 Age: From 0 To 5 Total Minutes: 425 Time In: 08:40 AM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the third temporary time period visit (TTP). W. Godley, Director of Facilities and A. Barnes, Administrator assisted me with the visit. This facility was issued a temporary license on August 21, 2023 to February 21, 2024. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The NC Secretary of State website was reviewed and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included cinnamon muffins, mixed fruit, and milk. Following breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included macaroni and cheese, roasted broccoli, pickled beets, and milk. The following violations were documented. Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner were not kept in locked storage in Space 1, Space 5, and Space 8. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. In Space 7, a bottle of over the counter Children's Liquid Melatonin was stored inside a bin on a high shelf. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on available in Space 7. 10A NCAC 09 .0803(4)(6-9) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. During the review of children’s files, a file for a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment available. GS110-91(1) * 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. On or before 2/16/24, 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. Mail or email the information to: Lakisha Skinner, Lead Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance with Documented Violations: Hazardous Materials - Over 2 million human poison exposures are reported to poison centers each year. Children under 6 years of age account for over half of the reports. Materials that are potentially harmful to children, such as cleaners and disinfectants, must always be kept in a locked storage. I observed the key left in the door lock of the designated storage space for items requiring locked storage in Space 1, Space 5, and Space 8. You indicated; this is a reminder that is expressed often. Hazardous items I observed when I opened the unlocked storage spaces included aerosol cans of Spray Glass Cleaner and the Works Toilet Bowl Cleaner. Storage of Medication - Each year, approximately 60,000 young children are treated in our nation’s emergency rooms due to accidental unsupervised medication ingestion. Safe Kids Worldwide compares this to approximately four busloads of children per day visiting the emergency room because they took medication on their own. The improper storage of medication was documented during your November 28, 2023 2nd Temporary Time Period visit. The correction verification letter you submitted documented implementation of the following procedures: “Medications will always be stored in a locked container and routine classroom compliance visits will be conducted weekly in each classroom to ensure that all medications are stored appropriately”. In Space 3, designated for the care of children ages birth-1 year old, a bottle of amoxicillin was stored in a Ziplock bag in the classroom refrigerator. A. Barnes stated she was going to ask about how to store the medication that type of medication which requires refrigeration. I indicated medication requiring refrigeration can be stored in a locked medication box inside the refrigerator. You moved the medication to the refrigerator in the kitchen that has a keypad lock. In Space 7, a bottle of over the counter Melatonin was stored inside a bin on a high shelf. You indicated the medication was for a child enrolled in another classroom who was cared for the previous day in the room to maintain staff/child ratios. You took the medication to its designated classroom and placed it in locked storage. It is important to remember that wherever the child is served, the medication must be kept in locked storage. Medication must be stored in a locked cabinet or other locked container. Because this is a repeated violation, you must implement a procedure that is effective and will ensure compliance is met and maintained. Medication Authorization - Administering medication requires skill, knowledge, and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/ teacher written authorization to administer medication to the child. 6-month authorization to administer the prescribed medication for a child diagnosed with a chronic illness was not on file in Space 7. Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, such as expiration dates, which may be harmful to the child. Create a tool or designate a staff person to aid the facility with tracking required medication forms and permissions. Medical Records/ Health Assessments – The required medical report ensures that children are healthy enough to be in care. During the review of children’s files, I observed a 4-year-old child enrolled on 8/25/23, did not have a medical report/ health assessment on file. You indicated because the 4-year-old child needed a physical to attend NC Pre-K, it was assumed to be had and not required in the file at the childcare. Utilize the Children’s File Checklist to ensure you have all required documents. If a physical is not obtained by the child’s 30th attendance day, the child should not be allowed to return until the physical is submitted. Rated License Process – Once ERS scores are received and all staff are evaluated in WORKS, the rated license assessment will be finalized. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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 .1003 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 11/28/2023 Number Present: 69 Completed Date: 11/28/2023 Age: From 0 To 5 Total Minutes: 300 Time In: 08:45 AM Time Out: 01:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the second temporary time period visit (TTP). Jamie Ferrell, Legal Designee, assisted me with the visit. This facility was issued a temporary license on August 21, 2023 with a restriction to provide daytime care only, outdoor play is restricted to the fenced area only and you are approved to care for a child 13 years of age. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The center's compliance history was reviewed. Your temporary license expires February 21, 2024. Prior to the expiration date of your license, one additional unannounced monitoring visit will be completed. 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 program’s compliance history was one hundred percent as of 11/27/23. The NC Secretary of State website was reviewed on 11/27/23 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Amber Barnes was identified as the new administrator during the visit. You provided the Preservice Requirements for Administrator of a Child Care Center today. I updated the information during the visit. You also provided an updated Legal Designee form identifying Jamie Ferrell to act on behalf of the facility in the absence of the administrator. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included waffles, bananas, and milk. Following the breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included chicken salad, Ritz crackers, cucumbers, mixed fruit, and milk. The following violations were documented. Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in in Space 1 was dated October 23-27, 2023. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The written feeding plans for children enrolled in Space 3 did not include parent signatures and were not dated when they were received by the center. .0902(a) 606 Running water, soap and individual sanitary towels, or other approved hand-drying devices were not supplied at each lavatory. Soap, paper towels and toilet tissue was unavailable in the bathroom located in the outdoor space for toddlers. 15A NCAC 18A .2818(b) & (d) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. 15A NCAC 18A .2820(d) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. A plastic Ziplock bag used to store plastic spoons was stored in an unlocked lower cabinet and an open box of Loo Nappy Bags was stored in the lower cabinet of the unlocked changing table in Space 1. Plastic bags with warning labels to keep out of reach of children containing extra shoes was also observed in the hallway leading to spaces designated for the care of infants and toddlers. .0604(q) 1128 For routine transport of children to and from the center, staff did not use the list to document attendance as children boarded and departed the vehicle. The transportation log did not include documentation of the time each child is picked up in the afternoons. 10A NCAC 09 .1003(l) * 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. On or before 12/12/2023, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Space 2 (designated for children one-two years-of-age) a plastic zip lock bag used to store spoons was stored in an unlocked lower cabinet under the sink. Shoes stored in plastic bags with keep out of reach warnings were also observed in the hallway leading to toddler classrooms. If plastic bags are going to be used, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Activity Plans – Current activity plans must be posted in the classroom and must address four of the five domains as listed in the NC Foundations for Early Learning. This allows parents to see what the children are learning and extend the topic at home. The posted activity plan in Space 1 was dated October 23-27, 2023. You indicated each space has 30 minutes of planning each day and you are unsure of why the current plan was not posted. Plans can be completed weekly or monthly but must be current and rotate activities to include all five domains. Storage of Hazardous Products & Medication - Intentional planning of the environment ensures a safe environment has been created which prevents and reduces injuries to young children. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. Prevention is the key to prevent poisonings by making sure all medications are kept in locked storage. Locked storage rooms and cabinets include those which are unlocked with a combination, electronic or magnetic device, key, keypad, or equivalent locking device. These unlocking devices must be kept out of the reach of a child and must not be stored in the lock. Transportation Logs - A good record keeping system will help save you time. Accurate pick up and drop off times must be maintained when providing transportation. You indicated you currently document the time you arrive back at the facility once the children are picked up but not the time you pick them up from various schools in the area. You stated you will update the transportation log so you can now document the times you pick up the children. Infant Feeding Plan - Growth and development during infancy require that nourishing, wholesome, and developmentally appropriate food be provided, using safe approaches to feeding. Individual written infant feeding plans regarding feeding needs and feeding schedule must be developed for each infant in consultation with the infant’s primary care provider and parents/guardians. The posted feeding plans in Space 3 did not include parent signatures, teacher signatures, or the date the plans were received. You indicated you were unfamiliar with this version of the feeding plan. We reviewed the plan together. You indicated you now understand how the document is to be completed. The feeding instructions for each infant must include child's name, be signed by the parent or health care provider, and be dated when received by the center. It must also include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Toileting Supplies - Hand hygiene is the most important way to reduce the spread of infection. Many studies have shown that improperly cleansed hands are the primary carriers of infections. Deficiencies in hand hygiene have contributed to many outbreaks of diarrhea among children and teachers in child care centers. The bathroom located in the outdoor space used by toddlers did not have soap, paper towels or tissue available. You indicated you did not know the items were not in there and had recently learned the bathroom was in the outdoor space. Teachers should be ready to provide help and guidance when children are ready to use the toilet correctly and independently. Teachers should make sure children correctly wash their hands after every use of the toilet, as well as monitor the bathroom to make sure that the toilet is flushed, the toilet seat and floor are free from stool or urine, and supplies (toilet paper, soap, and paper towels) are available. Rated License Process: We discussed the rated license process. The NCRLAP assessment window is scheduled to open on December 11, 2023 through January 12, 2024. We discussed staff identified on the updated staff and training worksheet who do not have a WORKS account. I explained the process to register and submit information in the DCDEE WORKS System for those individuals. Only the information reflected in WORKS will be used to determine the number of points earned in the education component. We discussed the quality point options. For continued eligibility in the subsidized child care program, you must achieve a three star or higher rated license at the end of the temporary licensed period. Instructions for the DCDEE WORKS system, including establishing a NCID, is located on our website at https://ncchildcare.ncdhhs.gov/. Remember to track the date information is submitted by staff. If you have questions regarding submitting information in the WORKS system, contact WORKS at 1-800-859-0829. In preparation for the ERS, we discussed the following items in detail: activity areas, materials needed for indoor and outdoor environments, substantial portion of the day, transitions and interactions, and sanitation procedures. I recommended you and your staff review the applicable assessment tools, visit www.ncrlap.org and review training modules available and the additional resources provided. You may also contact your local Child Care Resource and Referral Office for further technical assistance with the ERS. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. New Sanitation Rules - DCDEE and the Department of Public Health have received feedback from child care programs that additional guidance would be helpful in implementing the child care sanitation rules that the Public Health Commission readopted effective July 1, 2023. Please know that no demerits will be taken for new requirements of these rules until January 2024. Until then, DPH and DCDEE will work together to make sure NC child care centers have the necessary training, technical assistance, and operational support needed to meet the new requirements. The NC Early Childhood Credential Equivalency Exam is another pathway option comparable to a NC Early Childhood Credential. This equivalency exam assesses the foundations of culturally responsive, equitable and inclusive early childhood education, planning intentional developmentally appropriate experiences, learning activities, and teaching strategies for indoor and outdoor environments for all young children, guidance techniques, and professionalism. Moodle Support – The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle Support. To get help with Moodle, email DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. NITTO - The Birth-to-Three Quality Initiative and DCDEE are offering a New Infant Toddler Teacher Orientation (NITTO). * Free online format, with 14 credit hours upon completion * Comprehensive training completed in 7 weeks * Practical knowledge that you can apply in a birth-to-three classroom Understand your value as a birth-to-three teacher and ways to care for yourself while caring for our youngest. Find the course at dcdee.moodle.nc.gov. Individuals will need to have an NCID to access the Moodle site. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

GS 110-91 · Violation

Name of Operation: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 11/28/2023 Number Present: 69 Completed Date: 11/28/2023 Age: From 0 To 5 Total Minutes: 300 Time In: 08:45 AM Time Out: 01:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the second temporary time period visit (TTP). Jamie Ferrell, Legal Designee, assisted me with the visit. This facility was issued a temporary license on August 21, 2023 with a restriction to provide daytime care only, outdoor play is restricted to the fenced area only and you are approved to care for a child 13 years of age. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The center's compliance history was reviewed. Your temporary license expires February 21, 2024. Prior to the expiration date of your license, one additional unannounced monitoring visit will be completed. 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 program’s compliance history was one hundred percent as of 11/27/23. The NC Secretary of State website was reviewed on 11/27/23 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Amber Barnes was identified as the new administrator during the visit. You provided the Preservice Requirements for Administrator of a Child Care Center today. I updated the information during the visit. You also provided an updated Legal Designee form identifying Jamie Ferrell to act on behalf of the facility in the absence of the administrator. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included waffles, bananas, and milk. Following the breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included chicken salad, Ritz crackers, cucumbers, mixed fruit, and milk. The following violations were documented. Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in in Space 1 was dated October 23-27, 2023. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The written feeding plans for children enrolled in Space 3 did not include parent signatures and were not dated when they were received by the center. .0902(a) 606 Running water, soap and individual sanitary towels, or other approved hand-drying devices were not supplied at each lavatory. Soap, paper towels and toilet tissue was unavailable in the bathroom located in the outdoor space for toddlers. 15A NCAC 18A .2818(b) & (d) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. 15A NCAC 18A .2820(d) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. A plastic Ziplock bag used to store plastic spoons was stored in an unlocked lower cabinet and an open box of Loo Nappy Bags was stored in the lower cabinet of the unlocked changing table in Space 1. Plastic bags with warning labels to keep out of reach of children containing extra shoes was also observed in the hallway leading to spaces designated for the care of infants and toddlers. .0604(q) 1128 For routine transport of children to and from the center, staff did not use the list to document attendance as children boarded and departed the vehicle. The transportation log did not include documentation of the time each child is picked up in the afternoons. 10A NCAC 09 .1003(l) * 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. On or before 12/12/2023, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Space 2 (designated for children one-two years-of-age) a plastic zip lock bag used to store spoons was stored in an unlocked lower cabinet under the sink. Shoes stored in plastic bags with keep out of reach warnings were also observed in the hallway leading to toddler classrooms. If plastic bags are going to be used, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Activity Plans – Current activity plans must be posted in the classroom and must address four of the five domains as listed in the NC Foundations for Early Learning. This allows parents to see what the children are learning and extend the topic at home. The posted activity plan in Space 1 was dated October 23-27, 2023. You indicated each space has 30 minutes of planning each day and you are unsure of why the current plan was not posted. Plans can be completed weekly or monthly but must be current and rotate activities to include all five domains. Storage of Hazardous Products & Medication - Intentional planning of the environment ensures a safe environment has been created which prevents and reduces injuries to young children. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. Prevention is the key to prevent poisonings by making sure all medications are kept in locked storage. Locked storage rooms and cabinets include those which are unlocked with a combination, electronic or magnetic device, key, keypad, or equivalent locking device. These unlocking devices must be kept out of the reach of a child and must not be stored in the lock. Transportation Logs - A good record keeping system will help save you time. Accurate pick up and drop off times must be maintained when providing transportation. You indicated you currently document the time you arrive back at the facility once the children are picked up but not the time you pick them up from various schools in the area. You stated you will update the transportation log so you can now document the times you pick up the children. Infant Feeding Plan - Growth and development during infancy require that nourishing, wholesome, and developmentally appropriate food be provided, using safe approaches to feeding. Individual written infant feeding plans regarding feeding needs and feeding schedule must be developed for each infant in consultation with the infant’s primary care provider and parents/guardians. The posted feeding plans in Space 3 did not include parent signatures, teacher signatures, or the date the plans were received. You indicated you were unfamiliar with this version of the feeding plan. We reviewed the plan together. You indicated you now understand how the document is to be completed. The feeding instructions for each infant must include child's name, be signed by the parent or health care provider, and be dated when received by the center. It must also include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Toileting Supplies - Hand hygiene is the most important way to reduce the spread of infection. Many studies have shown that improperly cleansed hands are the primary carriers of infections. Deficiencies in hand hygiene have contributed to many outbreaks of diarrhea among children and teachers in child care centers. The bathroom located in the outdoor space used by toddlers did not have soap, paper towels or tissue available. You indicated you did not know the items were not in there and had recently learned the bathroom was in the outdoor space. Teachers should be ready to provide help and guidance when children are ready to use the toilet correctly and independently. Teachers should make sure children correctly wash their hands after every use of the toilet, as well as monitor the bathroom to make sure that the toilet is flushed, the toilet seat and floor are free from stool or urine, and supplies (toilet paper, soap, and paper towels) are available. Rated License Process: We discussed the rated license process. The NCRLAP assessment window is scheduled to open on December 11, 2023 through January 12, 2024. We discussed staff identified on the updated staff and training worksheet who do not have a WORKS account. I explained the process to register and submit information in the DCDEE WORKS System for those individuals. Only the information reflected in WORKS will be used to determine the number of points earned in the education component. We discussed the quality point options. For continued eligibility in the subsidized child care program, you must achieve a three star or higher rated license at the end of the temporary licensed period. Instructions for the DCDEE WORKS system, including establishing a NCID, is located on our website at https://ncchildcare.ncdhhs.gov/. Remember to track the date information is submitted by staff. If you have questions regarding submitting information in the WORKS system, contact WORKS at 1-800-859-0829. In preparation for the ERS, we discussed the following items in detail: activity areas, materials needed for indoor and outdoor environments, substantial portion of the day, transitions and interactions, and sanitation procedures. I recommended you and your staff review the applicable assessment tools, visit www.ncrlap.org and review training modules available and the additional resources provided. You may also contact your local Child Care Resource and Referral Office for further technical assistance with the ERS. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. New Sanitation Rules - DCDEE and the Department of Public Health have received feedback from child care programs that additional guidance would be helpful in implementing the child care sanitation rules that the Public Health Commission readopted effective July 1, 2023. Please know that no demerits will be taken for new requirements of these rules until January 2024. Until then, DPH and DCDEE will work together to make sure NC child care centers have the necessary training, technical assistance, and operational support needed to meet the new requirements. The NC Early Childhood Credential Equivalency Exam is another pathway option comparable to a NC Early Childhood Credential. This equivalency exam assesses the foundations of culturally responsive, equitable and inclusive early childhood education, planning intentional developmentally appropriate experiences, learning activities, and teaching strategies for indoor and outdoor environments for all young children, guidance techniques, and professionalism. Moodle Support – The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle Support. To get help with Moodle, email DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. NITTO - The Birth-to-Three Quality Initiative and DCDEE are offering a New Infant Toddler Teacher Orientation (NITTO). * Free online format, with 14 credit hours upon completion * Comprehensive training completed in 7 weeks * Practical knowledge that you can apply in a birth-to-three classroom Understand your value as a birth-to-three teacher and ways to care for yourself while caring for our youngest. Find the course at dcdee.moodle.nc.gov. Individuals will need to have an NCID to access the Moodle site. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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: Care-O-World Early Learning Center of Ayden Facility ID: 74000945 Consultant: LAKISHA SKINNER Operation Type: Center Case Number: Visit Date: 11/28/2023 Number Present: 69 Completed Date: 11/28/2023 Age: From 0 To 5 Total Minutes: 300 Time In: 08:45 AM Time Out: 01:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced * The purpose of today's visit was to monitor your program for compliance with all applicable child care requirements during the second temporary time period visit (TTP). Jamie Ferrell, Legal Designee, assisted me with the visit. This facility was issued a temporary license on August 21, 2023 with a restriction to provide daytime care only, outdoor play is restricted to the fenced area only and you are approved to care for a child 13 years of age. The sanitation inspection was completed on 8/15/23 with a “Superior” classification. The last fire inspection was conducted 8/16/23. The center's compliance history was reviewed. Your temporary license expires February 21, 2024. Prior to the expiration date of your license, one additional unannounced monitoring visit will be completed. 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 program’s compliance history was one hundred percent as of 11/27/23. The NC Secretary of State website was reviewed on 11/27/23 and PBLA, INC was listed as current- active. We reviewed your facility contact information listed on the Division of Child Development and Early Education (DCDEE) website. Amber Barnes was identified as the new administrator during the visit. You provided the Preservice Requirements for Administrator of a Child Care Center today. I updated the information during the visit. You also provided an updated Legal Designee form identifying Jamie Ferrell to act on behalf of the facility in the absence of the administrator. Contact me anytime you need to make any changes to your contact information, e.g., phone numbers, mailing address. Classrooms, the outdoor learning environment, staff and child files, and other required program records were monitored. The children were finishing breakfast which included waffles, bananas, and milk. Following the breakfast, children participated in handwashing and personal care routines before transitioning to free play activities. The outdoor learning environment included portable materials. Developmentally appropriate toys and materials were observed in the indoor and outdoor space. Lunch included chicken salad, Ritz crackers, cucumbers, mixed fruit, and milk. The following violations were documented. Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in in Space 1 was dated October 23-27, 2023. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The written feeding plans for children enrolled in Space 3 did not include parent signatures and were not dated when they were received by the center. .0902(a) 606 Running water, soap and individual sanitary towels, or other approved hand-drying devices were not supplied at each lavatory. Soap, paper towels and toilet tissue was unavailable in the bathroom located in the outdoor space for toddlers. 15A NCAC 18A .2818(b) & (d) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. 15A NCAC 18A .2820(d) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. A plastic Ziplock bag used to store plastic spoons was stored in an unlocked lower cabinet and an open box of Loo Nappy Bags was stored in the lower cabinet of the unlocked changing table in Space 1. Plastic bags with warning labels to keep out of reach of children containing extra shoes was also observed in the hallway leading to spaces designated for the care of infants and toddlers. .0604(q) 1128 For routine transport of children to and from the center, staff did not use the list to document attendance as children boarded and departed the vehicle. The transportation log did not include documentation of the time each child is picked up in the afternoons. 10A NCAC 09 .1003(l) * 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. On or before 12/12/2023, 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. Mail or email the information to: Lakisha Skinner, Child Care Consultant PO BOX 431 Grimesland, NC 27837 Lakisha.Skinner@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Insert Technical Assistance with Documented Violations: Plastic Bags – Plastic bags have been recognized for many years as a suffocation hazard. The U.S. Consumer Product Safety Commission (CPSC) has received average annual reports of twenty-five deaths per year to children due to suffocation from plastic bags. In child care facilities, plastic bags must be made inaccessible to children less than three years of age. In Space 2 (designated for children one-two years-of-age) a plastic zip lock bag used to store spoons was stored in an unlocked lower cabinet under the sink. Shoes stored in plastic bags with keep out of reach warnings were also observed in the hallway leading to toddler classrooms. If plastic bags are going to be used, then these bags must be stored out of reach of the children, which is defined as five feet or higher from the finished floor. Activity Plans – Current activity plans must be posted in the classroom and must address four of the five domains as listed in the NC Foundations for Early Learning. This allows parents to see what the children are learning and extend the topic at home. The posted activity plan in Space 1 was dated October 23-27, 2023. You indicated each space has 30 minutes of planning each day and you are unsure of why the current plan was not posted. Plans can be completed weekly or monthly but must be current and rotate activities to include all five domains. Storage of Hazardous Products & Medication - Intentional planning of the environment ensures a safe environment has been created which prevents and reduces injuries to young children. A bottle of Motrin Infant Drops was stored in an unlocked basket on top of a cabinet in Space 2. Prevention is the key to prevent poisonings by making sure all medications are kept in locked storage. Locked storage rooms and cabinets include those which are unlocked with a combination, electronic or magnetic device, key, keypad, or equivalent locking device. These unlocking devices must be kept out of the reach of a child and must not be stored in the lock. Transportation Logs - A good record keeping system will help save you time. Accurate pick up and drop off times must be maintained when providing transportation. You indicated you currently document the time you arrive back at the facility once the children are picked up but not the time you pick them up from various schools in the area. You stated you will update the transportation log so you can now document the times you pick up the children. Infant Feeding Plan - Growth and development during infancy require that nourishing, wholesome, and developmentally appropriate food be provided, using safe approaches to feeding. Individual written infant feeding plans regarding feeding needs and feeding schedule must be developed for each infant in consultation with the infant’s primary care provider and parents/guardians. The posted feeding plans in Space 3 did not include parent signatures, teacher signatures, or the date the plans were received. You indicated you were unfamiliar with this version of the feeding plan. We reviewed the plan together. You indicated you now understand how the document is to be completed. The feeding instructions for each infant must include child's name, be signed by the parent or health care provider, and be dated when received by the center. It must also include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Toileting Supplies - Hand hygiene is the most important way to reduce the spread of infection. Many studies have shown that improperly cleansed hands are the primary carriers of infections. Deficiencies in hand hygiene have contributed to many outbreaks of diarrhea among children and teachers in child care centers. The bathroom located in the outdoor space used by toddlers did not have soap, paper towels or tissue available. You indicated you did not know the items were not in there and had recently learned the bathroom was in the outdoor space. Teachers should be ready to provide help and guidance when children are ready to use the toilet correctly and independently. Teachers should make sure children correctly wash their hands after every use of the toilet, as well as monitor the bathroom to make sure that the toilet is flushed, the toilet seat and floor are free from stool or urine, and supplies (toilet paper, soap, and paper towels) are available. Rated License Process: We discussed the rated license process. The NCRLAP assessment window is scheduled to open on December 11, 2023 through January 12, 2024. We discussed staff identified on the updated staff and training worksheet who do not have a WORKS account. I explained the process to register and submit information in the DCDEE WORKS System for those individuals. Only the information reflected in WORKS will be used to determine the number of points earned in the education component. We discussed the quality point options. For continued eligibility in the subsidized child care program, you must achieve a three star or higher rated license at the end of the temporary licensed period. Instructions for the DCDEE WORKS system, including establishing a NCID, is located on our website at https://ncchildcare.ncdhhs.gov/. Remember to track the date information is submitted by staff. If you have questions regarding submitting information in the WORKS system, contact WORKS at 1-800-859-0829. In preparation for the ERS, we discussed the following items in detail: activity areas, materials needed for indoor and outdoor environments, substantial portion of the day, transitions and interactions, and sanitation procedures. I recommended you and your staff review the applicable assessment tools, visit www.ncrlap.org and review training modules available and the additional resources provided. You may also contact your local Child Care Resource and Referral Office for further technical assistance with the ERS. Additional Comments: The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. New Sanitation Rules - DCDEE and the Department of Public Health have received feedback from child care programs that additional guidance would be helpful in implementing the child care sanitation rules that the Public Health Commission readopted effective July 1, 2023. Please know that no demerits will be taken for new requirements of these rules until January 2024. Until then, DPH and DCDEE will work together to make sure NC child care centers have the necessary training, technical assistance, and operational support needed to meet the new requirements. The NC Early Childhood Credential Equivalency Exam is another pathway option comparable to a NC Early Childhood Credential. This equivalency exam assesses the foundations of culturally responsive, equitable and inclusive early childhood education, planning intentional developmentally appropriate experiences, learning activities, and teaching strategies for indoor and outdoor environments for all young children, guidance techniques, and professionalism. Moodle Support – The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle Support. To get help with Moodle, email DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. NITTO - The Birth-to-Three Quality Initiative and DCDEE are offering a New Infant Toddler Teacher Orientation (NITTO). * Free online format, with 14 credit hours upon completion * Comprehensive training completed in 7 weeks * Practical knowledge that you can apply in a birth-to-three classroom Understand your value as a birth-to-three teacher and ways to care for yourself while caring for our youngest. Find the course at dcdee.moodle.nc.gov. Individuals will need to have an NCID to access the Moodle site. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Lakisha Skinner, Child Care Consultant, 252-820-5976, Lakisha.Skinner@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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